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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.)