757.552.0800

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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.
UNDERSTANDING YOUR HEALTH RECORD INFORMATION
Each time you visit our office, we make a record of your visit. Typically,
this record contains your health history, current symptoms, examination and
test results, diagnosis, treatment, and a plan for future care. This
information, often referred to as your medical record, serves as a:
- Basis for planning
your care and treatment.
- Means of communication
with other health professionals who care for you.
- Legal document
describing the care you received.
- Means by which you or
a third-party payer can verify that you received the service billed for.
- A tool in medical
education.
- A source of
information for public health officials.
- A tool to assess the
appropriateness and quality of care you received.
- A tool to improve the
quality of healthcare and achieve better patient outcomes.
Understanding what is in your health records and how this is used helps
you to
- Ensure its accuracy
and completeness.
- Understand who, what,
where, why, and how others may access your health information.
- Make informed consent
decisions about authorizing disclosure to others.
- Better understand the
health information rights detailed below.
YOUR RIGHTS UNDER THE FEDERAL POLICY STANDARD
Although your health records are the physical property of the healthcare
provider, you have certain rights with regard to the information contained
herein. You have the right to.
- Request restrictions
on uses and disclosures of your health information for treatment,
payment, and health care operations (quality assurance, peer review
etc.)
- Ask us to communicate
with you by alternate means, and, if the method of communication is
reasonable, we must grant the alternate communication request.
- Receive and keep a
copy of this notice of information practices or our entire “HIPPA
Privacy Policy and Procedure Manual”. The law requires us to ask
you to acknowledge receipt of your copy.
- Inspect and copy your
health information upon request. Again, this right is not absolute. In
certain situations, such as if access would cause harm, we can deny
access. You do not have a right of access to the following
- Psychotherapy notes
- Information compiled
in anticipation of a civil, criminal, or administrative action.
- Information subject
to the Clinical Laboratory Improvements of 1988 (ClIA)
- Information obtained
from someone other than a healthcare provider under a promise of
confidentiality and the access requested would reveal the source of the
information.
In other situations, we may deny you access but,
if we do, we must provide you with a review of the decision denying access.
These reviewable grounds for denial include:
- When access is
likely to endanger the life or safety of the individual or another
person.
- When the request is
made by the individual’s personal representative and provision of
access to such person is likely to cause harm to the individual or
another person
For these reviewable grounds, another licensed
professional must review our decision denying access within 60 days. If we
deny you access, we will explain why and what your rights are, including how
to seek review.
- Request
amendment/correction of your health information. We do not have to grant
the request if:
- We did not create
the record. (For example: if we receive records from another provider,
you must request amendment or correction from that provider.)
- The records are not
available to you as discussed immediately above
- The record is
accurate and complete.
If we deny your request for amendment/correction,
we will notify you why, how you can attach a statement of disagreement to you
records (which we may rebut), and how you can complain to our complaint
official or to the Department of Health and Human Services. If we grant the
request, we will make the correction and distribute the correction to those
who need it and those you identify to us that you want to receive the
corrected information.
You may obtain an accounting of non-routine uses and disclosures of your
health record information. (Those other than for treatment, payment, and
health care operations.) We do not need to provide an accounting for the
following:
- Disclosures to you.
- Disclosures authorized
by you.
- Disclosures of limited
data sets (partially de-identified data used for research, public
health, or health care operations).
- Disclosures for the
facility directory or to persons responsible for your care (family
members, personal representatives, or other persons responsible for your
care).
- Disclosures for
national security or intelligence purposes.
- Disclosures to
correctional institutions or law enforcement officials.
- Disclosures that
occurred before April 14, 2003.
We must provide the accounting within 60 days. The accounting must
include:
- The date of each
disclosure.
- The name and address
of whomever received protected health information.
- A brief description of
the information disclosed.
- A brief statement of
the purpose of the disclosure that reasonable informs you of the basis
for the disclosure or, in lieu of such statement, a copy of the written
request for disclosure.
The first accounting in any 12-month period is free. Thereafter, we
reserve the right to charge a reasonable cost-based fee.
OUR RESPONSIBILITIES UNDER THE FEDERAL PRIVACY STANDARD
In addition to providing you with your rights the federal privacy standard
requires us to:
- Maintain the privacy
of your health information, including implementing reasonable and
appropriate physical, administrative, and technical safeguards to protect
the information.
- Provide you with this
notice as to our legal duties and privacy practices with respect to
individually identifiable health in formation we collect and maintain
about you.
- Abide by the terms of
this notice.
- Train our personnel
concerning privacy and confidentiality.
- Implement a sanction
policy to discipline those who breach privacy/confidentiality or our
policies with regard thereto.
- Mitigate (lessen the
harm of) any breach of privacy/confidentiality.
WE RESERVE THE RIGHT TO CHANGE OUR PRACTICES AND TO MAKE THE NEW
PROVISIONS EFFECTIVE FOR ALL HEALTH INFORMATION WE MAINTAIN. SHOULD WE CHANGE
OUR INFORMATION PRACTICES, WE WILL MAIL A REVISED NOTICE TO THE ADDRESS YOU
HAVE SUPPLIED US.
We will not use or disclose your health information without your
authorization except as described in this notice or otherwise requires by
law.
HOW TO GET MORE INFORMATION OR TO REPORT A PROBLEM
If you have questions or would like additional information, you may contact
our office and ask for the privacy officer at 552-0800.
EXAMPLES OF DISCLOSURES FOR TREATMENT,
PAYMENT, AND HEALTH OPERATIONS
- TREATMENT EXAMPLE: A
physician, nurse or other member of your healthcare team will record
information in your record to diagnose your condition and determine the
best course of treatment for you. The primary caregiver will give you
treatment orders and document what he or she expects other members of
the health care team to do to treat you. Those other members will then
document the actions they took and their observations. In that way, the
primary caregiver will know how you are responding to treatment.
We may provide your healthcare provider with copies of your records to
assist them in treating you once we are no longer treating you.
- PAYMENT EXAMPLE: We
may send a bill to you or to a third-party payer, such as a health
insurer. The information on or accompanying the bill may include
information that identifies you, your diagnosis, treatment received, and
supplies used.
- HEALTH OPERATIONS
EXAMPLE: Members of the medical staff, the risk or quality improvement
manager, or members of the quality assurance team may use information in
your health record to assess the care and outcomes in your cases and the
competence of the care-givers. We will use this information in an effort
to continually improve the quality and effectiveness of the healthcare
and services we provide.
USES AND DISCLOSURES OTHER THAN FOR TREATMENT, PAYMENT, OR HEALTH OPERATIONS
We may disclose health information to or for:
- BUSINESS ASSOCIATES:
(We provide some services through contracts with business associates
(collection agency, lawyer, etc). We require the business associate to
appropriately safeguard your information.)
- NOTIFICATION. assist
in notifying family member or person responsible for your care.
- COMMUNICATION WITH
FAMILY: (Unless you object, we may disclose to a family member, other
relative, close friends or any other person you identify, health
information relevant to that person’s involvement in your care or
payment related to your care.)
- RESEARCH: assist
researchers when their research has been approved by an institutional
review board to ensure the privacy of your healthinformation.
- FUNERAL DIRCTORS:
enable them to carry out their duties.(consistent with applicable law)
- MARKETING/CONTINUITY
OF CARE: provide appointment reminders or information about treatment
alternatives or services that may be of interest toyou.
- FOOD AND DRUG
ADMINISTRATION (FDA): (We may disclose to the FDA health information
relative to adverse effects/events with respect to drugs, supplements,
products, or post marketing surveillance information to enable product
recalls, repairs, or replacements.)
- WORKERS COMPENSATION:
to comply with laws related to workers compensation or other programs
established by law. (to the extent authorized)
- PUBLIC
HEALTH:OFFICIALS: to help prevent or control disease, injury, or
disability.
- CORRETIONAL
INSTITUTIONS: assist with your health and the health and safety of other
individuals, should you be an inmate of a correctional institution.
- LAW ENFORCEMENT: (In
response to a valid subpoena).
- HEALTH OVERSIGHT
AGENCY AND PUBLIC HEALTH AUTHORITIES: (If a member of our work force or
a business associate believes in good faith that we have engaged in
unlawful conduct or violated professional standards and are potentially
endangering one or more patients, workers or the public, they may
disclose your health information to health oversight agencies and/or
public health authorities such as the department of health.)
- THE FEDERAL DEPARTMENT
OF HEALTH AND HUMAN SERVICES (DHHS): (As necessary for them to determine
our compliance with those standards.)
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