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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. This Notice of Privacy Practices
describes how we may use and disclose your protected health information
(PHI)
to carry out treatment, payment or health care operations (TPO) and for
other
purposes that are permitted or required by law. It also describes your
rights
to access and control your protected health information.
“Protected health
information” is information about you, including demographic
information, that
may identify you and relates to your past, present or future physical
or mental
health or condition and related health care services. 1.
Uses and
Disclosures of Protected Health Information Your protected health
information may be used and disclosed by your physician, our staff and
others
outside of our office that are involved in your care and treatment for
the
purpose of providing health care services to you, to pay your health
care
bills, to support the operation of the physician’s practice,
and any other use
required by law. Treatment:
We will use and disclose your protected health information to provide,
coordinate, or manage 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. 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. Payment:
Your protected health information will be used, as needed, to obtain
payment
for your health care services. 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 Operations: We may use or disclose, as-needed,
your protected
health information in order to support the business activities of your
physician’s practice. These activities include, but are not
limited to, quality
assessment activities, employee review activities, training of medical
students, licensing, and conducting or arranging for other business
activities.
For example, we may disclose your protected health information to
medical
school students that may see patient records at our office. In
addition, we may
also call you by name in the waiting room when your physician is ready
to see
you. We may use or disclose your protected health information, as
necessary, to
contact you to remind you of your appointment... We may use or disclose your
protected health information in the following situations without your
authorization. These situations include: as Required By Law, Public
Health
issues as required by law, Communicable Diseases: Health Oversight:
Abuse or
Neglect: Food and Drug Administration requirements: Legal Proceedings:
Law
Enforcement: Coroners, Funeral Directors, and Organ Donation: Research:
Criminal Activity: Military Activity and National Security:
Workers’
Compensation: Inmates: Required Uses and Disclosures: Under the law, we
must
make disclosures to you and when required by the Secretary of the
Department of
Health and Human Services to investigate or determine our compliance
with the
requirements of Section 164.500. Other Permitted and Required Uses
and Disclosures
Will be Made Only With Your Consent, Authorization or
You may revoke this authorization, at any time, in writing, except to
the extent that
your physician or the physician’s practice has taken an
action in reliance on
the use or disclosure indicated in the authorization. Your Rights Following is a statement of
your rights with respect to your protected health information. You have the right to inspect and
copy your protected
health information. Under federal
law, however, you may not inspect or copy the following records;
psychotherapy
notes; information compiled in reasonable anticipation of, or use in, a
civil,
criminal, or administrative action or proceeding, and protected health
information that is subject to law that prohibits access to protected
health
information. You have the right to request a
restriction of your
protected health information.
This means you may ask us not to use or disclose any part of your
protected
health information for the purposes of treatment, payment or healthcare
operations. You may also request that any part of your protected health
information not be disclosed to family members or friends who may be
involved
in your care or for notification purposes as described in this Notice
of
Privacy Practices. Your request must state the specific restriction
requested
and to whom you want the restriction to apply. Your physician is not
required to agree to a restriction that you may request. If physician
believes
it is in your best interest to permit use and disclosure of your
protected
health information, your protected health information will not be
restricted.
You then have the right to use another Healthcare Professional. You have the right to request to
receive confidential
communications from us by alternative means or at an alternative
location. You
have the right to obtain a paper copy of this notice from us, upon request, even if you have
agreed to accept this
notice alternatively i.e. electronically. You may have the right to have your
physician amend
your protected health information.
If we deny your request for amendment, you have the right to file a
statement
of disagreement with us and we may prepare a rebuttal to your statement
and
will provide you with a copy of any such rebuttal. You have the right to receive an
accounting of certain
disclosures we have made, if any, of your protected health information. We reserve the right to
change the terms of this notice and will inform you by mail of any
changes. You
then have the right to object or withdraw as provided in this notice. Complaints You may complain to us or the
Secretary of Health and Human Services if you believe your privacy
rights have
been violated by us. You may file a complaint with us by notifying our
privacy
contact of your complaint. We will
not retaliate against you for filing a complaint. This notice was published and
becomes effective on/or before April
14, 2003. We are required by law to
maintain the privacy of, and provide individuals with, the notice of
our legal
duties and privacy practices with respect to protected health
information. If
you have any objections to this form, please ask to speak with our
HIPAA
Compliance Officer in person or by phone at our Main Phone Number. Signature below is only
acknowledgement
that you have received this Notice of our Privacy Practices: |
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The
Women's Clinic |
