This notice describes how medical information associated with this medical practice about you may be used and disclosed and how you can get access to this information.
We are required by law to maintain the privacy of your protected health information and to provide you with this Notice of our legal duties and privacy practices with respect to protected health information.
Uses and disclosures of protected health information for treatment, payment and health care operations
We will use your protected health information as part of rendering patient care, including treatment, payment and health care operations. The following are some, but not all, examples of the types of uses and disclosures that may be made by us:
- Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services.
- Payment: Your protected health information will be used, as needed, to obtain payment for your health care services.
- Healthcare Operations: We may use or disclose, as needed, your protected health information in order to support the business activities of your physician’s practice. We will share your protected health information with third party “business associates” that perform various activities (e.g., billing, transcription services) for the practice. Whenever an arrangement between our office and a business associate involves the use or disclosure of your protected health information, we will have a written contract that contains terms that will protect the privacy of your protected health information. Health information will be made only with your written authorization, unless otherwise permitted or required by law as described below. You may revoke an 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.
Permitted uses and disclosures of protected health information that may require an objection
We may use or disclose your protected health information in the following situations unless you object to the use and/or disclosure. These situations include:
- Limited use or disclosure when you are not present: If you are not present or able to agree or object to the use or disclosure of the protected health information because of incapacity or emergency circumstances, then your physician may, using professional judgment, determine whether the disclosure is in your best interest.
- Family, friends and telephone contacts: Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your protected health information that directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on your physician’s professional judgment. In addition, unless you object, we may leave appointment reminders, lab results and other messages with whoever answers at the telephone number that you designate for such purpose.
- Notification: Unless you object, we may use or disclose your protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death.
- Disaster relief: Unless you object, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.
Other permitted and required uses and disclosures that may be made without your authorization or opportunity to object
We may use or disclose your protected health information in the following situations without your authorization or opportunity to agree or object. These situations include:
- Emergencies: We may use or disclose your protected health information in an emergency treatment situation if, in your physician’s professional judgment, the use or disclosure is in your best interest. If so, we will disclose only the protected health information that is directly relevant to the person’s involvement with your health care.
- Required By Law: We may use or disclose your protected health information to the extent that the law requires such use or disclosure. You will be notified, if required by law, of any such uses or disclosures.
- Public Health: We may use or 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.
- Abuse or Neglect: We may disclose your protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect We may disclose your protected health information if we believe that you have been a victim of abuse, neglect or domestic violence to the governmental entity or agency authorized to receive such information.
- Food and Drug Administration: We may disclose your protected health information to comply with requirements or at the direction of the Food and Drug Administration.
- Legal Proceedings: We may disclose protected health information in the course of any judicial or administrative proceeding (to the extent such disclosure is expressly authorized).
- Law Enforcement: We may also disclose protected health information, so long as applicable legal requirements are met, for law enforcement purposes.
- Coroners and medical examiners: We may disclose protected health information to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law.
- Organ, eye or tissue donation: Protected health information may be used and disclosed to organ procurement organizations.
- Research: We may disclose your protected health information to researchers when their research has been approved by an institutional review board or privacy board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information.
- Military activity: 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;
- for separation or discharge from military service;
- for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits; or
- to foreign military authority if you are a member of that foreign military services.
- Workers’ Compensation: We may disclose your protected health information as authorized to comply with workers’ compensation laws.
- Communicable Diseases: We may disclose your protected health information, according to state 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.
You have the right to inspect and copy your protected health information. You may inspect and obtain a copy of protected health information about you that is contained in a “designated record set” for as long as we maintain the protected health information. A “designated record set” contains medical and billing records and any other records about you that your physician and the practice uses for making decisions about you. You will be charged a reasonable fee for any copies of your records as allowed under state law.
You have the right to amend protected health information. You may request an amendment, in writing, of protected health information about you in a designated record set for as long as we maintain this information. In certain cases, we may deny your request for an amendment. 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. This right applies to disclosures for purposes other than treatment, payment or healthcare operations.
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.
You may contact our Privacy Officer, M. Michelle Hart, at 913.696.1154 or at email@example.com for further information about the complaint process.
This notice was published and becomes effective on April 14, 2003.