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.
If
you have any questions, please contact our Privacy Officer Luchianna Branch
at 412-621-6166
This Notice of Privacy Practices describes how we may use and disclose
your protected health information to carry out treatment, payment or health
care operations and for other purposes that are permitted or required
by law. It also describes your rights to access and control your protected
health information. “Protected health information” is information
about you, including demographic information, that may identify you and
that relates to your past, present or future physical or mental health
or condition and related health care services.
We
are required to abide by the terms of this Notice of Privacy Practices.
We may change the terms of our notice at any time. The new notice will
be effective for all protected health information that we maintain at
that time. Upon your request, we will provide you with any revised Notice
of Privacy Practices by calling our office and requesting that a revised
copy be sent to you in the mail or asking for one at the time of your
next appointment.
1.
Uses and Disclosures of Protected Health Information
Uses
and Disclosures of Protected Health Information Based Upon Your Written
Consent
You
will be asked by your physician to sign a consent form. Once you have
consented to use the disclosure of your protected health information for
treatment, payment and health operations by signing the consent form,
your physician will use or disclose your protected health information
as described in this Section 1. Your protected health information may
be used and disclosed 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 health care services to you. Your protected health information
may also be used and disclosed to pay your health care bills and to support
the operation of the physician’s practice.
The
following are examples of the types of uses and disclosures of your protected
health care information that the physician’s office is permitted
to make once you have signed our consent form. These examples are not
meant to be exhaustive, but to describe the types of uses and disclosures
that may be made by our office once you have provided consent.
Treatment:
We will use and disclose your protected health information to provide,
coordinate, or manage your health care and any related services. This
includes the coordination or management of your health care with a third
party that has already obtained your permission to have access to your
protected health information. For example, we would disclose your protected
health information, as necessary, to a home health agency that provides
care to you. We will also disclose protected health information to other
physicians who may be treating you when we have the necessary permission
from you to disclose your protected health information. For example, your
protected health information may be provided to a physician to whom you
have been referred to ensure that the physician has the necessary information
to diagnose or treat you.
In
addition, we may disclose your protected health information from time-to-time
to another physician or health care provider (e.g., a specialist or laboratory)
who at the request of your physician becomes involved in your care by
providing assistance with your health care diagnosis or treatment to your
physician.
Payment:
Your protected health information will be used, as needed, to obtain payment
for your health care services. This may include certain activities that
your health insurance plan may undertake before it approves or pays for
the health care services we recommend for you such as; making a determination
of eligibility or coverage for insurance benefits, reviewing services
provided to you for medical necessity, and undertaking utilization review
activities. For example, obtaining approval for a hospital stay may require
that your relevant protected health information be disclosed to the health
plan to obtain approval for the hospital admission.
Healthcare
Operations: We may use or disclose, as needed, your protected health information
in order to support the business activities of your physician’s
practice. These activities include, but are not limited to, quality assessment
activities, employee review activities, training of medical students,
licensing, marketing and fundraising activities, and conducting or arranging
for other business activities.
For
example, we may disclose your protected health information to medical
school students that see patients at our office. In addition, we may use
a sign-in sheet at the registration desk where you will be asked to sign
your name and indicate your physician. We may also call you by name in
the reception room when your physician is ready to see you. We may use
or disclose your protected health information, as necessary, to contact
you to remind you of your appointment.
We
will share your protected health information with third party “business
associates” that perform various activities (e.g., billing, transcription
services) for the practice. Whenever an arrangement between our office
and a business associate involves the use or disclosure of your protected
health information, we will have a written contract that contains terms
that will protect the privacy of your protected health information.
We
may use or disclose your protected health information, as necessary, to
provide you with information about treatment alternatives or other health-related
benefits and services that may be of interest to you. We may also use
and disclose your protected health information for other marketing activities.
For example, your name and address may be used to send you a newsletter
about our practice and the services we offer. We may also send you information
about products or services that we believe may be beneficial to you. You
may contact our Privacy Contact to request that these materials not be
sent to you.
We may use or disclose your demographic information and the dates that
you received treatment from your physician, as necessary, in order to
contact you for fundraising activities supported by our office. If you
do not want to receive these materials, please contact our Privacy Contact
and request that these fundraising materials not be sent to you.
Uses
and Disclosures of Protected Health Information Based Upon Your Written
Authorization
Other
uses and disclosures of your protected health information will be made
only with your written authorization, unless otherwise permitted or required
by law as described below. You may revoke this authorization, at any time,
in writing, except to the extent that your physician or the physician’s
practice has taken an action in reliance on the use or disclosure indicated
in the authorization.
Other
Permitted and Required Uses and Disclosures That May Be Made With Your
Consent, Authorization or Opportunity to Object
We
may use and disclose your protected health information in the following
instances. You have the opportunity to agree or object to the use or disclosure
of all or part of your protected health information. If you are not present
or able to agree or object to the use or disclosure of the protected health
information, then your physician may, using professional judgment, determine
whether the disclosure is in your best interest. In this case, only the
protected health information that is relevant to your health care will
be disclosed.
Others
Involved In Your Healthcare: Unless you object, we may disclose to a member
of your family, a relative, a close friend or any other person you identify,
your protected health information that directly relates to that person’s
involvement in your health care. If you are unable to agree or object
to such a disclosure, we may disclose such information as necessary if
we determine that it is in your best interest based on our professional
judgment. We may use or disclose protected health information to notify
or assist in notifying a family member, personal representative or any
other person that is responsible for your care of your location, general
condition or death. Finally, we may use or disclose your protected health
information to an authorized public or private entity to assist in disaster
relief efforts and to coordinate uses and disclosures to family] or other
individuals involved in your health care.
Emergencies:
We may use or disclose your protected health information in an emergency
treatment situation. If this happens, your physician shall try to obtain
your consent as soon as reasonably practical after the delivery of treatment.
If your 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 protected health information to treat you.
Communication
Barriers: We may use and disclose your protected health information if
your physician or another physician in the practice attempts to obtain
consent from you but is unable to do so due to substantial communication
barriers and the physician determines, using professional judgment, that
you intend to consent to use or disclosure under the circumstances.
Other Permitted and Required Uses and Disclosures That May Be Made Without
Your Consent, Authorization or Opportunity to Object.
We
may use or disclose your protected health information in the following
situations without your consent or authorization. These situations include:
Required
by Law: We may use or disclose your protected health information to the
extent that the use or disclosure is required by law. The use or disclosure
will be made in compliance with the law and will be limited to the relevant
requirements of the law. You will be notified, as required by law, of
any such uses or disclosures.
Public
Health: We may disclose your protected health information for public health
activities and purposes to a public health authority that is permitted
by law to collect or receive the information. The disclosure will be made
for the purpose of controlling disease, injury or disability. We may also
disclose your protected health information, if directed by the public
health authority, to a foreign government agency that is collaborating
with the public health authority.
Communicable
Diseases: We may disclose your protected health information, 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.
Health
Oversight: We may disclose protected health information to a health oversight
agency for activities authorized by law, such as audits, investigations,
and inspections. Oversight agencies seeking this information include government
agencies that oversee the health care system, government benefit programs,
other government regulatory programs and civil rights laws.
Abuse
or Neglect: We may disclose your protected health information to a public
health authority that is authorized by law to receive reports of child
abuse or neglect. In addition, we may disclose your protected health information
if we believe that you have been a victim of abuse, neglect or domestic
violence to the governmental entity or agency authorized to receive such
information. In this case, the disclosure will be made consistent with
the requirements of applicable federal and state laws.
Food
and Drug Administration: We may disclose your protected health information
to a person or company required by the Food and Drug Administration to
report adverse events, product defects or replacements, or to conduct
post marketing surveillance, as required.
Legal
Proceedings: We may disclose protected health information in the course
of any judicial or administrative proceeding, in response to an order
of the court or administrative tribunal (to the extent such disclosure
is expressly authorized), in certain conditions in response to a subpoena,
discovery request or other lawful process.
Law
Enforcement: We may also disclose protected health information, so long
as applicable legal requirements are met, for law enforcement purposes.
These law enforcement purposes include (1) legal processes and otherwise
required by law, (2) limited information requests for identification and
location purposes, (3) pertaining to victims of a crime, (4) suspicion
that death has occurred as a result of criminal conduct, (5) in the event
that a crime occurs on the premises of the practice, and (6) medical emergency
(not on the Practice’s premises) and it is likely that a crime has
occurred.
Coroners,
Funeral Directors, and Organ Donation: We may disclose protected health
information to a coroner or medical examiner for identification purposes,
determining cause of death or for the coroner or medical examiner to perform
other duties authorized by law. We may also disclose protected health
information to a funeral director, as authorized by law, in order to permit
the funeral director to carry out their duties. We may disclose such information
in reasonable anticipation of death. Protected health information may
be used and disclosed for cadaveric organ, eye or tissue donation purposes.
Research:
We may disclose your protected health information to researchers when
their research has been approved by an institutional review board that
has reviewed the research proposal and established protocols to ensure
the privacy of your protected health information.
Criminal
Activity: Consistent with applicable federal and state laws, we may disclose
your protected health information, if we believe that the use or disclosure
is necessary to prevent or lessen a serious and imminent threat to the
health or safety of a person or the public. We may also disclose protected
health information if it is necessary for law enforcement authorities
to identify or apprehend an individual.
Military
Activity and National Security: When the appropriate conditions apply,
we may use or disclose protected health information of individuals who
are Armed Forces personnel (1) for activities deemed necessary by appropriate
military command authorities, (2) for the purpose of a determination by
the Department of Veterans Affairs of your eligibility for benefits, or
(3) to foreign military authority if you are a member of that foreign
military services. We may also disclose your protected health information
to authorized federal officials for conducting national security and intelligence
activities, including for the provision of protective services to the
President or others legally authorized.
Workers’
Compensation: Your protected health information may be disclosed by us
as authorized to comply with workers’ compensation laws and other
similar legally established programs.
Inmates:
We may use or disclose your protected health information if you are an
inmate of a correctional facility and your physician created or received
your protected health information in the course of providing care to you.
Required Uses and Disclosures: Under the law, we must make disclosures
to you and when required by the Secretary of the Department of Health
and Human Services to investigate or determine our compliance with the
requirements of Section 164.500 et. seq.
2.
Your Rights
The
following is a statement of your rights with respect to your protected
health information and a brief description of how you may exercise these
rights.
You
have the right to inspect and copy your protected health information.
This means you may inspect and obtain a copy of protected health information
about you that is contained in a designated record set for as long as
we maintain the protected health information. A “designated record
set” contains medical and billing records and any other records
that your physician and the practice uses for making decisions about you.
Under
federal law, however, you may not inspect or copy the following records;
psychotherapy notes; information compiled in reasonable anticipation of,
or use in, a civil, criminal, or administrative action or proceeding,
and protected health information that is subject to law that prohibits
access to protected health information. Depending on the circumstances,
a decision to deny access may be reviewable. In some circumstances, you
may have a right to have this decision reviewed. Please contact our Privacy
Contact if you have questions about access to your medical record.
You
have the right to request a restriction of your protected health information.
This means you may ask us not to use or disclose any part of your protected
health information for the purposes of treatment, payment or healthcare
operations. You may also request that any part of your protected health
information 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 your physician believes it is in your best interest to permit use and
disclosure of your protected health information, your protected health
information will not be restricted. If your physician does agree to the
requested restriction, we may not use or disclose your protected health
information in violation of that 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 request a restriction
by putting the request in writing with the date and your signature and
delivering it to the Privacy Contact.
You
have the right to request to receive confidential communications from
us by alternative means or at an alternative location. We will accommodate
reasonable requests. We may also condition this accommodation by asking
you for information as to how payment will be handled or specification
of an alternative address or other method of contact. We will not request
an explanation from you as to the basis for the request. Please make this
request in writing to our Privacy Contact.
You
may have the right to have your physician amend your protected health
information. This means you may request an amendment of protected health
information about you in a designated record set for as long as we maintain
this information. In certain cases, we may deny your request for an amendment.
If we deny your request for amendment, 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. Please contact
our Privacy Contact to determine if you have questions about amending
your medical record.
You
have the right to receive an accounting of certain disclosures we have
made, if any, of your protected health information. This right applies
to disclosures for purposes other than treatment, payment or healthcare
operations as described in the Notice of Privacy Practices. It excludes
disclosures we may have made to you, for a facility directory, 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 a shorter timeframe.
The right to receive this information is subject to certain exceptions,
restrictions and limitations.
You
have the right to obtain a paper copy of this notice from us, upon request,
even if you have agreed to accept this notice electronically.
3.
Complaints
You
may complain to us or to the Secretary of Health and Human Services if
you believe your privacy rights have been violated by us. You may file
a complaint with us by notifying our Privacy Contact of your complaint.
We will not retaliate against you for filing a complaint.
You
may contact our Privacy Officer Luchianna Branch
at 412-621-6166.
This
notice was published and becomes effective on April 14, 2003. |