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HIPAA NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
This notice is to inform you, the patient, how we may use and disclose your protected health information to carry out your treatment, payment or health care operations, and for other purposes that are permitted or required by law. It is also to inform you how you can get access to this information. Please review it carefully.
“Protected health information” is information about you, including demographic information that may identify you and that might relate to your past, present or future physical health condition and related health care services.
If you have any questions about this Notice, please contact our Privacy Officer, Susan Walker. She will be willing to assist you in any way she can.
We are required to abide by the Notice of Privacy Practices. The terms of this notice may change at any time. Upon your request, we will provide you with any revised Notice of Privacy Practices just by you calling our office and requesting it, or you may request it at your appointment time.
Your protected health care information may be used and disclosed as needed by your physician, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing services to you. Your protected health care information may also be used and disclosed to pay your health care bills. However, this will not be done until you have signed a consent form giving permission for this to take place. Upon your written consent, the following is examples in which your physician’s office might use and disclose your information.
We will use and disclose your PHI to provide, coordinate or manage your health care and any related services. This includes a third party that has already obtained your permission to have access to your information. For example: A home health agency that provides care to you; a physician to whom is already providing care to you such as your family physician; a physician to whom you have been referred; a laboratory; a specialist who might get involved in your care to assist in providing your physician with a diagnosis or treatment plan; an attorney in a questionable third party claim.
We may use and disclose your PHI to provide necessary information upon the request of your insurance company if necessary to insure correct and timely payment on your account
Example: determination of eligibility or coverage for insurance benefits if questioned about a medically necessary admission to the hospital.
We may use or disclose, as needed, your PHI to support the business activities of your physician’s practice. See the following examples:
- Medical students that see patients in our office.
- You will be requested to sign-in at our registration desk using your full name.
- You may be called by your name in our waiting room when your physician is ready to see you.
- We will use information as necessary to contact you by phone regarding your next appointment, etc.
- We will use your information to mail important documents to you to be returned to us by your appointment date.
- We will use your information to send, upon your request, documents pertaining to your health care to your place of work, insurance companies, credit agencies, social security, disability agencies, or any other respective agency, where it is necessary, in order for you to properly receive treatment.
- We will share your PHI with business associates that perform various activities for the practice (e.g., billing and/or transcription services). We may use or disclose your PHI to provide you with marketing information such as your name and address may be used to send you a newsletter about our practice and the services we offer. You may contact our Privacy officer to request that this information not be sent to you.
We may use or disclose your PHI in an emergency treatment situation. Your physician shall try to obtain you consent as soon as reasonably practical after the delivery of treatment. If you physician or another physician in the practice is required by law to treat you and the physician has attempted to obtain your consent, but is unable to obtain your consent, he or she may still use or disclose your PHI to treat you.
We may disclose your protected health information in the course of any judicial or administrative proceeding, in response to an order of a court, in certain conditions in response to a subpoena, discovery request or other lawful process to the extent such disclosure is authorized.
We may disclose your PHI to a public health authority that is authorized by law to receive reports of child abuse or neglect. We may disclose your PHI to the governmental agency authorized to receive such information if we believe that you have been a victim of abuse, neglect or domestic violence. In this case, the disclosure will be made consistent with the requirements of federal and state laws.
We may disclose PHI for law enforcement purposes to include (1) limited information requests for identification and location purposes (2) pertaining to victims of a crime, (3) any suspicion that death has occurred as a result of criminal act, (4) in the event that a crime occurs on the premises of this facility, (5) medical emergency, (not on the premises of this facility), in that it is likely that a crime has occurred, (6) to prevent or lessen a serious threat to the safety or the health of a person or the public, (7) if it becomes necessary for law enforcement authorities to identify or apprehend an individual.
INMATES: We may use or disclose your PHI if you are an inmate of a correctional facility and your physician received your PHI in the course of providing care to you.
We may disclose PHI to a coroner for identification purposes, determining cause of death. We may disclose PHI to a funeral director in order for them to carry out their duties.
We my disclose PHI when an individual is associated with the Armed Forces and it is requested for you by your name.
We may disclose your PHI, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.
Your PHI may be disclosed by us as authorized to comply with the laws of workers’ compensation laws and other similar legally established programs.
The following is a statement of your rights as a patient with respect to your protected health information and a brief description of how you may exercise these rights.
In the presence of an authorized Medical Records representative and the Privacy Officer in our facility, you may inspect and obtain a copy of PHI about you that is contained in a designated record file for as long as we maintain this information on you.
Under Federal Law, however, you may not inspect or copy the following records: information compiled in reasonable anticipation of, or use in, a civil, criminal or administrative action or proceeding and PHI that is subject to law that prohibits access to PHI.
You may ask us not to use or disclose any part of your PHI for the purposes of treatment, payment or healthcare operations. You may also request that any part of your PHI not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.
Your physician is not required to agree to a restriction that you may request. If the physician believes it is in your best interest to permit use and disclosure of your PHI, your PHI will not be restricted. If your physician does agree to the requested restriction, we may not use or disclose the information in violation of the restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request with your physician. You may obtain a restriction request by contacting the Medical Records Supervisor, Jamie Pickens at 618.997.4310, extension 1042.
This right applies to disclosures for reasons other than treatment, payment, or healthcare operations as described in this Notice of Privacy Practices. It excludes disclosures we may have made to you, to family members or friends involved in your care, or for notification purposes. You have the right to receive specific information regarding these disclosures that occurred after April 14, 2003.
You may request an amendment of PHI about you in a designated record for as long as we maintain this information. In certain cases, we may deny your request for an amendment. Our physician or office staff cannot change your PHI. If the request for an amendment is denied, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. If you have questions about amending your medical record contact our Privacy Officer: Susan Walker.
If you believe that your privacy right was violated by us, you may file a complaint with us by notifying our Administrator, Greg Thompson at (618) 997-4310, extension 1050 of your complaint.
This notice was published and becomes effective on: January 27, 2003.
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