NOTICE OF PRIVACY PRACTICES
This information is made available to all patients
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU MAY HAVE ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
THIS NOTICE APPLIES TO ALL OF THE RECORDS OF YOUR CARE GENERATED BY THE PRACTICE, WHETHER MADE BY THE PRACTICE OR AN ASSOCIATED FACILITY.
This notice describes our practice’s policies, which extend to:
Any health care professional authorized to enter information into your chart (including physicians, assistants, nurses, etc.);
All areas of the practice (front desk, administration, billing and collection, etc.);
All employees, staff and other personnel who work for or with our practice;
Our business associates (including a billing service, or facilities to which we refer patients), on-call physicians, and so on.
Queen City Ear Nose and Throat, PLLC provides this Notice to comply with the Privacy Regulations issued by the Department of Health and Human Services in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
OUR THOUGHTS ABOUT YOUR PROTECTED HEALTH INFORMATION:
We understand your medical information is private and personal to you, and we are committed to protecting that information. We create paper and electronic medical records about your health, our diagnosis and care for you, and the services and/or items we provide to you. We need this record to continue to provide for your care and comply with certain legal requirements, as stated in various sections of the HIPAA Regulatory Act.
By law we are required to:
-make sure that the protected health information about you is kept private;
-provide you with Notice of our Privacy Practices and your legal rights with respect to protected health information about you; and
-follow the conditions of the Notice that is currently in effect.
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
The following categories describe different ways we use and disclose your protected health information we maintain and share with others. Below provides examples of some possible uses of your information. Not every use or disclosure in a category below is listed or actually in use for our offices. The following explanation is provided for your general information only.
Medical Treatment. We use previously given medical information about you to provide you with current or suggested medical treatment or services. We may disclose medical information about you to doctors, nurses, medical assistants, technicians, medical students, interns or hospital personnel who are involved in taking care of you. Example: if a doctor to whom we refer you for ongoing or further care may need your medical record. Different areas of the Practice also may share medical information about you and the information maintained on your record(s), prescriptions, requests of lab work and x-rays. We may discuss your medical information with you to recommend possible treatment options or alternatives. We also may disclose medical information about you to people outside the Practice who may be involved in your medical care should you choose to leave the Practice; including your designated family members, or medical offices whom we refer you to, providing addition or alternative services which could be part of your care. Unless clearly instructed to the contrary, we may release medical information about you to a friend or family member who you have designated, about your medical care. We may also give information to someone who helps to pay or pays for your care.
Payment. We may use and disclose medical information about you for services and procedures so they may be billed and collected from you, an insurance company, or any other third party. Example: we may need to give your health care information, about treatment you received at our Practice, to obtain payment or reimbursement for the care we provided. We may also tell your health insurance plan and/or referring physician about a treatment you are planning to receive to obtain prior approval or to determine whether your plan will cover the treatment, to facilitate payment of a referring physician, or the like.
Operational Uses. We may disclose medical information about you so we can run our Practice more efficiently and make sure all Queen City Ear Nose and Throat patients receive quality care. These uses may include reviewing our treatment plans, suggestions and or services to evaluate the performance of our staff, deciding what additional services to offer and where, and whether certain treatments are effective. We may also disclose information to doctors, nurses, medical assistants, technicians, medical students, interns, and other personnel for review and learning purposes. We may also combine the medical information we have with medical information from other Practices to compare how we are doing and see where we can make improvements in the care and services we offer to our patients. We will make every reasonable effort to remove information that identifies you from this set of medical information, so others may use it to study health care and health care delivery without learning who the specific patients are.
We may also use or disclose information about you for internal or external utilization review and/or quality assurance, to business associates for purposes of helping us to comply with our legal requirements, to auditors to verify our records, to billing companies to aid us in this process and or other entities who have proven careful regulatory handling of your information for improving the way this information is handled and maintained. We shall endeavor, in all times when business associates are used, to advise them of their continued obligation to maintain the privacy of your medical records. We will also ensure we maintain agreement with these business associates to protect your information.
Appointment and Patient Recall Reminders. We may use and disclose medical information to contact you as a reminder that you have an appointment for medical care with the Practice or due to receive recurrent care from the Practice. This contact may be by phone, in writing, e-mail, text messages, or otherwise and may involve the leaving an e-mail, a message on an answering machines, or otherwise which could (potentially) be picked up by others depending on how you maintain access and security considerations to these message destination locations.
Others Involved in Your Care. In addition, we may disclose medical information about you to a group or person assisting in a disaster relief effort so your family can be notified about your condition, status and location.
Research. Under certain circumstances, we may use and disclose medical information about you for research purposes regarding medications, efficiency of treatment protocols and the like. All research projects are subject to an approval process, which evaluates a proposed research project and its use of medical information. Before we use or disclose medical information for research, the project will have been approved through this research approval process, but we may, however, disclose medical information about you to people preparing to conduct a research project. Example: to help them look for patients with specific medical needs, so long as the medical information they review does not leave the Practice. We will attempt to make the information non-identifiable to a specific patient, but instead place only demographical information for you such as your age, gender, treatment outcome. We cannot guarantee we can always do this, but we will make every reasonable effort to protect and secure your information whenever such information sharing is requested. We will endeavor to (but cannot guarantee we will) seek 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 with the Practice; provided, however that we will obtain your specific authorization if required by law.
Required By Law. We will disclose medical information about you when required to do so by federal, state or local law.
Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. This is particularly true if you make your health an issue. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in a dispute. In these cases we shall attempt to tell you about such request so you may obtain an order protecting the information requested if you desire. We may also use this information to defend ourselves or any member of our practice in any actual or threatened action.
Law Enforcement. We may release medical information if asked to do so by a law enforcement official:
In response to a court order, subpoena, warrant, summons or similar process;
To identify or locate a suspect, fugitive, material witness, or missing person;
About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement;
About a death we believe may be the result of criminal conduct;
About criminal conduct at the Practice; and
In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.
To Avert a Serious Threat to Health or Safety. We may use and disclose medical information about you when necessary to prevent a serious threat either to your health and safety or the health and safety of the public or another person. Any such disclosure, however, would only be to someone able to help prevent these types of threats.
Organ and Tissue Donation. If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
Public Health Risks. Law or public policy may require us to disclose medical information about you for public health activities. These activities generally include the following:
to prevent or control the spread of disease, injury or disability;
to report births and deaths;
to report child abuse or neglect;
to report negative reactions to medications or problems with products;
to notify people of recalls of products they may be using;
to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
to notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.
Investigation and Government Activities. We may disclose medical information to a local, state or federal agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the payor, the government and other regulatory agencies to monitor the health care system, government programs, and compliance with civil rights laws.
Coroners, Medical Examiners and Funeral Directors. We may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients of the Practice to funeral directors as necessary to carry out their duties.
Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical 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 your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
CHANGES TO THIS NOTICE
We reserve the right to change this notice at any time. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we may receive from you in the future. We will post a copy of the current notice in the Practice. The notice will contain on the first page, the date of last revision and effective date. In addition, each time you visit the Practice for treatment or health care services you may request a copy of the current notice in effect.
COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with the Practice or with the Secretary of the Department of Health and Human Services. To file a complaint with the Practice, contact our office manager, who will direct you on how to file an office complaint. All complaints must be submitted in writing, and all complaints shall be investigated, without repercussion to you.
You will not be penalized for filing a complaint.
OTHER USES OF MEDICAL INFORMATION.
Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission, unless those uses can be reasonably inferred from the intended uses above. If you have provided us with your permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you. You also understand if you deliver to the Practice a revocation of permission to release your medical information, we may be unable to properly treat you effectively and have the right to deny your visit due to certain limitations you may state in your written notice.
PATIENT RIGHTS
THIS SECTION DESCRIBES YOUR RIGHTS AND THE OBLIGATIONS OF THIS PRACTICE REGARDING THE USE AND DISCLOSURE OF YOUR MEDICAL INFORMATION.
You have the following rights regarding medical information we maintain about you:
Right to Inspect and Copy. You have the right to inspect and copy medical information that may be used to make decisions about your care. This includes your own medical and billing records, but does not include psychotherapy notes. Upon proof of an appropriate legal relationship, records of others related to you or under your care (guardian or custodial) may also be disclosed. To inspect and copy your medical record, you must submit your request in writing to our designated HIPAA Compliance Officer. Ask the front desk person for the name of the HIPAA Compliance Officer. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies (electronic records, USB media, etc.) associated with your request. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, you may request that our Compliance Committee review the details of that denial. Another licensed health care professional chosen by the 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 and recommendations from that scheduled review.
Right to Amend. If you feel the medical information we in your record is incorrect or incomplete, you may ask us to amend the information, following the procedure below. You have the right to request an amendment for as long as the Practice maintains your medical record. To request an amendment, your request must be submitted in writing, along with your intended amendment and a reason supporting your request to amend your record. The amendment must be signed and dated by you and notarized. We may deny your request for an amendment if it is not in writing, or does not include a reason to support the request, is not notarized by a certified notary, or if the request is not reasonable. In addition, we may deny your request if you ask us to amend information that:
Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
Is not part of the medical information kept by or for the Practice;
Is not part of the information which you would be permitted to inspect and copy; or
Is inaccurate and incomplete.
Right to an Accounting of Disclosures. You have the right to request an “accounting of disclosures.” This is a list of the disclosures we made of medical information about you, to others for purposes other than treatment, payment or healthcare operations.To request this list, you must submit your request in writing. Your request must state a time period not longer than six (6) years back from the current date of the request, and may not include dates before April 14, 2004 (or the actual implementation date of the HIPAA Privacy Regulations). Your request should indicate in what form you want the list (on paper or electronically). The first list you request within a twelve (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 before any costs are incurred.
Right to Request Restrictions. You have the right to request a restriction or limitation on the medical 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 medical information we disclose about you to someone who is involved in your care or the payment for your care (a family member or friend). For example, you could ask we not use or disclose information about treatment you received. We are not required to agree to your request and we may not be able to comply with your request. If we do agree, we will comply with your request. We shall not comply, even with a written request, if that information is needed to provide emergency treatment to you. To request restrictions, you must make your request in writing. In your request, you indicate:
-what information you want to limit;
-whether you want to limit our use, disclosure or both; and
-to whom you want the limits to apply, (e.g., disclosures to your children, parents, spouse, etc.)
Right to Request Confidential Communications. You have the right to request we communicate with you about medical matters in a certain way or at a certain location. For example, you can request we only contact you at work or by mail, or not leave voice mail or communicate by e-mail, etc. To request confidential communications, you must make your request in writing. We will not ask you the reason for your request. We will attempt to accommodate all reasonable requests. Your request must specify how or where you wish us to contact you.
Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.
