| This notice describes how 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 a hospital, physician, or other healthcare
provider, a record of your visit is made. Typically, this
record contains your symptoms, examination and test results,
diagnoses, treatment, and a plan for future care or treatment.
This information, often referred to as your health or medical
record, serves as a:
- basis for planning your care and treatment
- means of communication among the many health professionals
who contribute to your care
- legal document describing the care you received
- means by which you or a third party payer can verify that
services billed were actually provided
- a tool in educating health professionals
- a source of data for medical research
- a source of information for public health officials charged
with improving the health of the nation
- a source of data for facility planning and marketing
and
- a tool with which we can assess and continually work to
improve the care we render and the outcomes we achieve.
Understanding what is in your record and how your health
information is used helps you to:
- ensure its accuracy
- better understand who, what, when, where and why others
may access your health information
- make more informed decisions when authorizing disclosure
to others.
Your Health Information Rights:
Although your health record is the physical property of the
healthcare practitioner or facility that compiled it, the
information belongs to you. You have the right to:
- request a restriction on certain uses and disclosures
of your information. To do so, The Request for Limitations
and Restrictions of Protected Health Information form must
be completed. You do not need to give a reason for your
request.
- obtain a paper copy of the Notice of Privacy Practices
upon request.
- inspect and copy your health record. This request must
be made on the Request to Inspect and Copy Protected Health
Information form. Our practice may charge a fee for the
cost of this service.
- amend your health record by completing the Request for
Correction/Amendment of Protected Health Information form.
You must provide a reason that supports your request. Your
request may be denied if you ask us to amend information
that in our opinion is (a) accurate and complete; (b) not
part of the information kept by or for the practice; (c)
not part of your health record which you would be permitted
to inspect; or (d) not created by our practice.
- request communications of your health information by
alternative means or at alternative locations. By filing
a Patient Authorization for Practice to Release Protected
Health Information to Third Parties form with our office,
we will attempt to comply with your request within reason.
- revoke your authorization to use or disclose health information
except to the extent that action has already been taken.
- file a Patient Complaint Form if you feel your health
information has not been kept confidential.
- request an itemized listing of the disclosures made by
our office by submitting a Request for an Accounting of
Certain Disclosure of Protected Health Information for Non-TPO
Purposes form to our office. These are annual reports and
there is a fee for this service.
Our Responsibilities:
This organization is required to:
- maintain the privacy of your health information
- provide you with a notice as to our legal duties and
privacy practices with respect to information we collect
and maintain about you
- abide by the terms of this notice
- notify you if we are unable to agree to a requested restriction
- accommodate reasonable requests you may have to communicate
health information by alternative means or at alternative
locations.
We reserve the right to change our practices and to make
the new provisions effective for all protected health information
we maintain. You may request a copy of our Notice of Privacy
Practices at any time.
We will not use or disclose your health information without
your authorization, except as described in this notice.
Examples of Disclosures for Treatment, Payment and Health
Operations
We will use your health information for treatment. For
example: Information obtained by a nurse, physician or
other member of your healthcare team will be recorded in your
record and used to determine the course of treatment that
should work best for you. Members of your healthcare team
will then record the actions they took and their observations.
In that way the physician will know how you are responding
to treatment.
We will also provide your physician or a subsequent healthcare
provider with copies of various reports that should assist
him/her in treating you.
We will use your health information for payment. For
example: A bill may be sent to you or a third party payer
(your insurance carrier). The information on or accompanying
the bill may include information that identifies you, as well
as your diagnosis, procedures and supplies used.
We will use your health information for regular health
operations. For example: Members of the medical staff,
the risk or quality improvement manager, or members of the
quality improvement team may use information in your health
record to assess the care and outcomes in your case and others
like it. This information will then be used in an effort to
continually improve the quality and effectiveness of the healthcare
and service we provide.
Other Uses or Disclosures
Business Associates: There are some services provided
in our organization through contacts with business associates.
Examples include physician services in the hospitals and certain
laboratories so that they can perform the job we’ve
asked them to do and bill you or your third party payer for
services rendered. So that your health information is protected,
however, we require the business associate to appropriately
safeguard your information.
Notification: We may use or disclose information
to notify or assist in notifying a family member, personal
representative, or another person responsible for your care,
your location, and general condition.
Communication with Family: Health professionals,
using their best judgment, may disclose to a family member,
other relative, close personal friend or any other person
you identify, health information relevant to that person’s
involvement in your care or payment related to your care.
Research: We may disclose 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 health information.
Funeral Directors: We may disclose health information
to funeral directors consistent with applicable law to carry
out their duties.Marketing: We may contact you to provide
appointment reminders or information about treatment alternatives
or other health related benefits and services that may be
of interest to you.
Food and Drug Administration (FDA): We may disclose
to the FDA health information relative to adverse events with
respect to food, supplements, product and product defects
or post marketing surveillance information to enable product
recalls, repairs or replacement.
Workers Compensation: We may disclose health information
to the extent authorized by and to the extent necessary to
comply with laws relating to workers compensation or other
similar programs established by law.
Public Health: As required by law, we may disclose
your health information to public health or legal authorities
charged with preventing or controlling disease, injury or
disability.
Correctional Institution: Should you be an inmate
of a correctional institution, we may disclose to the institution
or agents thereof, health information necessary for your health,
and the health and safety of other individuals.
Law Enforcement: We may disclose health information
for law enforcement purposes as required by law, or in response
to a valid subpoena.
Federal law makes provision for your health information
to be released to an appropriate health oversight agency,
public health authority or attorney, provided that a workforce
member or business associate believes in good faith that we
have engaged in unlawful conduct or have otherwise violated
professional or clinical standards and are potentially endangering
one or more patients, workers or the public.
If you have any questions regarding this notice, please
let the receptionist know and someone will explain our privacy
policies to you.
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