Effective Date: September 1, 2013
HIPAA: Health Insurance Portability and Accountability Act
This notice describes how health information about you may be used and disclosed, as well as how you can get access to this information.
Please review it carefully. If you have any questions about this notice, please contact the Office Manager
Each time you visit a hospital, physician, or other healthcare provider, a record of your visit is made. Typically, this record contains your symptoms, examination, test results, diagnoses, treatment, a plan for future care or treatment, and billing related information. This notice applies to all of the records of your care generated, whether made by personnel or agents for the clinic.
We are required by law to maintain the privacy of your health information and provide you with a description of our privacy practices. We will abide by the terms of this notice.
How we may use and disclose Health Information about you:
The following categories describe examples of the way we use and disclose health information:
For Treatment: We may use health information about you to provide you treatment or services. We may disclose health information about you to doctors, nurses, technicians, health students, or other clinical personnel who are involved in taking care of you at the clinic. We may also provide your physician or a subsequent healthcare provider with copies of various reports that should assist him or her in treating of once you are discharged.
For Payment: We may use and disclose health information about your treatment and services to bill and collect payment from you, your insurance company, or a third-party payer. For example, we may need to give your insurance company information about your progress so they will pay us or reimburse you for the treatment. We may also tell your health plan about treatment you are going to receive to determine whether it is a covered service under your plan.
For Health Care Operations: Members of the medical staff and/or quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. The results will then be used to continually improve the quality of care for all patients we serve. For example, we may also combine health information about many patients to evaluate the need for new services or treatment. We may disclose information to doctors, nurses, and students for educational purposes.
Marketing & Any Purposes which Require the Sale of Your Information: The following uses and disclosures of your PHI will be made only with your written authorization: 1) Uses and disclosures of PHI for marketing purposes; and 2) Disclosures that constitute a sale of your PHI. Other uses and disclosures of PHI not covered by this Notice or the laws that apply to us will be made only with your written authorization. If you do give us an authorization, you may revoke it at any time by submitting a written revocation to our Privacy Officer and we will no longer disclose PHI under the authorization. We may remove information that identifies you from this set of health information to protect your privacy.
We may also use and disclose health information:
When disclosing information, primary appointment reminders and billing/collections efforts, we may leave messages on your answering machine or voice mail.
Business Associates: There are some services provided in our organization through contracts with business associates. When these services are contracted, we may disclose your health information to our business associates so that they can perform the job we have asked them to do, as well as bill you, your insurance company, or a third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.
Individuals Involved in your Care or Payment for Your Care: We may release health information about you to a friend or family member who is involved in your medical care or who helps pay for your care. In addition, we may disclose health information about you to an entity assisting in disaster relief effort so that your family can be notified about your condition, status and location.
Research: We may disclose information to researchers when an institutional review board that has reviewed the research proposal and
established protocols to ensure the privacy of your health information has approved their research and granted a waiver of the authorization requirement.
Future Communications: We may communicate to you via email, newsletters, and mailings or other means regarding treatment options, health related information, disease-management programs, wellness programs, or other community based programs.
Organized Health Care Arrangement: This facility and its medical staff members have organized and are presenting you this document as a joint notice. Information will be shared as necessary to carry out treatment, payment and healthcare operations.
As required by law, we may also use and disclose health information for the following types of entities, including but not limited to:
Law Enforcement/Legal Proceedings: We may disclose health
information for law enforcement purposes as required by law or in
response to a valid subpoena.
State Specific Requirements: Many states have requirements for reporting including population-based activities relating to improving health or reducing healthcare costs. Some states have separate privacy laws that may apply additional legal requirements. If the state privacy laws are more stringent than federal privacy laws, the state law preempts the federal law.
Although your health record is the physical property of the healthcare practitioner or facility that compiled it, you have the right to:
We reserve the right to change this notice and the revised or changed notice will be elective for information we already have about you as well as any information we receive in the future. The current notice will be posted and include the effective date. In addition, each time you register for treatment or healthcare services, we will offer you a copy of the current notice in effect.
If you believe your privacy rights have been violated, you may file a complaint with the facility by following the process outlined in the facility’s Patient Rights documentation. You may also file a complaint with the Secretary of the Department of Health and Human Services. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
Other uses and disclosures of health information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose health 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 health 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 and documented in the office or clinic.