Privacy Policy

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.

Like everything else in the fast-moving and legalistic world of today, the practice of medicine today is much more complex than it used to be. Part of what that means to you as a patient is that the records the clinic keeps of your visits here are often used in new ways. We are providing you with this information as a requirement of the Health Insurance Portability and Accountability Act of 1996, but we are also happy for the opportunity to share our feelings about the responsibility we feel toward you and the private information with which you have entrusted us.

While the records belong to the clinic, you have a right to know what is in them. If you need a copy of some portion of your medical or financial records we will provide you with a paper copy of requested records. If your records are maintained electronically and you request an electronic copy in writing, we will provide you with a copy of the records in electronic format.

The primary use for your medical record remains to help your health care provider keep track of your health history including all the symptoms that have brought you to the clinic, your family health history, examination and test results, diagnoses made, treatments supplied, and medications given. We now maintain most patient records electronically, and we may use your electronic health record to obtain information from your other health care providers to ensure the we have up-to-date information regarding your health history, treatment, and medications. Other examples of how we might use or disclose your medical records or information are described below.

We might use your medical records or information in the following ways:

• They might be shared with or sent to another doctor, therapist, or other health care professional who provides you with treatment.
• We might use them as part of our quality assessment program in which we review the care our patients receive to be sure that we are documenting well and that each provider is rendering high-quality care.
• Our billing clerks might read a certain day’s progress notes to decide how best to enter codes into a bill to your insurance company.
• We might send a copy of a course of treatment to an insurer who asks us to send records that support a bill we have sent them for your care. We ask you to authorize that by signing a form when you first sign up as a new patient.
• We may contact you to provide appointment reminders or to provide you with information about treatment alternatives or other health-related benefits and services we offer that may be of interest to you.
• We may contact you as part of a fundraising effort related to the practice, but you have the right to tell us if you do not want to be contacted again.
• We may contact you to comply with this notice and applicable laws governing your health information.
• Your records might also be seen by business associates whom we hire to do such things as help us devise better record systems, store our records electronically, train our billing staff or other jobs related to the efficient operation of the clinic. To protect your privacy in these cases, we require all of our business associates to demonstrate that they comply with our confidentiality requirements and to sign an agreement that limits what they can do with the records.
• There may be other instances where we would need to use or disclose your protected health information. These include uses and disclosures of your protected health information for marketing purposes, and disclosures that constitute the sale of your protected health information. We would only be permitted to use or disclose protected health information in these instances with your written permission.

Your financial records:

The primary use for any financial records we keep is to help us remember how much is owed and whether the bill goes to you, an insurance company, or a public health care payer. Uses to which those records might be put include:

• Insurers sometimes ask for copies of records of payment for a certain service, so we would send to them that segment of your payment records to support the billing.
• Our accounts receivable department might see an amount due in your account when performing monthly jobs like balancing or aging accounts receivable or performing collections duties.
• If we were to change financial management software programs or needed to refer an account for collections, a business associate might have to read your account in order to deal with it effectively. Business associates sign agreements assuring confidentiality, as noted above.

Uses and disclosures we are permitted to make unless you object:

Unless you object, we may also use and disclose your protected health information in circumstances in which you are either not present or able to agree to the use or disclosure. For example, we may disclose to a member of your family, a relative, a close friend or any other person you identify, medical information that directly relates to the person’s involvement in your health care. If you are unable to object, we will use our professional judgment and only disclose relevant information that is in your best interest. We may also use or disclose your protected health information to help notify a family member, personal representative, or any other person responsible for your care, of your location and general condition. Finally, on rare occasions we may use or disclose your protected health information to authorities to assist in disaster relief.

Disclosures we are permitted to make without your authorization or opportunity to object:

We may use or disclose your protected health information in the following situations without your authorization. These situations include:

• Required By Law: Sometimes the law requires us to divulge your protected health information. For example, in medical malpractice cases or criminal cases where treatment might be related to injuries sustained during a crime the court might subpoena the medical records of patients involved. Another case like this is when we are required to divulge knowledge or suspicion of abuse, neglect, or domestic violence. Required uses or disclosures will be made in compliance with the law and will be limited to the relevant requirements of the law.
• Public Health: We may disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. These disclosures are made for the purpose of controlling disease, injury, or disability.
• Communicable Diseases: We may disclose your protected health information, as authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.
• Health Oversight: We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, inspections, and licensure or disciplinary actions. Oversight agencies seeking this information include government agencies that oversee the health care system and government benefit programs, such as Medicare and Medicaid.
• Food and Drug Administration: We may disclose your protected health information as required by the Food and Drug Administration to report adverse events and product defects or problems; to track products; to enable product recalls; to make repairs or replacements; or to conduct post marketing surveillance, as required.
• Legal Proceedings: We may disclose protected health information in the course of any judicial or administrative proceeding, in response to an order of a court (to the extent such disclosure is expressly authorized), and in certain conditions in response to a subpoena, discovery request or other lawful process.
• Law Enforcement: We may also disclose protected health information for law enforcement purposes when required by law. These disclosures include responding to requests for information pursuant to court orders and subpoenas; providing information in the event a crime occurs on the practice’s premises; and, providing limited information to identify or locate a suspect, fugitive, material witness, or missing person.
• Coroners, Medical Directors, Funeral Directors: As permitted or required by applicable laws, we may disclose protected health information to a coroner, medical examiner, or funeral director so that they may carry out their duties.
• Organ Donation: Consistent with applicable laws, your protected health information may also be disclosed to facilitate organ, eye, or tissue donation and transplantation.
• Research: We may disclose your protected health information to researchers when their research has been approved by an institutional review or privacy board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information.
• Threatening Activity: Consistent with applicable federal and state laws, we may disclose your protected health information, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.
• Military Activity and National Security: When the appropriate conditions apply, we may use or disclose protected health information of individuals who are Armed Forces personnel for activities deemed necessary by appropriate military command authorities. We may also disclose your protected health information to authorized federal officials for conducting national security and intelligence activities permitted by law.
• Workers’ Compensation: Your protected health information may be disclosed by us as authorized and to the extent necessary to comply with workers’ compensation laws.
• Inmates: If you are an inmate of a correctional institution, or under the custody of a law enforcement official, we may release protected health information about you to the institution or law enforcement official as may be necessary for your health, as well as for the health and safety of others.
• 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 privacy standards applicable to your protected health information.

Other uses and disclosures with your written authorization:

Other than the uses and disclosures of your protected health information described above, we will only make uses or disclosures with your written authorization. You may revoke such an authorization, at any time, in writing, except to the extent that your physician or the practice has already acted in reliance on the authorization you provided.

Your individual rights:

Even though the medical practice and not the patient own the medical record, you have the following rights with respect to your protected health information:

• You have a right to request a restriction of your protected health information. Your request must be in writing and must state the specific restriction requested and to whom you want the restriction to apply. While the law does not require us to abide by such restrictions, in most cases we pledge to do our best to do so. However, we are required to agree to your request when you ask us to refrain from sharing your information with a health plan for payment purposes or for a purpose related to the operation of our business, if the information pertains to a health care item or service that you have paid for out of pocket in full.
• You have a right to inspect and obtain a paper or electronic copy of your protected health information. We will do our best to honor your requests for access to your health information in a timely fashion. In some cases, we have a right to deny your request. If we deny a request, we will provide you with a written explanation for the denial and an opportunity to request a review of our decision. The decision will be reviewed by another licensed health care professional chosen by us. We will comply with the outcome of the review.
• You have a right to request that we communicate with you in a certain way or at a particular location. For example, you may request that we contact you at an alternative address, such as your work address, or you may request that we only contact you by mail. Any such request must be made by you in writing and must specify how or where you want to be contacted. We will accommodate reasonable requests.
• You have a right to request that we amend your protected health information if you believe the information is incomplete or incorrect. You must provide a reason why you want the change and must make this request in writing. If we feel it is appropriate to deny the request, we may do so in some circumstances. If your request is denied, you have a right to submit a statement of disagreement. We then have a right to prepare a rebuttal statement, a copy of which will be provided to you.
• You have a right to request an accounting of certain disclosures of your health information made by us. Your request must be submitted in writing and specify the period of time which may not be longer than six years and must not include dates before April 14, 2003.
• You have a right to receive notifications from us if the privacy or security of your protected health information is breached.

Our staff is trained to protect the privacy of your medical records and financial information. You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. Filing a complaint will not affect the care you receive nor will it result in any retaliation.

We are required by law to maintain the privacy of, and provide individuals with, this notice of our legal duties and privacy practices with respect to protected health information, and to follow the terms of this notice. We reserve the right to change the terms of this notice and to make the new provisions effective for all health information we maintain. If we change our notice, we will make a copy of the revised notice available to you. We are required to abide by the terms of our notice that is currently in effect.

Thank you for taking the time to read this and thank you, too, for selecting us as your health care provider. If you have any questions about this paper or any other aspect of your care here, please ask to speak with our HIPAA Compliance Officer in person or by phone at our Main Phone Number (502) 896-8700.

A Copy of the “HIPAA Notice of Privacy Practices” is available at the front desk.