NOTICE OF PRIVACY
PRACTICES
Effective April 2003
This information is made available on request by a patient
THIS NOTICE DESCRIBES
HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND
HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
THIS NOTICE APPLIES TO ALL OF THE RECORDS OF YOUR CARE GENERATED
BY THE PRACTICE, WHETHER MADE BY THE PRACTICE OR AN ASSOCIATED FACILITY.
This notice describes
our Practice’s policies, which extend to:
- Any health care professional
authorized to enter information into your chart (including physicians,
PAs, RNs, etc.);
- All areas of the Practice (front desk, administration, billing
and collection, etc.);
- All employees, staff and other personnel that work for our
Practice;
- Our business associates (including a billing service, or facilities
to which we refer patients), on-call physicians, and so on.
The Practice provides this Notice to comply with the Privacy Regulations
issued by the Department of Health and Human Services in accordance
with the Health Insurance Portability and Accountability Act of 1996
(HIPAA).
OUR THOUGHTS ABOUT YOUR PROTECTED HEALTH INFORMATION:
We understand that your medical information is personal to you,
and we are committed to protecting the information about you. As
our patient, we create paper and electronic medical records about
your health, our care for you, and the services and/or items we
provide to you as our patient. We need this record to provide for
your care and to comply with certain legal requirements.
We are required by law to:
- Make sure that the
protected health information
about you is kept private;
- Provide you with a Notice of our Privacy
Practices and your legal rights with respect to
protected health information about you; and
- Follow the conditions of the Notice that is
currently in effect.
HOW WE MAY USE
AND DISCLOSE MEDICAL INFORMATION ABOUT YOU:
The following categories describe different ways that we use and
disclose protected health information that we have and share with
others. Each category of uses or disclosures provides a general
explanation and provides some examples of uses. Not every use or
disclosure in a category is either listed or actually in place.
The explanation is provided for your general information only.
Medical Treatment.
We use previously given medical information about you to provide
you with current or prospective medical treatment or services. Therefore
we may, and most likely will, disclose medical information about
you to doctors, nurses, technicians, medical students, or hospital
personnel who are involved in taking care of you. For example, a
doctor to whom we refer you for ongoing or further care may need
your medical record. Different areas of the Practice also may share
medical information about you including your record(s), presriptions,
requests of lab work and x-rays. We may also discuss your medical
information with you to recommend possible treatment options or
alternatives that may be of interest to you. We also may disclose
medical information about you to people outside the Practice who
may be involved in your medical care after you leave the Practice;
this may include your family members, or other personal representatives
authorized by you or by a legal mandate (a guardian or other person
who has been named to handle your medical decisions, should you
become incompetent).
Payment.
We may use and disclose medical information about you for services
and procedures so they may be billed and collected from you, an
insurance company, or any other third party. For example, we may
need to give your health care information, about treatment you received
at the Practice, to obtain payment or reimbursement for the care.
We may also tell your health plan and/or referring physician about
a treatment you are going to receive to obtain prior approval or
to determine whether your plan will cover the treatment, to facilitate
payment of a referring physician, or the like.
Health Care
Operations. We may use and disclose medical information
about you so that we can run our Practice more efficiently and make
sure that all of our patients receive quality care. These uses may
include reviewing our treatment and services to evaluate the performance
of our staff, deciding what additional services to offer and where,
deciding what services are not needed, and whether certain new treatments
are effective. We may also disclose information to doctors, nurses,
technicians, medical students, and other personnel for review and
learning purposes. We may also combine the medical information we
have with medical information from other Practices to compare how
we are doing and see where we can make improvements in the care
and services we offer. We may remove information that identifies
you from this set of medical information so others may use it to
study health care and health care delivery without learning who
the specific patients are.
We may also use or disclose
information about you for internal or external utilization review
and/or quality assurance, to business associates for purposes of
helping us to comply with our legal requirements to auditors to
verify our records, to billing companies to aid us in this process
and the like. We shall endeavor, at all times when business associates
are used, to advise them of their continued obligation to maintain
the privacy of your medical records.
Appointment
and Patient Recall Reminders. We may ask that you sign
in writing at the Receptionists’ Desk, a “Sign In”
log on the day of your appointment with the Practice. We may use
and disclose medical information to contact you as a reminder that
you have an appointment for medical care with the Practice or that
you are due to receive periodic care from the Practice. This contact
may be by phone, in writing, e-mail, or otherwise and may involve
leaving an e-mail, a message on an answering machine, or otherwise
which could (potentially) be received or intercepted by others.
Emergency Situations. In addition, we may disclose
medical information about you to an organization assisting in a
disaster relief effort or in an emergency situation so that your
family can be notified about your condition, status and location.
Research. Under certain circumstances, we may
use and disclose medical information about you for research purposes
regarding medications, efficiency of treatment protocols and the
like. All research projects are subject to an approval process,
which evaluates a proposed research project and its use of medical
information. Before we use or disclose medical information for research,
the project will have been approved
through this research approval process. We will obtain an Authorization
from you before using or disclosing your individually identifiable
health information unless the authorization requirement has been waived.
If possible, we will make the information non-identifiable to a specific
patient. If the information has been sufficiently deidentified, an
authorization for the use or disclosure is not required.
Required By
Law. We will disclose medical information about you when
required to do so by federal, state or local law.
To Avert a Serious
Threat to Health or Safety. We may use and disclose medical
information about you when necessary to prevent a serious threat
either to your specific health and safety or the health and safety
of the public or another person. Any disclosure, however, would
only be to someone able to help prevent the threat.
Organ and Tissue Donation. If you are an organ
donor, we may release medical information to organizations that
handle organ procurement or organ, eye or tissue transplantation
or to an organ
donation bank, as necessary to facilitate organ or tissue donation
and transplantation.
Workers’ Compensation. We may release medical
information about you for workers’ compensation or similar
programs. These programs provide benefits for work-related injuries
or illness.
Public Health
Risks. Law or public policy may require us to disclose
medical information about you for public health activities. These
activities generally include the following:
- to
prevent or control disease, injury or disability;
- to report births and deaths;
- to report child abuse or neglect;
- to report reactions to medications or problems
with products;
- to notify people of recalls of products they
may be using;
- to notify a person who may have been exposed
to a disease or may be at risk for contracting or spreading
a disease or condition;
- to notify the appropriate government authority
if we believe a patient has been the victim of abuse, neglect
or domestic violence. We will only make this disclosure if you
agree or when required or authorized by law.
Investigation
and Government Activities. We may disclose medical information
to a local, state or federal agency for activities authorized by
law.
These oversight activities include, for example, audits, investigations,
inspections, and licensure. These activities are necessary for the
payor, the government and other regulatory agencies to monitor the
health care system, government programs, and compliance with civil
rights laws.
Lawsuits and Disputes. If you are involved in
a lawsuit or a dispute, we may disclose medical information about
you in response to a court or administrative order. This is particularly
true if you make your health an issue. We may also disclose medical
information about you in response to a subpoena, discovery request,
or other lawful process by someone else involved in the dispute.
We shall attempt in these cases to tell you about the request so
that you may obtain an order protecting the information requested
if you so desire. We may also use such information to defend ourselves
or any member of our Practice in any actual or threatened action.
Law Enforcement.
We may release medical information if asked to do so by a law enforcement
official:
- In
response to a court order, subpoena, warrant, summons or similar
process;
- To
identify or locate a suspect, fugitive, material witness, or missing
person;
- About
the victim of a crime if, under certain limited circumstances,
we are unable to obtain the person’s agreement;
- About
a death we believe may be the result of criminal conduct;
- About
criminal conduct at the Practice; and - In emergency circumstances
to report a crime; the location of the crime or victims; or the
identity, description or location of the person who committed
the crime.
Coroners, Medical Examiners and Funeral Directors.
We may release medical information to a coroner or medical examiner.
This may be necessary, for example, to identify a deceased person
or determine the cause of death. We may also release medical information
about patients of the Practice to funeral directors as necessary
to carry out their duties.
Inmates. If you are an inmate of a correctional
institution or under the custody of a law enforcement official,
we may release medical information about you to the correctional
institution or law enforcement official. This release would be necessary
(1) for the institution to provide you with health care; (2) to
protect your health and safety or the health and safety of others;
or (3) for the safety and security of the correctional institution.
CHANGES TO THIS NOTICE
We reserve the right to change this notice at any time. We reserve
the right to make the revised or changed notice effective for medical
information we already have about you as well as any information
we may receive from you in the future. We will post a copy of the
current notice in the Practice. The notice will contain on the first
page, in the top righthand corner, the date of last revision and
effective date. In addition, each time you visit the Practice for
treatment or health care services you may request a copy of the
current notice in effect.
COMPLAINTS
If you believe your privacy rights have been violated, you may file
a complaint with the Practice or with the Secretary of the Department
of Health and Human Services. To file a complaint with the Practice,
contact our office manager, who will direct you on how to file an
office complaint. All complaints must be submitted in writing, and
all complaints shall be investigated, without repercussion to you.
[The Office Manager can be reached at this number 717-397-4724.]
You will not be penalized for filing a complaint.
OTHER USES OF MEDICAL INFORMATION
Other uses and disclosures of medical information not covered by
this notice or the laws that apply to us will be made only with
your written permission, unless those uses can be reasonably inferred
from the intended uses above. If you have provided us with your
permission to use or disclose medical information about you, you
may revoke that permission, in writing, at any time. If you revoke
your permission, we will no longer use or disclose medical information
about you for the reasons covered by your written authorization.
You understand that we are unable to take back any
disclosures we have already made with your permission, and that
we are required to retain our records of the care that we provided
to you.
PATIENT RIGHTS
THIS SECTION DESCRIBES YOUR RIGHTS AND THE OBLIGATIONS OF THIS PRACTICE
REGARDING THE USE AND DISCLOSURE OF YOUR MEDICAL INFORMATION.
You have the following rights regarding medical
information we maintain about you:
Right to Inspect
and Copy. You have the right to inspect and copy medical
information that may be used to make decisions about your care.
This includes your own medical and billing records, but does not
include psychotherapy notes. Upon proof of an appropriate legal
relationship, records of others related to you or under your care
(guardian or custodian) may also be disclosed.
To inspect and copy your medical record, you must submit your request
in writing to our Compliance Officer. Ask the front desk person
for the name of the Compliance Officer. If you request a copy of
the information, we may charge a fee for the costs of copying, mailing
or other supplies (tapes, disks, etc.) associated with your request.
We may deny your request to inspect and copy in certain very limited
circumstances. If you are denied access to medical information,
you may request that our Compliance Committee review the denial.
Another licensed health care professional chosen by the Practice
will review your request and the denial. The person conducting the
review will not be the person who denied your request. We will comply
with the outcome and recommendations from that review.
Right to Amend.
If you feel that the medical information we have about you in your
record is incorrect or incomplete, then you may ask us to amend
the information, following the procedure below. You have the right
to request an amendment for as long as the Practice maintains your
medical record.
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