THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.  PLEASE REVIEW THIS NOTICE CAREFULLY.

The Health Insurance Portability and Accountability Act of 1996, otherwise known as HIPAA, has generated several sets of federal regulations applicable to health care practitioners. These regulations went into effect on April 14, 2003.

Your health record contains personal information about you and your health. This information about you that may identify you and that relates to your past, present or future health care or conditions related to health care services is referred to as Protected Health Information (“PHI”). This Notice of Privacy Practices describes how we may use and disclose your PHI in accordance with the applicable laws. It also describes your rights regarding how you may gain access to and control your PHI.

OUR USES AND DISCLOSURES

How do we typically use or share your health information?  We typically use or share your health information in the following ways:

Help manage the health care treatment you receive We can use your health information and share it with professionals who are treating you . Your health information may be used and disclosed by those who are involved in your care for the purpose of providing, coordinating, or managing your health care treatment and related services.

Bill for your services   We may use and share your health information to bill and get payment from health plans or other entities.  This will only be done with your authorization.

Run our organization We can use and share your health information to run our practice, improve your care when necessary.  We may use or disclose, as needed, your health information in order to support our business activities including, but not limited to, licensing, and conducting or arranging for other business activities.

How else can we use or share your health information? We are allowed or required to share your information in other ways–usually in ways that contribute to the public good, such as public health and research.  We have to meet many conditions in the law before we can share your information for these purposes.  For more information see: http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

Without Authorization

Child Abuse: Whenever we, in our professional capacity, have knowledge of or observe a child we know or reasonably suspect, has been the victim of child abuse or neglect, we must immediately report such to Child Protective Services or a police department or sheriff’s department, county probation department, or county welfare department.

Adult and Domestic Abuse: If we, in our professional capacity, have observed or have knowledge of an incident that reasonably appears to be physical abuse, abandonment, abduction, isolation, financial abuse or neglect of an elder or dependent adult, or if we are told by an elder or dependent adult that he or she has experienced these or if we reasonably suspect such, we must report the known or suspected abuse immediately to the local Adult Protective Services or the local law enforcement agency.

Serious Threat to Health or Safety: If you communicate to us of a serious threat of physical violence against an identifiable victim, we must make reasonable efforts to communicate that information to the potential victim and the police.  If we have reasonable cause to believe that you are in such a condition, as to be dangerous to yourself or others, we may release relevant information as necessary to prevent the threatened danger.

Comply with the law: Under the law, we must make disclosures of your PHI to you upon your request. In addition, we must make disclosures to the Secretary of the Department of Health and Human Services for the purpose of investigating or determining our compliance with the requirements of the Privacy Rule.

Address worker’s compensation: If you file a worker’s compensation claim, we must furnish a report to your employer, incorporating our findings about your injury and treatment as required by the administrative director of the Worker’s Compensation Commission in order to determine your eligibility for worker’s compensation.

Respond to a lawsuit or legal action: We can share health information about you in response to a court or administrative order or in response to a subpoena..

Law enforcement and other government requests:  We can use or share information about you for law enforcement purposes, with a law enforcement official, for special government functions such as military, national security and presidential protective services. 

With Authorization

We may use or disclose PHI for purposes outside of treatment, payment, and health care operations when your appropriate authorization is obtained. For example, we may also disclose your information to family members that are directly involved in your treatment only with your written permission.  In those instances when we are asked for information for purposes outside of treatment and payment operations, we will obtain an authorization from you before releasing this information. 

YOUR RIGHTS

Get a copy of your medical record. You can ask to see or get a copy of your medical record and other health information we have about you. Ask us how to do this. We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your medical record. You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this. We may refuse your request, but we’ll tell you why in writing within 60 days.

Request confidential communications. You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. We will agree to all reasonable requests.

Ask us to limit what we use or share. You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may not agree to it if it would affect your care.

Get a list of those with whom we’ve shared information. You can ask for a list (accounting) of the times we’ve shared your health information for 7 years prior to the date you ask, who we shared it with, and why.  

Get a copy of the full privacy notice. You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you. If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.

File a complaint if you believe your privacy rights have been violated. You can complain with us or the U.S. Department of Health and Human Services Office for Civil Rights.

Our Responsibilities  

We are required by law to maintain the privacy and security of your protected health information.

We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

We must follow the duties and privacy practices described in this notice and give you a copy of it.

We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

For more information please refer to the complete Notice of Privacy Practices provided to you at the time of admission.