NOTICE OF PRIVACY PRACTICES
Health Insurance Portability and Accountability Act (HIPAA)
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 that relates to your past, present or future physical or mental health or condition and related health care services.
Uses and Disclosures of Protected Health Information: Your protected health information may be used and disclosed by our organization, our office 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 organization, 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 and any related services. This includes the coordination or management of 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. Your protected health information also 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 equipment or supplies coverage may require that your relevant protected health information be disclosed to the health plan to obtain approval for coverage.
Healthcare Operations: We may use or disclose, as-needed, your protected health information in order to support the business activities of our organization. These activities include, but are not limited to, quality assessment activities, employee review activities, accreditation activities, and conducting or arranging for other business activities. For example, we may disclose your protected health information to accrediting agencies as part of an accreditation survey. We may also call you by name while you are at our facility. We may use or disclose your protected health information, as necessary, to contact you to check the status of your equipment.
We also may use or disclose your protected health information without your authorization under certain circumstances related to the following situations:
- As Required By Law: We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law;
- Public Health and Safety Issues: We can share information about your for certain situations such as:
- Preventing disease;
- Healing with product recalls;
- Reporting adverse reactions to medications;
- Reporting suspected abuse, neglect, or domestic violence; and
- Preventing or reducing a serious threat to anyone’s health or safety.
- Research: We can use or share your information for health research;
- Respond to lawsuits and legal actions: We can share health information about you in response to a court or administrative order, or in response to a subpoena;
- Address workers’ compensation, law enforcement, and other government requests: We can use or share health information about you:
- For workers’ compensation claims;
- For law enforcement purposes or with a law enforcement official;
- With health oversight agencies for activities authorized by law; and
- For special government functions such as military, national security, and presidential protective
We must obtain your authorization before using or disclosing psychotherapy notes (except in certain limited situations), before using or disclosing protected health information for marketing purposes, or for any disclosure of protected health information which is considered a sale of protected health information. Other permitted and required uses and disclosures not specified in this notice will be made only with your authorization. You may revoke an authorization that you have provided to us, at any time, in writing, except to the extent that your physician or this organization 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 do not have the right to 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 the 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. Our organization is not required to agree to a restriction that you may request, unless the request is to restrict disclosure of protected health information to a health plan for the purpose of carrying out payment or health care operations and the protected health information pertains solely to a health care item or service for which you (or someone on your behalf other than the health plan) has paid in full. If our organization 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 our organization 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 will (and are required by law to) notify affected individuals following a breach of unsecured protected health information.
We reserve the right to change the terms of this notice and to make the new notice provisions effective for all protected health information in our possession. We will inform you of any changes by mailing you a copy of the revised notice. You then have the right to object or withdraw as provided in this notice.
Complaints: You may complain to our HIPAA Compliance Officer or to 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 the HIPAA Compliance Officer of your complaint using the contact information listed below. We will not retaliate against you for filing a complaint.
This notice was published and becomes effective on/or before September 10, 2013. We are required to abide by the
terms of the notice currently in effect.
We are required by law to maintain the privacy of protected health information and to provide individuals with this notice of our legal duties and privacy practices with respect to protected health information. If you have any questions concerning or objections to this form, please ask to speak with our HIPAA Compliance Officer in person or by phone at (623) 780-8686 x: 274.
Updated April 1, 2016