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Notice of Privacy Practices
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.
Our office respects your privacy. We understand that your personal
health information (PHI) is very sensitive. We will not disclose your
information to others unless you tell us to do so, or unless the law
authorizes or requires us to do so.
The law protects the privacy of the health information we create and
obtain in providing our care and services to you. For example, your
protected health information includes your symptoms, test results,
diagnoses, treatment, health information from other providers, and billing
and payment information relating to these services. Federal and state law
allows us to use and disclose your protected health information for
purposes of treatment and health care operations. State law requires us to
get your authorization to disclose this information for payment purposes.
Examples of Use and Disclosures of Protected Health Information for
Treatment, Payment, and Health Operations
For treatment:
- Information obtained by a nurse, physician, or other member of our
health care team will be recorded in your medical record and used to
help decide what care may be right for you.
- We may also provide information to others providing you care. This
will help them stay informed about your care.
For payment:
- We request payment from your health insurance plan. Health plans
need information from us about your medical care. Information provided
to health plans may include your diagnoses; procedures performed, or
recommended care.
For health care operations:
- We use your medical records to assess quality and improve services.
- We may use and disclose medical records to review the qualifications
and performance of our health care providers and to train our staff.
- We may contact you to remind you about appointments and give you
information about treatment alternatives or other health-related
benefits and services.
- We may use and disclose your medical records for reporting of ART
statistics to the CDC.
- We may use and disclose your information to conduct or arrange for
services, including:
- medical quality review by your health plan;
- accounting, legal, risk management, and insurance services;
- audit functions, including fraud and abuse detection and
compliance programs.
Your Health Information Rights
The health and billing records we create and store are the property of
the practice/health care facility. The protected health information in it,
however, generally belongs to you. You have a right to:
- Receive, read, and ask questions about this Notice;
- Ask us to restrict certain uses and disclosures. You must deliver
this request in writing to us. We are not required to grant the request.
But we will comply with any request granted;
- Request and receive from us a paper copy of the most current Notice
of Privacy Practices for Protected Health Information (“Notice”);
- Request that you be allowed to see and get a copy of your protected
health information. You may make this request in writing. We have a form
available for this type of request.
- Have us review a denial of access to your health information—except
in certain circumstances;
- Ask us to change your health information. You may give us this
request in writing. You may write a statement of disagreement if your
request is denied. It will be stored in your medical record, and
included with any release of your records.
- When you request, we will give you a list of disclosures of your
health information. The list will not include disclosures to third-party
payors. You may receive this information without charge once every 12
months. We will notify you of the cost involved if you request this
information more than once in 12 months.
- Ask that your health information be given to you by another means or
at another location. Please sign, date, and give us your request in
writing.
- Cancel prior authorizations to use or disclose health information by
giving us a written revocation. Your revocation does not affect
information that has already been released. It also does not affect any
action taken before we have it. Sometimes, you cannot cancel an
authorization if its purpose was to obtain insurance.
For help with these rights during normal business hours, please
contact: Our Privacy Officer.
Our Responsibilities
We are required to:
- Keep your protected health information private;
- Give you this Notice;
- Follow the terms of this Notice.
We have the right to change our practices regarding the protected
health information we maintain. If we make changes, we will update this
Notice. You may receive the most recent copy of this Notice by calling and
asking for it or by visiting our office/medical records department to pick
one up.
To Ask for Help or Complain
If you have questions, want more information, or want to report a
problem about the handling of your protected health information, you may
contact:
ORH Privacy Officer.
If you believe your privacy rights have been violated, you may discuss
your concerns with any staff member. You may also deliver a written
complaint to ORH Privacy Officer at our practice/health care facility. You
may also file a complaint with the U.S. Secretary of Health and Human
Services.
We respect your right to file a complaint with us or with the U.S.
Secretary of Health and Human Services. If you complain, we will not
retaliate against you.
Other Disclosures and Uses of Protected Health Information
Notification of Family and Others
- Unless you object, in writing, we may release health information
about you to a friend or family member who is involved in your medical
care. We may also give information to someone who helps pay for your
care. We may tell your family or friends your condition and that you
are in a hospital. In addition, we may disclose health information
about you to assist in disaster relief efforts.
- Hospitals] Information may be provided to people who ask for you
by name. We may use and disclose the following information in a
hospital directory:
- your name,
- location,
- general condition, and
- religion (only to clergy).
You have the right to object to this use or disclosure of your
information. If you object, we will not use or disclose it.
We may use and disclose your protected health information without
your authorization as follows:
- With Medical Researchers -- if the research has been approved
and has policies to protect the privacy of your health information. We
may also share information with medical researchers preparing to conduct
a research project.
- To Funeral Directors/Coroners consistent with applicable law
to allow them to carry out their duties.
- To Organ Procurement Organizations (tissue donation and
transplant) or persons who obtain, store, or transplant organs.
- To the Food and Drug Administration (FDA) relating to
problems with food, supplements, and products.
- To Comply With Workers’ Compensation Laws -- if you make a
workers’ compensation claim.
- For Public Health and Safety Purposes as Allowed or Required by
Law:
- to prevent or reduce a serious, immediate threat to the health
or safety of a person
or the public.
- to public health or legal authorities
- to protect public health and safety
- to prevent or control disease, injury, or disability
- to report vital statistics such as births or deaths.
- To Report Suspected Abuse or Neglect to public authorities.
- To Correctional Institutions if you are in jail or prison, as
necessary for your health and the health and safety of others.
- For Law Enforcement Purposes such as when we receive a
subpoena, court order, or other legal process, or you are the victim of
a crime.
- For Health and Safety Oversight Activities. For example, we
may share health information with the Department of Health.
- For Disaster Relief Purposes. For example, we may share
health information with disaster relief agencies to assist in
notification of your condition to family or others.
- For Work-Related Conditions That Could Affect Employee Health.
For example, an employer may ask us to assess health risks on a job
site.
- To the Military Authorities of U.S. and Foreign Military
Personnel. For example, the law may require us to provide
information necessary to a military mission.
- In the Course of Judicial/Administrative Proceedings at your
request, or as directed by a subpoena or court order.
- For Specialized Government Functions. For example, we may
share information for national security purposes.
Other Uses and Disclosures of Protected Health Information
- Uses and disclosures not in this Notice will be made only as allowed
or required by law or with your written authorization.
Effective Date: April 14, 2003
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