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Notice of Privacy Policies
PURPOSE:
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.
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This notice takes effect on April 1, 2003 and shall remain in effect until we replace it.
1. Our Pledge Regarding Medical Information
The privacy of your medical information is important to us. We understand that your medical information is personal, and we are committed to protecting it. We create a record of the care and services you receive at our organization. We need this record in order to provide you with quality care and to comply with certain legal requirements. This notice will tell you about the ways we may use and share medical information about you. We also describe your rights and certain duties we have regarding the use and disclosure of medical information.
Law Requires Us to:
1.Keep your medical information private.
2.Give you notice describing our legal duties, privacy practices and your rights regarding your medical information.
3.Follow the terms of the notice that is now in effect.
We Have the Right to:
1.Change our privacy practices and terms of this notice at any time, provided that the changes are permitted by law.
2. Make the changes in our privacy practices, and the new terms of our notice effective for all medical information that we keep, including information previously created or received before the changes.
3. Use And Disclosure of Your Medical Information
Privacy Practices:
1.Before we make an important change in our privacy practices, we will change this notice and make the new notice available upon request.
The following section describes different ways that we use and disclose medical information. For each kind of use or disclosure, we will explain what we mean and give an example. Not every use or disclosure will be listed; however, we have listed all of the different ways we are permitted to use and disclose medical information.
FOR TREATMENT:
We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students, or other people who are taking care of you.
Example: You are in the hospital with a broken leg. You also have diabetes. A number of health care and support staff need to know about your diabetes during your stay:
• The doctor treating you for the broken leg needs to know if you have diabetes, because the diabetes may slow the healing process.
• The dietitian needs to know about your diabetes to arrange proper meals.
• The pharmacy needs to know about possible medicines that you may need as a diabetic.
• The information about your diabetes may help in diagnostics, testing and X-ray work. We may
also share your medical information about you to your other health care providers to assist them in treating you.
FOR PAYMENT:
We may use and disclose your medical information for payment purposes.
Example: You are treated in the hospital for a broken leg.
• We may need to give your health insurance plan information about surgery you received at our organization so that your health plan will pay us or repay you for any surgery that you paid for.
• We may also tell your health plan about a treatment you are going to receive to get approval or to determine if your plan will pay for the treatment.
FOR HEALTH CARE OPERATIONS:
We may use and disclose your medical information for our health care operations. This might include measuring and improving quality, evaluating the performance of our employees, conducting training programs and getting the accreditation, certificates, licenses and credentials we need in order to serve you.
ADDITIONAL USES AND DISCLOSURES:
In addition to using and disclosing your medical information for treatment, payment, and health care operations, we may use and disclose medical information for the following purposes.
Notification
Medical information to notify or help notify:
• A family member.
• Your personal representative.
• Another person responsible for your care.
We will share information about your location, general condition, or death. If you are present, we will get your permission, if possible, before we share; or, give you opportunity to refuse permission. In case of emergency, and if you are unable to give or refuse permission, we will share only the health information that is directly necessary for your health care, according to our professional judgment. We will also use our professional judgment to make decisions in your best interest about allowing someone to pick up medicine, medical supplies, X-ray or medical information for you.
Disaster Relief: Medical information with a public or private organization or person who can legally assist in disaster relief efforts.
Research in Limited Circumstances: Medical information for research purposes in limited circumstances where the research has been approved by a review board that has reviewed the research proposal and established protocols to ensure the privacy of medical information.
Funeral Director, Coroner, Medical Examiner: To help them carry out their duties, we may share information of a person who has died with a coroner, medical examiner, funeral director or an organ procurement organization.
Specialized Government Functions: Subject to certain requirements, we may disclose or use information for military personnel and veterans for national security and intelligence activities, for protective services for the President and others, for medical suitability determinations for the Department of State, for correctional institutions and other law enforcement custodial situations, and for government programs providing public benefits.
Court Orders and Judicial and Administrative Proceedings: We may disclose medical information in response to a court or administrative order, subpoena, discovery request, or other lawful process, under certain circumstances. Under limited circumstances, such as a court order, warrant, or grand jury subpoena, we may share your medical information with law enforcement officials. We may share limited information with a law enforcement official concerning the medical information of a suspect, fugitive, material witness, crime victim or missing person. We may share the medical information of an inmate, or other person in lawful custody with a law enforcement official or correctional institution under certain circumstances.
Public Health Activities: As required by law, we may disclose your medical information to public health or legal authorities charged with preventing or controlling disease, injury, or disability. This includes child abuse or neglect. We may also disclose your medical information to persons subject to jurisdiction of the Food and Drug Administration for purposes of reporting adverse events associated with products defects or problems, to enable product recalls, repairs or replacements, to track products, or to conduct activities required by the Food and Drug Administration. We may also, when we are authorized by law to do so, notify a person who may have been exposed to a communicable disease or otherwise be at risk of contracting or spreading a disease or condition.
Victims of Abuse, Neglect, or Domestic Violence: We may disclose medical information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes. We may share your medical information if it is necessary to prevent a serious threat to your health or safety or the health of safety of others. We may share medical information when necessary to help law enforcement official capture a person who has admitted to being part of a crime or has escaped from legal custody.
Workers Compensation: We may disclose health information when authorized and necessary to comply with laws relating to workers compensation or other similar programs.
Health Oversight Activities: We may disclose medical information to an agency providing health oversight activities authorized by law, including audits, civil, administrative, or criminal investigations or proceedings, inspections, licensure, or disciplinary actions or other authorized activities.
Law Enforcement: Under certain circumstances, we may disclose health information to law enforcement officials. These circumstances include: reporting required by certain laws ( such as the reporting of certain types of wounds), pursuant to certain subpoenas or court orders, reporting limited information concerning the identification and location at the request of a law enforcement official, reports regarding suspected victims of crimes at the request of a law enforcement official, reporting death, crimes on our premises, and crimes in emergencies.
If you request copies, we will charge you $1.50 for each page and postage if you want the copies mailed to you. Contact us using the information listed at the end of this notice for a full explanation of our fee structure.
4. YOUR INDIVIDUAL RIGHTS
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You Have A Right to:
1. Look at or get copies of your medical information. You must make your request in writing. You may get the form to request access by using the contact information listed at the end of this notice. You may also request access by sending a letter to the contact person listed at the end of this notice.
2. Request that we place additional restrictions on our use or disclosure of your medical information. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement ( except in case of emergency.)
3. Request that we communicate with you about your medical information by different means or to different locations. Your request that we communicate your medical information to you by different means or at different locations must be made in writing to the contact person listed at the end of this notice.
4. Request that we change your medical information. We may deny your request if we did not create the information you want changed or for certain other reasons. If we deny your request, we will provide you with a written explanation. You may respond with a statement of disagreement that will be added to the information you wanted changed. If we accept your request to change the information, we will make reasonable efforts to tell others, including people you name, of the change and to include the changes in any future sharing of that information.
If you have questions or concerns regarding this privacy policy, please feel free to contact our Practice Administrator, at 505-872-4700.
If you think that we may have violated your privacy rights, contact the person named above. You may also submit a written complaint to the U.S. Department of Health and Human Services. We will provide you with the address to file your complaint with the U.S. Department of Health and Human Services. We will not retaliate in any way if you choose to file a complaint. |
