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Effective Date:
April 14, 2003
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION
PLEASE REVIEW IT CAREFULLY WHO WILL FOLLOW THIS NOTICE:
This notice describes our privacy practices. We are affiliated with:
All these entities, sites, and locations follow the terms of this notice. In addition, these entities, sites, and locations may share health information with each other for treatment, payment, or healthcare operation purposes described in this notice. We also provide services at several other (outreach) sites. For a list of these sites, please contact our Security Officer. Depending on the business arrangements which HIPAA requires us to have with each outreach site, we will be abide by the privacy practices of Cardiologists, P.C. or the specific outreach site. OUR PLEDGE
REGARDING HEALTH INFORMATION:
HOW MAY WE USE AND
DISCLOSE HEALTH INFORMATION ABOUT YOU For Treatment:
We may use health information about you to provide you with, or coordinate
your health care, treatment, or services. We may disclose health
information about you to doctors, nurses, technicians, health students, or
other personnel whom we believe are involved in taking care of you. They
may work at our offices, at the hospital if you are hospitalized under our
supervision, at another doctor’s office, lab, pharmacy, or other health
care provider to whom we may refer you for consultation, to perform
diagnostic tests, to have prescriptions filled, or for other treatment
purposes. For example, a doctor treating you for a broken leg may need to
know if you have a heart condition because your heart condition may slow
the healing process, or the doctor may need to tell the dietitian at the
hospital if you have a heart condition so they can arrange for appropriate
meals. We may also disclose health information about you to an entity
assisting in a disaster relief effort so that your family can be notified
about your condition, status and location. For Payment: We may use and disclose health information about you so that the treatment and services you receive from us may be billed to and payment collected from you, an insurance company, and/or a third party. For example, we may need to give your health plan information about your office visit to your insurance company so your health plan will pay us or reimburse you for that visit. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment. We may leave a message on your answering machine or leave a message with someone else in the household to have you return our call. We may call you at work to discuss your account. We may share with a family member, relative, friend, or other person identified by you, PHI directly related to payment for your care. For Health Care Operations: We may use and disclose health information about you for operations of our health care practice. These uses and disclosures are necessary to run our practice and make sure that all of our patients receive quality care. For example, we may use health information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine health information about many patients to decide what additional services we should offer, what services are not needed, whether certain new treatments are effective, or to compare how we are doing with others and to see where we can make improvements. We may remove information that identifies you from this set of health information so others may use it to study health care delivery without identifying our patients specifically. Appointment Reminders: We may use and disclose health information to contact you as a reminder that you have any appointment. Appointment messages may be left on your answering machine, or with someone else at your household. Please let us know if you do not wish to have us contact you concerning your appointment, or if you wish to have us use a different address or telephone number to contact you for this purpose. Lab and Diagnostic Treatment: We may leave a message on your answering machine, or with someone else at your household, to return our call regarding your lab results (e.g. protime, cholesterol, or other routine lab work) and/or other diagnostic tests or treatments. We may share with a family member, relative, friend, or other person identified by you, PHI directly related to your care. Health related Services and Treatment Alternatives: We may use and disclose health information to tell you about health-related services or recommend possible treatment options or alternatives that may be of interest to you. Please let us know if you do not wish us to send you this information, or if you wish to have us use a different address to send this information to you. Research: Under certain circumstances, we may use and disclose health information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another, for the same condition. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of health information, trying to balance the research needs with patients’ need for privacy of their health information. Before we use or disclose health information for research, the project will have been approved through the research approval process; but we may disclose health information about you to people preparing to conduct a research project. For example, we may help potential researchers look for patients with specific health needs, so long as the health information they review does not leave our facility. We will almost always ask for your specific permission if the researcher will have access to your name, address, or other information that reveals who you are, or will be involved in your care. Organ and Tissue Donation: If you are an organ donor, we may release health information to organizations that handle organ donation and/or procurement including the heart or other organs as necessary, to facilitate organ or tissue donation and transplantation. As Required by Law: We will disclose health information about you when required to do so by federal, state, or local law. To Avert a Serious Threat to Health or Safety: We may use and disclose health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone, we believe, is able to help prevent the threat. Military and Veterans: If you are a member of the armed forces or separated/discharged from military services, we may release health information about you as required by military command authorities or the Department of Veterans Affairs as may be applicable. We may also release health information about foreign military personnel to the appropriate foreign military authorities. Workers Compensation: We may release health information about you for worker’s compensation or similar programs. These programs provide benefits for work-related injuries or illness. Public Health Risks: We may disclose health information about you for public health activities. These activities generally include the following:
Health Oversight Activities: We may disclose health information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws. Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, we may disclose health information about you in response to a court or administrative order. We may also disclose health information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested. Law Enforcement: We may release health information if asked to do so by a law enforcement official:
Coroners, Health Examiners, and Funeral Directors: We may release health information to a coroner or health examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release health information about patients to funeral directors as necessary to carry out their duties. Protected Health Information of a deceased person will be treated the same as that of a living person. National Security and Intelligence Activities: We may release health information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by the law. Protective Services for the President and Others: We may disclose health information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations. Inmates: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release health information about you to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to provide you with health care; (2) to protect you health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution. YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU: You have the following rights regarding health information we maintain about you: Right to Inspect and Copy: You have the right to inspect and copy health information that may be used to make decisions about your care. Usually, this includes health and billing records. To inspect and copy health information in our records which have been used to make decisions about your care, you must submit your request in writing to the Manager of Medical Records. If you request a copy of the information, we may charge a fee for the costs of copying, mailing, and other supplies and services associated with your request. We may deny your request to inspect and copy in certain, very limited, circumstances. If you are denied access to health information, you may request that the denial be reviewed. Another licensed health care professional chosen by our practice will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review. Right to Amend: If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as we keep the information. To request an amendment, your request must be made in writing, submitted to the Manager of Medical Records, and must be contained on one page of paper, legibly handwritten or typed in at least 10 point font size. In addition, you must provide a reason that supports your request for an amendment. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
Any amendment we make to your health information will be disclosed to those with whom we disclose information as previously specified. Right to an Accounting of Disclosures: You have the right to request a list accounting for any disclosures of your health information we have made, except for uses and disclosures for treatment, payment, and health care operations, as previously described. To request this list of disclosures, you must submit your request in writing to the Manager of Medical Records. Your request must state a time period which may not be longer than six years and may not include dates before April 14, 2003. The first list you request within a 12 month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred. We will mail you a list of disclosures in paper form within 30 days of your request, or notify you if we are unable to supply the list within that time period and by what date we can supply the list; but this date will not exceed a total of 60 days from the date you made the request. Right to Request Restrictions: You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment, or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care, such as a family member or friend. For example, you could ask that we not disclose information to your spouse about a surgery you had. We are not required to agree to, or abide by, your request for restrictions if it is not feasible for us to ensure our compliance or believe it will negatively impact the care we may provide you. If we do agree, and we can reasonably do so, we will comply with your request unless the information is needed to provide you emergency treatment. To request a restriction, you must make your request in writing to the Manager of Medical Records. In your request, you must tell us what information you want to limit and to whom you want the limits to apply. Right to Request Confidential Communications: You have the right to request that we communicate with you about health matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail to a post office box. To request confidential communications, you must make your request in writing to the Manager of Medical Records. We will not ask you the reason for the request. We will make every effort to accommodate all reasonable requests. Your request must specify how or where you wish to be contacted. Right to a Paper Copy of This Notice: You have the right to obtain a paper copy of the notice. To obtain a copy, please request it from Cardiologists, P.C.’s Medical Records Department. You may also obtain a copy of this notice from our website, www.cardiologistspc.com. Even if you have received a notice electronically, you still retain the right to receive a paper copy upon request.
CHANGES TO THIS NOTICE
COMPLAINTS
OTHER USES OF HEALTH INFORMATION
ACKNOWLEDGEMENT OF RECEIPT OF THIS NOTICE |
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