This notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review this notice carefully.
The Center, our physicians and staff are committed to using your protected health information responsibly. This Notice describes the personal information we collect, and how and when we use or disclose this information. This Notice is effective as of September 23, 2013, and applies to all of your protected health information (PHI) as defined by federal regulations.
PHI is information about you including demographic information that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.
You have the following right with respect to your PHI:
- Request restrictions on the use of your PHI. However, the Center is not required to agree to the restriction, except if you pay for a service entirely out-of-pocket. If you pay for a service entirely out-of-pocket, you may request that information regarding the service be withheld and not provided to a third party payor. The Center is obligated by law to abide by such restriction. If you wish to request a restriction on the use and disclosure of your PHI, please provide a written request describing your requested disclosure to theCenter's Privacy Officer. The Center will notify you of our decision regarding the requested restriction.
- Receive confidential communications concerning your medical condition and treatment or have communications addressed to an alternative location.
- Inspect and receive a copy of your medical record, as provided by federal regulations, including receiving an electronic copy of your medical record if the Center maintains your medical record in an electronic health record. The Center may charge you a reasonable fee to cover its costs for this service. You may also request that we provide a copy of your medical record to another person or entity.
- Request and receive an accounting of how and to whom your PHI has been disclosed, except for disclosures made for the purposes of treatment, payment, health care operations and certain other purposes if such disclosures were made through a paper record or other health record that is not electronic, as set forth in federal regulations. If you request an accounting of disclosures of your PHI, the accounting may include disclosures made for the purpose of treatment, payment and health care operations to the extent that disclosures are made through an electronic health record.
- Receive a printed copy of this Notice from the Center upon request.
- Request that the Center amend your medical record, to the extent that such amendments are permissible under federal regulations
- If you execute any authorization(s) for the use and disclosure of your health information, revoke such authorization(s), except to the extent that action has already been taken in reliance on such authorization.
The Center is required by law to:
- Maintain the privacy of your health information;
- Provide you with this Notice as to our legal duties and privacy practices with respect to information we collect and maintain about you;
- Abide by the terms and obligations of this Notice that are currently in effect; and
- Notify you if we discover a breach of any of your PHI that is not secured in accordance with federal guidelines.
As permitted by law, the Center reserves the right to amend or modify its privacy policies and practices. These changes may be required by amendments to federal and state laws and regulations. When revisions occur, the Center will make the revised Notice available to you upon your request. The revised policies and practices will be applied to all PHI that the Center maintains.
How we may use or disclose your health information without your authorization:
We will use your health information for treatment.
We may use or disclose your PHI to other healthcare professionals for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. For example: results of laboratory tests and procedures will be available in your medical record to all health professionals who may provide treatment to you, or who may be consulted regarding your treatment by physicians and staff.
We will use your information for payment purposes.
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, or a third party. For example, we may need to give your health plan information about your office visit so your health plan will pay us or reimburse you for the 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 will use your information in the operation of the Center's business.
Your health information may be used to make business decisions necessary for the management, operation, and development of the Center. For example: information on the services you receive may be used to support the budgeting and financial reporting, and activities to support quality assurance.
We might use your information for the purpose of research.
We may disclose your health information for the purpose of research. We will only disclose your health information for research purposes (i) with your express authorization, unless a waiver of authorization has been obtained from an institutional review board or privacy board; or (ii) where we have received assurances from a researcher that the health information is sought solely for review as necessary to prepare a research protocol or for similar purposes preparatory to research and no health information will be removed from our premises in the course of the review.
Federal law may require us to release your information to appropriate health oversight agencies for purposes relating to the oversight of the health care system and government benefit programs such as Medicare or Medicaid.
Public Health Reporting
Your health information may be disclosed to public health officials, as required by law.
Law Enforcement and Government Authorities.
- The Center may disclose your PHI to law enforcement officials for law enforcement purposes.
- The Center may disclose your PHI to an appropriate governmental authority if we reasonably believe that you may be a victim of abuse, neglect, or domestic violence.
- If the Center believes it is necessary to avert a serious threat to the health or safety of yourself or the public, the Center may disclose your PHI to a person or persons who we believe are reasonably able to prevent or lessen the threat.
- The Center may disclose your PHI as required by federal and state laws and regulations.
- The Center may disclose your PHI in the course of a judicial or administrative proceeding in response to a court order, subpoena, discovery request or other lawful process.
- The Center may disclose your PHI to a coroner or medical examiner for the purpose of identifying a deceased person, determining a cause of death, or other purposes as authorized by law. The Center may also disclose your PHI to funeral directors as necessary to carry out their duties.
- The Center may disclose your PHI to organizations involved in the procurement, banking, or transplantation of cadaveric organs, eyes or tissue, for the purpose of facilitating organ and tissue donation, where applicable.
- If you are a member of the United States or foreign Armed Forces, the Center may disclose your PHI for activities that are deemed necessary by appropriate military command authorities to assure the proper execution of a military mission.
- The Center may disclose your PHI to authorized federal officials for the conduct of lawful intelligence, counter-intelligence and other national security functions authorized by law, or for the purpose of providing protective services to the President or foreign heads of state.
- The Center may disclose your PHI to a correctional institution or a law enforcement official having lawful custody of you.
The Center may disclose your PHI as authorized by, and in compliance with, laws relating to workers' compensation and similar programs established by law that provide benefits for work-related illnesses and injuries without regard to fault.
The Center may contact you or provide certain information regarding your care to a third party for the purpose of raising funds for the Center. You have the right to opt out of receiving such communications.
Examples of other permissible or required disclosures
The Center may provide your information to Business Associates.
In some instances the Center has contracted with separate parties to provide services for the Center. These "business associates" require your health information in order to perform the contracted services. Examples of when the Center may use a business associate include coding and claims submission performed by a third party billing company, consulting and quality assurance activities provided by an outside consultant, billing and coding audits performed by an outside auditor, and other legal and consulting services provided in response to billing and reimbursement matters that may arise from time to time. When the Center enters into contracts to obtain these services, the Center may need to disclose your health information to our business associate so that the associate may perform the job which the Center has requested. To protect your health information, however, the Center requires our business associate to appropriately safeguard your information.
Communication of information to family members and others.
Due to the nature of medical care the Center may use our best judgment when disclosing your medical information to a family member, or any other person who is involved in you care or whom you have authorized to receive your information. Please inform the Center if your family situation changes, or in case you do not want a family member or other person to have authorization to receive your PHI.
We may not use or disclose your protected health information for the following purposes without your authorization:
- We must obtain an authorization from you to use or disclose psychotherapy notes unless it is for treatment, payment or health care operations or is required by law, permitted by health oversight activities, to a coroner or medical examiner, or to prevent a serious threat to health or safety.
- We must obtain an authorization for any use or disclosure of your PHI for any marketing communications to you about a product or service that encourages you to use or purchase the product or service unless the communication is either (a) a face-to-face communication or; (b) a promotional gift of nominal value. However, we do not need to obtain an authorization from you to provide refill reminders, information regarding your course of treatment, case management or care coordination, to describe a health-related products or services that we provide, or to contact you in regard to treatment alternatives. We must notify you if the marketing involves financial remuneration.
- We must obtain an authorization for any disclosure of your PHI which constitutes a sale of such PHI.
- We must obtain an authorization for all other uses and disclosures of your PHI not described in this notice.
Revoking Your Authorization
If you provide us permission to use or disclose health 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 health 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.
Other Use and Disclosures
Disclosures of your PHI or its use for any purpose other than those previously mentioned, or as required by law requires your specific written authorization.
If you change your mind after authorizing a use or disclosure of your information, you may submit a written revocation of authorization to the Center. However, your decision to revoke the authorization will not affect or undo any use or disclosure of information that occurred before you notified the Center of your decision to revoke the authorization.
For more information, or to report a problem:
If you believe your privacy rights have been violated, you may file a complaint with the Privacy Officerof the Center or with the Secretary of the Department of Health and Human Services. If you would like more information regarding this Notice of the Center's privacy practices, please contact:
Sharon Grayson, Privacy Officer at 423-486-9514 or email email@example.com
Office of Civil Rights, U.S. Dept. of Health and Human Services
200 Independence Ave., S.W., Room 509F, HHH Building
Washington, DC. 20201
There will be no retaliation for filing a complaint with either the Center's Privacy Officer or with the Office of Civil Rights.