Notice of privacy practices
This Notice of Privacy Practices (“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.
The law requires that we protect the privacy of your Protected Health Information (PHI) and that we give you a Notice of our legal duties and privacy practices with respect to PHI. PHI contains information that may identify your past, present or future physical or mental health conditions or healthcare services. This Notice explains how we can use or disclose the PHI in the course of providing treatment, collecting payment and managing healthcare operations, and for other specific purposes permitted or required by law.
Protected Health Information includes:
- Information we place in your medical record,
- Conversations your doctors have about your care or treatment with nurses and others,
- Information about your health and healthcare in our computer systems, and
- Billing information about you at our facility.
The Notice also explains your health information privacy rights.
The privacy practices described in this Notice will be followed by our entire workforce (employees, volunteers and contractors).
We will not use or disclose your PHI without your written authorization, except as described in this Notice.
YourHealth Information Privacy Rights
You have the right to:
- Receive the Notice of our Privacy Policies (this Notice), which tells you how your Protected Health Information (PHI) may be used and shared. In most cases, this Notice should be made available to you on your first visit, and you can ask for a copy of it at any time.
- Inspect and obtain a copy of your health records. You can ask to see and get a copy of your PHI, including its electronic format. You may be charged a fee for the cost of copying and mailing necessary to fulfill your request. We may deny your request to inspect and obtain a copy of your PHI in certain limited circumstances. For example, if your doctor decides that something in your file might endanger you or someone else, the doctor might not give this information to you. You have the right to appeal the denial.
- Amend your health information. You may request that we amend any incorrect or incomplete PHI that we maintain about you. For example, if we both agree that your file has the wrong test result, wewill change it. In certain cases, we may deny your request for amendment. If we deny your request for amendment you have certain rights to formally disagree with our decision. We will provide you with further information regarding these rights upon request.
- Authorize disclosure of your PHI. In general, your PHI, including psychotherapy notes,will not be givento your employer, used or shared for sales calls or marketing, or used or shared for many other purposes unless you give your permission by signing an authorization form.
- Request a report on how we disclosed your health information.Under the law, your PHI may be used and shared for particular reasons, like making sure we give good care, reporting when the flu is in your area, or making required reports to the police.You can request a list of all non-authorized disclosures and who your health information has been shared with.
- Requestto be contacted at a different address or in a different way than we contact you now.You have the right to ask us to contact you about your PHI at a different address or in a different way than we contact you now. These requests are often made when a person feels his or her health or safety is in danger if PHI is sent to his or her home address. We will do our best to accommodate all reasonable requests.
- Request restrictions on certain use or disclosure of PHI. You canrequest additional restrictions on the use or disclosure of your PHI. However, weare not required to agree with your request for additional restrictions.
- Request a restriction on disclosure of PHI to a health plan with respect to health care for which you are paying out of pocket in full. You have to make this request before services are provided and you may be asked to pay in full for those services at that time.
- Ask for additional information or file complaints. If you believe your PHI was used or shared in a way that is not allowed under the privacy law, or if you were not able to exercise your rights, you can file a complaint with us or with the U.S. Government. This Notice tells you who to talk to and how to file a complaint.
11. You have the right to be notified about data breaches of your unsecured PHI.
We ask that you exercise your rights in writing. We offer forms and templates to help you exercise your privacy rights andtohelp us protect your PHI.Our front desk staff will make these forms available to you upon your request.
Reasons and Examples of How WeMay Use or DiscloseYour PHI
- Treatment - so you can get medical care. For example, we may share your PHI with your doctors or pharmacy so that they can give you medical care and the right medicine. We may also call or write to provide refill reminders or to tell you about treatment options or other health-related services. We will not disclose PHI without authorization for marketing purposes.
- Payments - so we can determine plan coverage, billing/collection, and assist another health care provider with payment activities or recover payment from medical insurance. For example, the information accompanying the bill or insurance verification request may identify you as well as your treatment.
- Operations - so we can perform our duties. For example, we may use or share your PHI to assess quality of care,conduct training orto manage your care. We may also disclose PHI to an oversight agency in the course of audits, complaint investigations and inspections necessary for our licensure, to satisfy government monitoring activities and regulatory compliance.
- There are some services provided by us through contracts with Business Associates, for example billing, scheduling or transcription services. When these services require access to your PHI we will disclose only minimum necessary information so the contractors may perform their job. To protect your PHI we require Business Associates to safeguard PHI appropriately.
- To comply with the law. We may share your PHI to comply with legal proceedings, or in response to valid court or administrative order or subpoena.
- For other reasons. Examples include:
- i. We may disclose PHI to support law enforcement (e.g. government authority such as police, social services) to protect someone’s health and safety (e.g. victims of abuse, domestic violence);
- ii. We will use our professional judgment and may share PHI with a family member, friend or other relative to help you obtain or pay for your health care;
- iii. We may share PHI to notify a family member, relative, personal representative or other person responsible for your care about your general condition and location;
- iv. So a personal representative you appoint or a court appoints for you can help you get health benefits;
- v. To support research as long as the privacy and security of PHI areensured;
- vi. So a coroner or medical examiner can identify a deceased person or cause of death or so a funeral director can arrange burial;
- vii. To support,in limited circumstances,an organ procurement organization;
- viii. To protect you against a serious threat to your health or safety, or to protect the health or safety of others;
- ix. To support a government agency overseeing health care programs. For example, we may disclose your PHI to the Food and Drug Administration to enable investigations, drug/product recalls or replacements;
- x. We may disclose your PHI as authorized or necessary to comply with worker’s compensation laws or other similar programs;
- xi. For lawful national security purposes including intelligence or national security activities;
- xii. For public health purposes to prevent or control disease; and
- xiii. For military purposes, if you are a member of the armed forces.
We will obtain your written authorization before using or disclosing your PHI for purposes other than those described in this Notice or as otherwise permitted by law, e.g. marketing and sale of PHI. You will be able to revoke this authorization at any time.
- 2. Changes to this Notice
- For More Information or to Report a Problem
This Notice of Privacy Practices is effective as of October 23, 2013
The Notice of Privacy Practices was last revised on: 10/23/2013