Notice of Privacy Practices
This notice describes how health information about you as a patient of this practice may be used and disclosed, and how you can get access to your individually identifiable health information. Please review it carefully.
Our Commitment to Your Privacy
Our practice is dedicated to maintaining the privacy of your individually identifiable health information (IIHI). In conducting our business, we will create records regarding you and the treatment and service we provide to you. We are required by law to maintain the confidentiality of health information that identifies you. We also are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your IIHI. By federal and state law, we must follow the terms of the notice of privacy practices that we have in effect at the time.
Individually Identifiable Health Information
We may use and disclose your Individually Identifiable Health Information (IIHI) in the following ways:
Treatment
Many of the people who work for our practice including, but not limited to, our doctors and staff may use or disclose your IIHI in order to treat you or to assist others in your treatment. Additionally, we may disclose your IIHI to others who may assist in your care, such as your spouse, children, or parents. We may also disclose your IIHI to other health care providers for purposes related to your treatment.
Payment
Our practice may use and disclose your IIHI in order to bill and collect payment from your insurance, third parties such as a spouse or family member or you directly. We may contact your health insurance to certify eligibility, coverage and status of claims. We may disclose your IIHI to other health care providers and entities to assist in their billing and collection efforts.
Health Care Operations
Our practice may use and disclose your IIHI in order to operate our business, conduct cost-management activities and assist other entities in their health care operations and when we are required to do so by federal, state or local law.
We may use or disclose your IIHI, as necessary, to contact you to remind you of your appointment. We may also call you by name in the waiting room when your physician is ready to see you.
Use and Disclosure of Your IIHI Without
Your Authorization as Required by Law
These situations include:
- Public Health Risks—communicable diseases—abuse or neglect
- Health Oversight Activities—audits—compliance with the health care system
- Law Enforcement—criminal conduct—warrant—subpoenas
- Coroners—funeral directors—organ donation
- Military and National Security
- Inmates
- Workers Compensation
- Research
Research
Our practice may use and disclose your IIHI for research purposes in certain limited circumstances. We will obtain your written authorization to use your IIHI for research purposes except when an IRB or Privacy Board has determined that the waiver of your authorization satisfies the following: (i) the use or disclosure involves no more than a minimal risk to the individual's privacy based on the following: (A) an adequate plan to protect the identifiers from improper use and disclosure; (B) an adequate plan to destroy the identifiers at the earliest opportunity consistent with the research (unless there is a health or research justification for retaining identifiers or such retention is otherwise required by law); and (C) adequate written assurances that the PHI will not be re-used or disclosed to any other person or entity (except as required by law) for authorized oversight of the research study, or for other research for which the use or disclosure would otherwise be permitted; (ii) the research could not practicably be conducted without the waiver; and (iii) the research could not practicably be conducted without access to and use of the PHI.
The terms of this notice apply to all records containing your IIHI that are created or retained by our practice. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all of your records that our practice has created or maintained in the past, and for any of your records that we may create or maintain in the future. Our practice will post a copy of our current Notice in our offices in a visible location at all times, and you may request a copy of our most current Notice at any time.
Your Rights
You have the right to request a restriction of your IIHI for treatment, payment or health care operations. You may request that we restrict our disclosure to only certain individuals involved in your care or payment for your care, such as family members. Your request must describe the information you wish restricted and to whom you want the limits to apply. We are not required to agree to your request if the physician believes it is in your best interest, required by law or in emergencies.
You have the right to request to receive confidential communications from us by alternative means or at an alternative location.
You have the right to inspect and obtain a copy of your IIHI, medical records, and billing records, but not psychotherapy notes. Our practice will charge a fee for the cost of copying, mailing, labor and supplies associated with your request. Our practice may deny your request in certain limited circumstances and under federal and state law.
You may ask us to amend your health information. You must provide us with a reason for your request. We may deny your request for amendment.
You have the right to request an accounting of disclosures for non treatment purposes. All requests must state a time period, which may not be longer than six years from the date of disclosure and may not include dates before April 14, 2003. The office may charge for additional lists within the same 12 month period.
You have the right to file a complaint with us or the Secretary of the Department of Health and Human Services if you believe your privacy rights have been violated. You will not be penalized for filing a complaint.
You have the right to a paper copy of this notice.
This notice was published and becomes effective on/or before April 14, 2003.
Thank you for being one of our valued patients.