Notice of Privacy Practices

 

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 takes effect on 12/28/18 and remains in effect until we replace it.

OUR PLEDGE REGARDING MEDICAL INFORMATION

The privacy of your medical information is important to us. We understand that your medical information is personal and we are committed to protecting it. We create a record of the care and services you receive in our practice. We need this record to provide you with quality care and to comply with certain legal requirements. This notice tells you about the ways we may use and share medical information about you. It also describes your rights and certain duties we have regarding the use and disclosure of medical information.

OUR LEGAL DUTY

Where applicable law requires us to:

  • Keep your medical information private.

  • Give you notice describing our legal duties, privacy practices and your rights regarding your medical information.

  • Follow the terms of the notice that is now in effect.

We Have the Right to:

  • Change our privacy practices and the terms of this notice at any time provided the changes are permitted by law.

  • Make the changes in our privacy practices and the new terms of our notice effective for all medical information that we keep, including information previously created or received before the changes.

Notice of Change to Privacy Practices:

  • Before we can make an important change in our privacy practices, we will change this notice and make the new notice available upon request.

USE AND DISCLOSURE OF YOUR MEDICAL INFORMATION

This section describes the ways we can use and disclose information. Not every use or disclosure will be listed. We will not use or disclose your medical information for any purpose not listed below without your specific written authorization. Any specific authorization you provide may be revoked at any time by writing to us.

FOR TREATMENT: We may use the medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students, or other people who are taking care of you. We may also share medical information about you to your other health care providers to assist in your evaluation & treatment.

FOR PAYMENT: We may use and disclose your medical information for payment purposes.

FOR HEALTH CARE OPERATIONS: We may use and disclose your medical information for our health care operations. This might include measuring and improving quality, evaluating the performance of employees, conducting training programs, and getting the accreditation, certificates, licenses and credentials we need to serve you.

ADDITIONAL USES AND DISCLOSURES: In addition to using your medical information for treatment, payment and health care operations we may use and disclose medical information for the following purposes:

  • Notification: Medical information to notify or help notify: a family member, your personal representative or another person responsible for your care. We will share information about your location, general condition or death. If you are present, we will get your permission if possible before we share, or give you the opportunity to refuse permission. In case of emergency, and if you are not able to give or refuse permission, we will share only the health information that is directly necessary for your health care, according to our professional judgment. We will also use our professional judgment to make decisions in your best interest about allowing someone to pick up medicine, medical supplies, x-ray or medical information for you.

  • Disaster relief: Medical information with a public or private entity who can legally assist in disaster relief efforts.

  • Funeral Director, Coroner, Medical Examiner: To help them carry out their duties, we may share the medical information of a person who has died with any of these or an organ procurement organization. Specialized Government Functions: Subject to certain requirements, we may disclose or use health information for military personnel and veterans, for national security and intelligence activities, for protective services for the President and others, for medical suitability determinations for the Department of State, for correctional institutions and other law enforcement custodial situations, and for government programs providing public benefits.

  • Court Orders and Judicial and Administrative Proceedings: We may disclose medical 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 share your medical information with law enforcement officials. We may share limited information with a law enforcement official concerning the medical information of a suspect, fugitive, material witness, crime victim or missing person. We may share the medical information of an inmate or other person in lawful custody with a law enforcement official or correctional institution under certain circumstances.

  • Public Health Activities: As required by law, we may disclose your medical information to public health or legal authorities charged with preventing or controlling disease, injury or disability, including child abuse or neglect. We may also disclose your medical information to persons subject to jurisdiction of the Food and Drug Administration (FDA) for purposes of reporting adverse events associated with product defects or problems, to enable product recalls, repairs or replacements, to track products or to conduct activities required by the FDA. We may also, when we are authorized by law to do so, notify a person who may have been exposed to a communicable disease or otherwise be at risk of contracting or spreading a disease or condition.

  • Victims of Abuse, Neglect, or Domestic Violence: We may disclose medical information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect or domestic violence or the possible victim of other crimes. We may share your medical information if it is necessary to prevent a serious threat to your health or safety or the health or safety of others. We may share the medical information when necessary to help law enforcement officials capture a person who has admitted to being part of a crime or who has escaped from legal custody.

  • Workers Compensation: We may disclose health information when authorized and necessary to comply with laws relating to workers compensation or other similar programs.

  • Health Oversight Activities: We may disclose medical information to an agency providing health oversight activities authorized by law, including but not limited to audits, civil, administrative, or criminal investigations or proceedings, inspections, licensure or disciplinary actions.

  • Law Enforcement: Under certain circumstances, we may disclose health information to law enforcement officials. These circumstances include reporting required by certain laws, such as the reporting of certain types of wounds, pursuant to certain subpoenas or court orders, reporting limited information concerning identification and location at the request of a law enforcement official, reports regarding suspected victims of crimes at the request of a law enforcement official, reporting death, crimes on our premises and crimes in emergencies.

YOUR INDIVIDUAL RIGHTS

Unless otherwise precluded by law or regulation, you have a right to:

  • Get copies of your medical information. You may request that we provide copies in a format other than photocopies. We will use the format you request unless it is impractical for us to do so. You must make your request in writing. You may get the form to request access by using the contact information contained in this notice. You may also request access by sending a letter to the contact person listed in this notice. If you request copies, a fee for copying and processing will be charged. You may contact us for a full explanation of the fees. Upon receipt of written request & payment, copies will be provided within 7 business days.

  • Receive a list of all the times we or our business associates shared your medical information for purposes other than treatment, payment, healthcare operations and other specified exemptions.

  • Request that we place additional restrictions on our use or disclosure of your medical information. We are not required to agree to these additional restrictions but if we do agree, we will abide by our agreement, except in the case of emergency.

  • Request that we communicate with you about your medical information by different means or to different locations. Your request that we communicate by different means or different locations must be made in writing to the contact person listed in this notice.

  • Request that we change your medical information. We may deny your request if we did not create the information you want changed and for certain other reasons. If we deny your request, we will provide you a written explanation. You may respond with a statement of disagreement that will be added to the information you want changed. If we accept your request to change the information, we will make reasonable efforts to tell others, including people you name, of the change and to include the changes in any future sharing of that information.

  • Review your record. This right may be exercised by appointment with the contact person whose name is listed at the top of this notice.

  • You have a right to a paper copy of this notice.

QUESTIONS AND COMPLAINTS

If you have any questions about this notice or you think that we may have violated your privacy rights, please contact us. You may also submit a written complaint to the U.S. Department of Health and Human Services. We will provide you with the address to file your complaint to the U.S. Department of Health and Human Services. We will not retaliate in any way if you choose to file a complaint.