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NOTICE OF
PRIVACY PRACTICES
Date of Last Revision: April
14, 2003
Effective Date: Immediately
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 AND
MAINTAINED BY THE PRACTICE.
This notice
describes our Practice’s policies, which apply to, but not limited
to the following:
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Any health care
professional authorized to enter information into your chart
(including physicians, PAs, RNs, LPNs, etc.);
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All areas of the
Practice (front desk, administration, billing and collection,
etc.);
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All employees,
staff and other personnel that work for or with our Practice;
and
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Our business
associates (including a billing service, or facilities to which
we refer patients).
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 of 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:
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make sure that the
protected health information about you is kept private:
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provide you with a
Notice of our Privacy Practices and your legal rights with
respect to protected health information about you: and
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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 examples of 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 medical facility personnel who are involved in taking
care of you or persons who are arranging for your care. 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),
prescriptions, and 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 care; this may
include other doctors providing services to you, pharmacies,
family members or legally appointed persons (i.e. should you
become incompetent). We may communicate results and medical
messages with you and/or other healthcare providers/facilities by
phone, facsimile, e-mail, in writing or otherwise which could
(potentially) be received or intercepted by others. In our cardiac
rehab program medical care is in a group setting, some personal
medical data may be potentially heard by others (i.e. rest and
exercise B/P).
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. We may also communicate with family and other personal
representatives that will assist you in filing insurance and
payment of accounts.
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, services, and programs 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, for example. 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. We may use or disclose your demographic
information and the dates that you secured treatment from your
physician in order to contact you for fundraising activities
supported by our office.
Appointment and
Patient Recall Reminders. We may ask that you sign in writing at
the Receptionists’ Desk a “Sign In” log and may call you by name
in the waiting room 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 the leaving of an e-mail or
message on an answering machine which could (potentially) be
received or intercepted by others.
Treatment
Alternatives. We may use and disclose your health information to
tell you about or recommend possible treatment options or
alternatives.
Health Related
Benefits and Services. We may use and disclose your health
information to tell you about health-related benefits or services.
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 and/or their employer
(i.e. military furlough or FMLA Leave) can be notified about your
condition, status and location.
Research. We may
disclose limited information for medical research under certain
circumstances.
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.
Military. If you are
a member of the armed forces, we may release health information
about you as required by military command authorities. We may also
release health information about foreign military personnel to the
appropriate foreign military authority.
Worker’s
Compensation. We may release medical information about you for
worker’s 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:
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To prevent or
control disease, injury or disability;
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To report births
and deaths;
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To report abuse or
neglect (i.e. child abuse, domestic violence);
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To report
reactions to medications or problems with products;
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To notify people
of recalls of products they may be using;
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To notify a person
who may have been exposed to a disease or may be at risk for
contacting or spreading a disease or condition;
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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.
Food and Drug
Administration (FDA). We may disclose your protected health
information to the FDA relative to adverse events with respect to
food, supplements, product and product defects, and post marketing
surveillance information to track FDA regulated products or enable
product recalls, repairs or replacement.
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 information about you in response to a court or
administrative order. We may also disclose information about you
in response to a subpoena, discovery request, or other lawful
process if we receive satisfactory assurances that you have been
notified of the request or that an effort was made to secure a
protective order. If you are involved in a lawsuit or dispute
against GRHI, PSC, we may share information as necessary to support GRHI,
PSC’s position and to obtain legal services.
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Law Enforcement.
We may release medical information if asked to do so by a law
enforcement official:
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In response to a
court order, subpoena, warrant, summons or similar process;
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To identify or
locate a suspect, fugitive, material witness, or missing person;
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About the victim
of a crime if, under certain limited circumstances, we are
unable to obtain the person’s agreement;
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About a death we
believe may be the result of criminal conduct;
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About criminal
conduct at the Practice; and
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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 to carry out their
duties.
National Security.
We may release health information about you to authorized federal
officials for intelligence, counterintelligence and other national
security activities authorized by law. We also may disclose health
information about you to authorized federal officials so they may
provide protection to the President, other authorized persons or
foreign heads of state or conduct special investigations.
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 right-hand 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 privacy officer, 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 Privacy Officer
can be reached at this number 270-688-0808.]
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 authorization, unless these uses can be reasonably
inferred from the intended uses above. If you have provided us
with your authorization to use or disclose medical information
about you, you may revoke that authorization, in writing, at any
time. If you revoke your authorization, 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
authorization, 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:
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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 under your
care (guardian or custodial) may also be disclosed to you.
To inspect and copy your medical record, you must submit your
request in writing to our Privacy Officer. If you request a copy
of the information, we may charge a reasonable 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 HIPAA Compliance Committee
review the denial. Another licensed health care professional
within our office other than the person who denied your request
may be chosen by the Practice to review your request and denial.
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.
To request an amendment, your request must be submitted in
writing, along with your intended amendment and a reason that
supports your request to amend. The amendment must be dated and
signed by you and notarized.
Your failure to submit your request and the reason supporting
your request in writing will result in our denying your request.
In addition, we may deny your request if you ask us to amend
information that:
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Was not created
by us, unless the person or entity that created the
information is no longer available to make the amendment
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Is not part of
the medical information kept by or for the Practice
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Is not part of
the information which you would be permitted to inspect and
copy; or
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Is accurate and
complete.
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Right to an
Accounting of Disclosures. You have the right to request an
“accounting of disclosures.” This is a list of the disclosures
we made of medical information about you to others, for purposes
other than treatment, payment and operations as described in
this notice.
To request this list, you must submit your request in writing.
Your request must state a time period not longer than six (6)
years and may not include dates before April 14, 2003 (or the
actual implementation date of the HIPAA Privacy Regulations).
Your request should indicate in what form you want the list (for
example, on paper or electronically). If you request a list of
disclosures more than once in twelve months, we may charge you a
reasonable fee. We will notify you of the cost involved and you
may choose to withdraw or modify your request before any costs
are incurred.
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Right to
Request Restrictions. You have the right to request a
restriction or limitation on the information we use or disclose
about you for treatment, payment or health care operations. You
also have the right to request a limit on the information we
disclose about you to someone who is involved in your care or
the payment for your care, like a family member or friend. Your
request must be submitted in writing to the Medical Records
Department. Your request must state the specific restriction
requested and to whom you want the restriction to apply. We are
not required to agree to a requested restriction. However, if we
do agree, we will comply with your request unless the
information is needed to provide you with emergency treatment.
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Right to
Request Confidential Communications. You have the right to
request that we communicate with you about medical matters in a
certain way or at a certain location. For example, you can ask
that we only contact you at work or by mail or that we not leave
voice mail or e-mail.
To request
confidential communications, you must make your request in
writing. We will not ask you the reason for your request. We will
accommodate all reasonable requests. Your request must specify how
or where you wish for us to contact you.
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