Notice of Privacy Practices
HOW WE MAY USE AND DISCLOSE PROTECTED HEALTH INFORMATION ABOUT YOU
[CAUTION: You should consult with legal counsel to make sure this section includes required descriptions of any additional prohibitions or limitations on the described uses and disclosures under other federal laws or state laws.]
USES AND DISCLOSURES FOR THE TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS
The following categories describe the different ways we may use and disclose PHI for treatment, payment, or health care operations without your consent or authorization. The examples included in each category do not list every type of use or disclosure that may fall within that category.
Treatment: We may use and disclose PHI about you to provide, coordinate, or manage your health care and related services. We may consult with other health care providers regarding your treatment and coordinate manage your health care with others. For example, we may use and disclose PHI when you need a prescription, lab work, an X-ray, or other health care services. In addition, we may use disclose PHI about you when referring you to another heath care provider. For example, if you are referred to another physician, we may disclose PHI to you new physician regarding whether you are allergic to any medications. In emergencies, we may use and disclose PHI to provide the treatment you need.
We may also disclose PHI about you for the treatment activities of another health care provider. For example, we may send a report about you to a physician that we refer you to so that the other physician may treat you.
Payment: We may use and disclose PHI so that we can bill and collect payment for the treatment and services provided to you. Before providing treatment or services, we may share details with your health plan concerning the services you are scheduled to receive. For example, we may ask for payment approval from your health plan before we provide care services. We may disclose PHI to find out if your health plan will cover the cost of care and services we provide. We may use and disclose Phi to confirm you are receiving the appropriate amount of care to obtain payment for services. We may use and disclose PHI for billing, claims management, and collection activities. We may disclose PHI to insurance companies providing you with additional coverage. We may disclose limited PHI to consumer reporting agencies relating to collection of payments owed to us.
We may also disclose PHI to another health care provider or to a company or health plan required to comply with the HIPAA Privacy Rule for the payment activities of that health care provider, company, or health plan. For example, we may allow a health insurance company to review PHI for the insurance company’s activities to determine the insurance benefits to be paid for your care.
Health Care Operations: We may use and disclose PHI in performing business activities that are called health care operations. Health care operations include doing things that allow us to improve the quality of care we provide and to reduce health care costs. We may use and disclose PHI for the following health care operations:
- Reviewing and improving the quality, efficiency, and cost of care that we provide to our patients. For example, we may use PHI about you to develop ways to assist our physicians and staff in deciding how we can improve the medical treatment we provide to others.
- Improving health care and lowering costs for groups of people who have similar health problems and helping to manage and coordinate the care for these groups of people. We may use PHI to identify groups of people with similar health problems to give them information, for instance, about treatment alternatives and classes.
- Reviewing and evaluating the skills, qualifications, and performance of health care providers taking care of you and our other patients.
- Providing training programs for students, trainees, health care providers, or non-health care professionals (for example, billing personnel) to help them practice or improve their skills.
- Cooperating with outside organizations that asses the quality of care that we provide.
- Cooperating with outside organizations that evaluate, certify, or license health care providers or staff in a particular field or specialty. For example, we may use or disclose PHI so that one of our nurses may become certified as having expertise in a specific field of nursing.
- Cooperating with various people who review our activities. For Example, PHI may be seen by doctors reviewing the services provided to you, and by accountants, lawyers, and others who assist us in in complying with the law and managing our business.
- Assisting us in making plans for our practice’s future operations.
- Resolving grievances within our practice.
- Reviewing our activities and using or disclosing PHI in the event that we sell our practice to someone else or combine with another practice.
- Business planning and development, such as cost-management analyses.
- Business management and general administrative activities of our practice, including managing our activities related to complying with the HIPAA Privacy Rule and other legal requirements.
- Creating “de-identified” information that is not identifiable to any individual, and disclosing PHI to a business associate for the purpose of creating de-identified information, regardless of whether we will use the de-identified information.
- Creating a “ limited data set” of information that does not contain information directly identifying a patient. Our ability to disclose this information to others under limited conditions is discussed later in the Notice.
If another health care provider, company, or health care plan that is required to comply with the HIPAA Privacy Rule also has or once had another relationship with you, we may disclose PHI about you for certain health care operations of that health care provider or company. For example, such health care operations may include: reviewing and improving the quality, efficiency, and cost of care provided to you; reviewing and evaluating the skills, qualifications, and performance of health care providers; providing training programs for students, trainees, health care providers, or non-health care professionals; cooperating with outside organizations that evaluate, certify, or license health care providers or staff in a particular field or specialty; and assisting with legal compliance activities of that health care provider company.
We may also disclose PHI for the health care operations of any “organized health care arrangement” in which we participate. An example of an organized health care arrangement is the joint care provided by a hospital and the physicians who see patients at the hospital.
Communication From Our Office: We may contact you to remind you of appointments and to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you.
OTHER USES AND DISCLOSURES WE CAN MAKE WITHOUT YOUR WRITTEN AUTHORIZATION FOR WHICH YOU HAVE THE OPPORTUNITY TO AGREE OR OBJECT
Individuals involved in your care or payment for your care: We may use and disclose PHI about you in some situations where have the opportunity to agree or object to certain uses and disclosures of PHI.
- We may disclose PHI about you to your family member, close friend, or any other person identified by you if that information is directly relevant to the person’s involvement in your care or payment for your care.
- If you are present and able to consent or object, (or if you are available in advance), then we may only use or disclose PHI if you do not object after you have been informed of your opportunity object.
- If you are not present or you are unable to consent or object , we may exercise professional judgment in determining whether the use or disclosure of PHI is in your best interests. For example, If you are brought into this office and are unable to communicate normally with your physician for some reason, we may find it is in your best interest to give your prescription and other medical supplies to the friend or relative who brought you in for treatment.
- We may also use and disclose Phi to notify such persons of your location, general condition, or death. We also may coordinate with disaster relief agencies to make this type of notification.
- We may also use professional judgment and our experience with common practice to make reasonable decisions about your best interests in allowing a person to act on your behalf to pick up filled prescriptions, medical supplies, X-rays,, or other things that contain PHI about you.
OTHER USESAND DISCLOSURES WE CAN MAKE WITHOUT YOUR WRITTEN AUTHORIZATION OR OPPORTUNITY TO AGREE OR OBJECT
We may use and disclose PHI about you in the following circumstances without your authorization or opportunity to agree or object , provided that we comply with certain conditions that may apply.
Required By Law : We may use and disclose PHI as required by federal, state, or law to the extent that the use or disclosure complies with the law and is limited to the requirements of the law.
Public Health Activities: We may use and disclose PHI to public health authorities or other authorized persons to carry out certain activities related to public health, including the following activities:
- To prevent or control disease, injury, or disability
- To report disease, injury, birth, or death
- To report child abuse or neglect
- To report reactions to medications or problems with products or devices regulated by the Federal Food and Drug Administration (FDA) or other activities related to qualify, safety, or effectiveness of FDA-regulated products or activities
- To locate and notify persons of recalls of products they may be using
- To notify a person who may have been exposed to a communicable disease in order to control who may be at risk of contracting or spreading the disease
- To report your employer, under limited circumstances, information related primarily to workplace injured or illness, or workplace medical surveillance
[NOTE: Consult with legal counsel to determine additional disclosures that may be made for public health purposes under state laws that survive HIPAA preemption and incorporate these into the above list.]
Abuse, Neglect, or Domestic Violence: We may disclose PHI in certain cases to proper government authorities if we reasonably believe that a patient has been a victim of domestic violence, abuse, or neglect.
Health Oversight Activities : We may disclose PHI to a health oversight agency for oversight including, for example, audits, investigations, inspections, licensure and disciplinary activities, and other activities conducted by heath oversight agencies to monitor the health care system, government healthcare programs, and compliance with certain laws.
Lawsuits and Other Legal Proceedings: We may use or disclose PHI when required by a court of administrative tribunal order. We may also disclose PHI in response to subpoenas, discovery requests, or other required legal process when efforts have been made to advise you of the request or to obtain an order protecting the information requested.
Law Enforcement : Under certain conditions, we may disclose PHI to law enforcement officials for the following purposes where the disclosure is:
- About a suspected crime victim if, under certain limited circumstances, we are unable to obtain a person’s agreement because of incapacity or emergency
- To alert law enforcement of a death that we suspect was the result of criminal product
- Required by law
- In response to a court order, warrant, subpoena, summons, administrative agency request, or other authorized process
- To identify or locate a suspect crime committed at our office
- In response to a medical emergency not occurring at the office, if necessary to report a crime, including the nature of the crime, the location of the crime or the victim, and the identity of the person who committed the crime
Coroners, Medical Examiners, Funeral Directors: We may disclose PHI to a coroner or medical examiner to identify a deceased person and determine the cause of death. In addition, we may disclose PHI to funeral directors as authorized by law, so that they may carry out their jobs.
Organ and Tissue Donation: If you are an organ donor, we may use or disclose PHI to organizations that help procure, locate, and transplant organs in order to facilitate an organ, eye, or tissue donation and transplant.
Research: We may use and disclose PHI about you for research purposes under certain circumstances. We must obtain a written authorization to use and disclose PHI about you for research purposes, except in situations where a research project meets specific, detailed criteria established by the HIPAA Privacy Rule to ensure the privacy of PHI.
To Avert a Serious Threat to Health or Safety: We may use and disclose PHI about you in limited circumstances when necessary to prevent a threat to the health or safety of a person or to the public. This disclosure can only be made to a person who is able to help prevent the threat.
Specialized Government Functions: Under Certain conditions, we may disclose PHI:
- For certain Military and Veteran activities, including determination of eligibility for veterans benefits and where deemed necessary by military command authorities
- For national security and intelligence activities
- To help provide protective services for the President of the United States and other
- For the health or safety of inmates and others at correctional institutions or other law enforcement custodial situations or for general safety and health related to correctional facilities
Workers’ Compensation: We may disclose PHI as authorized by workers’ compensation laws or other similar programs that provide benefits for work-related injuries or illness.
[NOTE: The above list of uses and disclosures that can be made without authorization or opportunity to agree or object should be edited to address any uses or disclosures that are not permitted under more stringent state laws that survive preemption.]
Disclosures Required by HIPAA Privacy Rule: We are required to disclose PHI to the Security of the United States Department of Health and Human Services when requested by the Secretary to review our compliance with the HIPAA Privacy Rule. We are also required in certain cases to disclose PHI to you upon your request to access PHI or for an accounting of certain disclosures of PHI about you (these requests are described in Section III of this Notice).
Incidental Disclosures: We may use or disclose PHI incident to a use or disclosure permitted by the HIPAA Privacy Rule so long as we have reasonably safeguarded against such incidental uses and disclosures and have limited them to the minimum necessary information.
Limited Data Set Disclosures: We may use or disclose a limited data set (PHI that has certain identifying information removed) for the purposes of research, public health care operations . This information may only be disclosed for research, public health, and health care operations purposes. The person receiving the information must sign an agreement to protect the information.
OTHER USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION REQUIRE YOUR AUTHORIZATION
All other uses disclosures of PHI about you will only be made with your written authorization. If you have authorized us to use or disclose PHI about you, you may later revoke your authorization.
