We will use and disclose your protected health information
about you for treatment, payment, and health care
operations.
Following are examples of the types of uses and disclosures
of your protected health care information that may occur.
These examples are not meant to be exhaustive, but to
describe the types of uses and disclosures that may be made
by our office.
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. 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. 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, anesthesia 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 protected
health 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.
Health Care Operations:
We may use or disclose, as needed, your protected health
information in order to conduct certain business and
operational activities. These activities include, but are
not limited to, quality assessment activities, employee
review activities, training of students, licensing, and
conducting or arranging for other business activities.
For example, we may use a sign-in sheet at the registration
desk where you will be asked to sign your name. We may also
call you by name in the waiting room when your doctor is
ready to see you. We may use or disclose your protected
health information, as necessary, to contact you by
telephone or mail 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 us to request that these materials not be sent to
you.
Uses and Disclosures Based On Your Written Authorization:
Other uses and
disclosures of your protected health information will be
made only with your authorization, unless otherwise
permitted or required by law as described below.
You may give us written authorization to use your protected
health information or to disclose it to anyone for any
purpose. If you give us an authorization, you may revoke it
in writing at any time. Your revocation will not affect any
use or disclosures permitted by your authorization while it
was in effect. Without your written authorization, we will
not disclose your health care information except as
described in this notice.
Others Involved in Your Health Care:
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.
Marketing:
We may use your
protected health information to contact you with information
about treatment alternatives that may be of interest to
you. We may disclose your protected health information to a
business associate to assist us in these activities. Unless
the information is provided to you by a general newsletter
or in person or is for products or services of nominal
value, you may opt out of receiving further such information
by telling us using the contact information listed at the
end of this notice.
Research; Death; Organ Donation:
We may use or disclose your protected health information for
research purposes in limited circumstances. We may disclose
the protected health information of a deceased person to a
coroner, protected health examiner, funeral director or
organ procurement organization for certain purposes.
Public Health and Safety:
We may disclose your protected health information to the
extent necessary to avert a serious and imminent threat to
your health or safety, or the health or safety of others.
We may disclose your protected health information to a
government agency authorized to oversee the health care
system or government programs or its contractors, and to
public health authorities for public health purposes.
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
problems, biologic product deviations; to track products; to
enable product recalls; to make repairs or replacements; or
to conduct post marketing surveillance, as required.
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.
Required by Law:
We may use or
disclose your protected health information when we are
required to do so by law. For example, we must disclose
your protected health information to the U.S. Department of
Health and Human Services upon request for purposes of
determining whether we are in compliance with federal
privacy laws. We may disclose your protected health
information when authorized by workers’ compensation or
similar laws.
Process and Proceedings:
We may disclose your protected health information in
response to a court or administrative order, subpoena,
discovery request or other lawful process, under certain
circumstances. Under limited circumstances, such as a court
order, warrant or grand jury subpoena, we may disclose your
protected health information to law enforcement officials.
Law Enforcement:
We may disclose limited information to a law enforcement
official concerning the protected health information of a
suspect, fugitive, material witness, crime victim or missing
person. We may disclose the protected health information
of an inmate or other person in lawful custody to a law
enforcement official or correctional institution under
certain circumstances. We may disclose protected health
information where necessary to assist law enforcement
officials to capture an individual who has admitted to
participation in a crime or has escaped from lawful custody.
Access: You have the right
to look at or get copies of your protected health
information, with limited exceptions. You must make a
request in writing to the contact person listed herein to
obtain access to your protected health information. You may
also request access by sending us a letter to the address at
the end of this notice. If you request copies, we will
charge you $10.00, and postage if you want the copies mailed
to you. If you prefer, we will prepare a summary or an
explanation of your protected health information for a fee.
Contact us using the information listed at the end of this
notice for a full explanation of our fee structure.
Accounting of Disclosures:
You have the right to receive a list of instances in which
we or our business associates disclosed your protected
health information for purposes other than treatment,
payment, health care operations and certain other activities
after April 14, 2003. After April 14, 2009, the accounting
will be provided for the past six (6) years. We will
provide you with the date on which we made the disclosure,
the name of the person or entity to whom we disclosed your
protected health information, a description of the protected
health information we disclosed, the reason for the
disclosure, and certain other information. If you request
this list more than once in a 12-month period, we may charge
you a reasonable, cost-based fee for responding to these
additional requests. Contact us using the information
listed at the end of this notice for a full explanation of
our fee structure.
Restriction Requests:
You have the right to request that we place additional
restrictions on our use or disclosure of your protected
health information. We are not required to agree to these
additional restrictions, but if we do, we will abide by our
agreement (except in an emergency). Any agreement we may
make to a request for additional restrictions must be in
writing signed by a person authorized to make such an
agreement on our behalf. We will not be bound unless our
agreement is so memorialized in writing.
Confidential Communication:
You have the right to request that we communicate with you
in confidence about your protected health information by
alternative means or to an alternative location. You must
make your request in writing. We must accommodate
your request if it is reasonable, specifies the alternative
means or location, and continues to permit us to bill and
collect payment from you.
Amendment:
You have the right to
request that we amend your protected health information.
Your request must be in writing, and it must explain why the
information should be amended. We may deny your request if
we did not create the information you want amended or for
certain other reasons. If we deny your request, we will
provide you a written explanation. You may respond with a
statement of disagreement to be appended to the information
you wanted amended. If we accept your request to amend the
information, we will make reasonable efforts to inform
others, including people or entities you name, of the
amendment and to include the changes in any future
disclosures of that information.
Electronic Notice:
If you receive this
notice on our website or by electronic mail (e-mail), you
are entitled to receive this notice in written form. Please
contact us using the information listed at the end of this
notice to obtain this notice in written form.