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Privacy Policy

HIPAA NOTICE OF PRIVACY PRACTICES 

Effective Date: November 4, 2019 

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 to carry out treatment, payment or health care operations 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.  

We are required to abide by the terms of this Notice of Privacy Practices. We may change the terms of  our notice, at any time. The new notice will be effective for all protected health information that we  maintain at that time. We will provide you with any revised Notice of Privacy Practices. You may request  a revised version by accessing our website, or calling the office and requesting that a revised copy be  sent to you in the mail or asking for one at the time of your next appointment.  

1. Uses and Disclosures of Protected Health Information That May Be Made Without Your  Authorization or Opportunity to Agree or Object 

Your protected health information may be used and disclosed by your physician, our office staff and  others outside of our office who are involved in your care and treatment for the purpose of  providing health care services to you. Your protected health information may also be used and  disclosed to pay your health care bills and to support the operation of your health care provider. 

Following are examples of the types of uses and disclosures of your protected health information  that your health care provider is permitted to make.  

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 another provider. For example, we would disclose your protected health  information, as necessary, to a home health agency that provides care to you. We will also disclose  protected health information to other physicians who may be treating you. For example, your  protected health information may be  provided to a physician or other provider to whom you have been referred to ensure that the  provider has the necessary information to diagnose or treat you.  

Payment: Your protected health information may be used and disclosed to obtain payment for your  health care services provided by us or by another provider. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we  recommend for you such as making a determination of eligibility or coverage for insurance benefits,  reviewing services provided to you for medical necessity, and undertaking utilization review  activities.  

Health Care Operations: We may use or disclose your protected health information in order to  support the business activities of your health care provider. These activities include, but are not  limited to, quality assessment and compliance activities, employee review activities, training and  licensing.  

Business Associates. We will share your protected health information with third party “business  associates” that perform various activities (for example, billing or transcription services) for our  business. 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.  

Certain Marketing Activities. We may use or disclose your protected health information, as  necessary, to provide you with information about treatment alternatives or other health-related  benefits and services that may be of interest to you. You may contact our Privacy Officer to request  that these materials not be sent to you.  

Required By Law: We may use or disclose your protected health information to the extent that the  use or disclosure is required by law. The use or disclosure will be made in compliance with the law  and will be limited to the relevant requirements of the law.  

Public Health Authorities: 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. For example, a disclosure may be made to a public health authority for the purpose of  preventing or controlling disease or preventing or reporting child abuse or neglect. We may also  disclose your protected health information to a person or company required by the Food and Drug  Administration for the purpose of quality, safety, or effectiveness of FDA-regulated products or  activities including, to report adverse events, product defects or problems, biologic product  deviations, to track products; to  enable product recalls; to make repairs or replacements, or to conduct post marketing surveillance,  as required. 

Health Oversight Agencies: We may disclose protected health information to a health oversight  agency for activities authorized by law, such as audits, investigations, and inspections. Oversight  agencies seeking this information include government agencies that oversee the health care system,  government benefit programs, other government regulatory programs and civil rights laws.  

Victim of Abuse or Neglect: We may disclose your protected health information to a government  authority if we believe that you have been a victim of abuse, neglect or domestic violence. In this case, the disclosure will be made consistent with the requirements and limitations of applicable  federal and state laws.  

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 or administrative tribunal (to the  extent such disclosure is expressly authorized), or in certain conditions in response to a subpoena,  discovery request or other lawful process.  

Law Enforcement: We may also disclose protected health information, so long as applicable legal  requirements are met, for certain law enforcement purposes. These law enforcement purposes  include (1) legal processes and otherwise required by law, (2) limited information requests for  identification and location purposes, (3) pertaining to victims of a crime, (4) suspicion that death has  occurred as a result of criminal conduct, (5) in the event that a crime occurs on the premises of our  business, and (6) in the case of a medical emergency (not on our business’s premises) and it is likely  that a crime has occurred.  

Coroners, Funeral Directors, and Organ Donation: 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. We may also disclose  protected health information to a funeral director, as authorized by law, in order to permit the  funeral director to carry out their duties. We may disclose such information in reasonable  anticipation of death. Protected health information may be used and disclosed for cadaveric organ,  eye or tissue donation purposes.  

Research: We may disclose your protected health information to researchers in certain  circumstances. For example, we may disclose such information when the research has been  approved by an institutional review board that has reviewed the research proposal and established  protocols to ensure the privacy of your protected health information.  

Avert Imminent Threat to Health or Safety: 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 (1) for  activities deemed necessary by appropriate military command authorities; (2) for the purpose of a  determination by the Department of Veterans Affairs of your eligibility for benefits, or (3) to foreign  military authority if you are a member of that foreign military services. We may also disclose your  protected health information to authorized federal officials for conducting national security and  intelligence activities, including for the provision of protective services to the President or others  legally authorized. 

Workers’ Compensation: We may disclose your protected health information as authorized to  comply with workers’ compensation laws and other similar legally-established programs.  

Inmates: We may use or disclose your protected health information if you are a lawful inmate of a  correctional facility or other custodial institution in certain circumstances. For example, we may use  or disclose such information if the institution or facility represents that such information is  necessary for your care, or for the health or safety of you, other inmates, or facility staff.  

2. Other Permitted and Required Uses and Disclosures That Require Providing You the Opportunity to Agree or Object:

We may use and disclose your protected health information in the following  instances. You have the opportunity to agree or object to the use or disclosure of all or part of  your protected health information. If you are not present or able to agree or object to the use or  disclosure of the protected health information, then your provider may, using professional  judgment, determine whether the disclosure is in your best interest.  

Others Involved in Your Health Care or Payment for your Care: 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 our professional judgment. We may use or  disclose 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. Finally, 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.  

3. Uses and Disclosures of Protected Health Information Requiring 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 as described below. This  includes but is not limited to any use or disclosure of your psychotherapy notes (as defined by  HIPAA), as well as the use of your protected health information for marketing activities that  require patient authorization under HIPAA and/or applicable state law. You may revoke any  such authorization in writing at any time. If you revoke your authorization, we will no longer use  or disclose your protected health information for the reasons covered by your written  authorization, but please understand that we are unable to take back any disclosures already  made with your authorization.  

4. Your Rights  

Following is a statement of your rights with respect to your protected health information and a brief  description of how you may exercise these rights. 

You have the right to inspect and copy your protected health information. This means you may  inspect and obtain a copy of protected health information about you for so long as we maintain the  protected health information. You may obtain your medical record that contains medical and billing  records and any other records that your physician and the practice uses for making decisions about  you. As permitted by federal or state law, we may charge you a reasonable copy fee for a copy of  your records.  

Under federal law, however, you may not 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 laboratory results that are subject to law that prohibits  access to protected health information. Depending on the circumstances, a decision to deny access  may be reviewable. In some circumstances, you may have a right to have this decision reviewed.  Please contact our Privacy Officer if you have questions about access to your medical record.  

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 health care 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. We are not required to agree to a restriction that you may request, except for restriction  requests pertaining to disclosures to health plans for payment or health care operations purposes  for items or services paid for in full by you.  

You have the right to request to receive confidential communications from us by alternative means  or at an alternative location. We will accommodate reasonable requests. We may also condition this  accommodation by asking you for information as to how payment will be handled or specification of  an alternative address or other method of contact. We will not request an explanation from you as  to the basis for the request. Please make this request in writing to our Privacy Officer.  

You may have the right to request that your provider amend your protected health information  maintained in a designated record set. 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. Please contact our Privacy Officer if you have questions about amending  your medical record.  

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 health care operations, and other permissible uses or disclosures exempted from such  accountings by applicable laws and regulations.  

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 electronically. 

5. Complaints  

You may complain to us or to the Secretary of the U.S. Department of Health and Human Services if  you believe your privacy rights have been violated by us. More information about this complaint  process is available at https://www.hhs.gov/hipaa/filing-a-complaint/complaint-process/index.html.  You may also file a complaint with us by notifying our Privacy Officer of your complaint. You can  reach our Privacy Officer by calling our office at 720-674-0143. We will not retaliate against you for  filing a complaint.

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