This Privacy Policy applies to the services our office provides to you. By law, we must safeguard the privacy of protected health information and give you this Policy describing our legal duties and privacy practices concerning such information. “Protected health information” means details about you (including demographic data) that can identify you and that relate to your past, present, or future physical or mental health or condition, as well as related health care services.
This Policy explains how we may use and disclose your protected health information for treatment, payment, and health care operations. Any other use or disclosure will occur only with your written authorization (unless otherwise allowed or required by law). The Policy also outlines your rights to access and control your protected health information and tells you how to file a complaint—either with our office or with the Secretary of Health and Human Services—if you believe your rights have been violated.
We are obligated to follow this Policy. We may change it at any time. Any revised notice will apply to all protected health information we maintain at the time of the change. We can provide a revised Policy upon request. You may contact our office in either of two ways: call our Office Manager to request a mailed copy, or ask for one at your next appointment.
Please read this Policy carefully.
NOTICE OF PRIVACY PRACTICES
This Notice explains how medical information about you may be used and disclosed, and how you can access this information. Please review it carefully.
If you have questions about this Notice, please contact the OFFICE MANAGER.
We are required by law to maintain the privacy of our patients’ health information and to provide you with this Notice of our legal duties and privacy practices regarding protected health information. Protected health information includes information about you—demographic details included—that may identify you and that relates to your past, present, or future physical or mental health or condition and related health care services.
1 USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
Uses and Disclosures of Protected Health Information for Treatment, Payment, or Operations
Your protected health information may be used by your doctor for treatment, payment, and health care operations as described here without your authorization. It may also be used and disclosed by your doctor, office staff, and others outside our office involved in your care and treatment to provide health care services to you and to obtain payment for your health care bills, which supports the operation of the doctor’s practice.
Below are examples of how your protected health information may be used by your doctor and office staff without your specific authorization. These examples are illustrative, not exhaustive, and simply show the kinds of uses and disclosures our office may make.
Treatment: Your protected health information may be used and disclosed to provide, coordinate, or manage your care and related services, including services from another doctor, consultations with another doctor, or coordinating your care with a third party.
Payment: Your information may be used, as needed, to obtain or provide payment for your medical services. This includes disclosures to other entities—for example, when your health plan conducts activities (such as determining eligibility or coverage, reviewing services provided, or performing utilization review) before approving or paying for services recommended to you.
Operations: Your protected health information may be used or disclosed, as needed, to support the business activities of your doctor’s practice. These activities include—but are not limited to—quality assessment and improvement; reviewing professional competence or qualifications; business planning and development; and conducting or arranging other business functions.
As part of our operations, we may use a sign-in sheet at the registration desk where you will sign your name and indicate your treating provider. We may call you by name in the waiting room and may use or disclose your protected health information, as needed, to remind you of appointments.
Whenever your protected health information is used or disclosed in an arrangement with a business associate, we will have a written contract in place that requires the associate to protect your information.
We may use or disclose your protected health information, as necessary, to provide you with information about a product or service to encourage you to purchase or use it. This is done only for a few specific, limited purposes.
Your protected health information may also be disclosed to another provider, health plan, or health care clearinghouse for certain operational purposes, provided that entity has, or has had, a relationship with you.
Uses and Disclosures of Protected Health Information Based upon Your Written Authorization
Other uses and disclosures of your protected health information will be made only with your written authorization unless otherwise permitted or required by law. You may revoke an authorization at any time in writing, except to the extent your doctor or the practice has already acted in reliance on it.
2 YOUR RIGHTS
Below is a summary of your rights concerning your protected health information and how you may exercise them.
Inspect and copy: You may review and obtain a copy of your protected health information in your chart, including medical and billing records, and any other records your doctor and the practice use to make decisions about your treatment.
You may not inspect or copy information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding. Depending on circumstances, a denial of access may be reviewable. Please contact our Office Manager with any questions about your access to your medical record.
Request restrictions: You may ask us not to use or disclose any part of your protected health information for treatment, payment, or health care operations. You may also request that we not disclose your protected health information to family members or friends involved in your care. Your request must specify the restriction and to whom it applies.
Your doctor is not required to agree to a requested restriction but may permit use and disclosure of your protected health information if he or she believes it is in your best interest. If your doctor agrees to a restriction, we will not use or disclose your information except as needed to provide emergency treatment. If you wish to place a restriction on your protected health information, speak with the Office Manager.
Confidential communications: You may request that we communicate with you by alternative means or at an alternative location; we will accommodate reasonable requests. We will not ask for your reasons, but we may require information about payment arrangements or an alternate address or other method of contact. Please submit this request in writing to our Office Manager.
Amendments: You may have the right to ask your provider to amend your protected health information, though we reserve the right to deny the request. This may include asking to amend protected health information about you in a designated record set for as long as we maintain that information. If we deny your request, you may submit a statement of disagreement. We may prepare a rebuttal and will provide you a copy of any rebuttal.
Accounting of disclosures: You may request an accounting of certain disclosures, if any, that we have made of your protected health information. This applies to disclosures other than for treatment, payment, or health care operations as described in this Policy, and excludes disclosures made to you, for a facility directory, to family or friends involved in your care, for notification purposes, or pursuant to your authorization. This right is subject to certain exceptions, restrictions, and limits.
3 COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with us by notifying our Office Manager or with the Secretary of Health and Human Services. We will not retaliate against you for filing a complaint.
For further details about the complaint process, contact the Office Manager.
This Policy was published and became effective on March 21, 2019.