This notice describeshow medical information about you may be used and disclosed and how you can getaccess to this information. Please review it carefully. If you have anyquestions about this Notice please contact our Privacy officer.
This Notice ofPrivacy Practices describes how we may use and disclose your protected healthinformation to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes yourrights to access and control your protected health information. "Protectedhealth information" is information about you, including demographicinformation, that may identify you and that relates to your past, present orfuture physical or mental health or condition and related health care services.
We are required toabide by the terms of this Notice of Privacy Practices. We may change the termsof our notice, at any time. The new notice will be effective for all protectedhealth information that we maintain at that time. Upon your request, we willprovide you with any revised Notice of Privacy Practices by calling the officeand requesting that a revised copy be sent to you in the mail or asking for oneat the time of your next appointment.
1. Uses and Disclosures ofProtected Health Information
Uses and Disclosures of Protected HealthInformation Based Upon Your Written Consent
You will be asked byyour physician to sign a consent form. Once you have consented to use anddisclosure of your protected health information for treatment, payment and health care operations by signingthe consent form, your physician will use or disclose your protected healthinformation as described in this Section 1. Your protected health informationmay be used and disclosed by your physician, our office staff and others outside of our office that are involved in your care and treatment for the purpose ofproviding health care services to you. Your protected health information mayalso be used and disclosed to pay your health care bills and to support theoperation of the physicians practice.
The nature of patienttreatment requires the doctor and or associates to identify you by name toassure proper delivery of services. This being the case, by being a patient ofthis practice your identity (your name) will be known to the doctor, staff andpossibly patients in the waiting room or office who know you.
Following are examples of the types of uses and disclosures of yourprotected health care information thatthe physician's office is permitted to make once you have signed our consentform. These examples are not meant to be exhaustive, but to describe the typesof uses and disclosures that may be made by our office once you have provided consent. We may remind you ofimportant medical appointments, messages or information by any method you provide to us including answering machine, text message, email orregular mail.
Treatment:We will use and disclose your protected health information to provide,coordinate, or manage your health care and any related services. This includesthe coordination or management of your health care with a third party that hasalready obtained your permission to have access to your protected healthinformation. For example, we would disclose your protected health information,as necessary, to a home health agency that provides care to you.
We will also discloseprotected health information to other physicians who may be treating you whenwe have the necessary permission from you to disclose your protected healthinformation. For example, your protected health information may be provided toa physician to whom you have been referred to ensure that the physician has thenecessary information to diagnose or treat you.
In addition, we maydisclose your protected health information from time-to-time to anotherphysician or health care provider (e.g., a specialist or laboratory) who, atthe request of your physician, becomes involved in your care by providingassistance with your health care diagnosis or treatment to your physician.
Payment: Yourprotected health information will be used, as needed, to obtain payment foryour health care services. This may include certain activities that your health insurance plan may undertake before it approves or paysfor the health care services we recommend for you such as; making adetermination of eligibility or coverage for insurance benefits, reviewingservices provided to you for medical necessity, and undertaking utilizationreview activities. For example, obtaining approval for a hospital stay mayrequire that your relevant protected health information be disclosed to the health plan to obtainapproval for the hospital admission.
Healthcare Operations:We may use or disclose, as-needed, your protected health information in orderto support the business activities of your physician's practice. Theseactivities include, but are not limited to, quality assessment activities,employee review activities, training of medical students, licensing, marketingand fundraising activities, and conducting or arranging for other businessactivities.
For example, we maydisclose your protected health information to medical school students that seepatients at our office. In addition, we may use a sign-in sheet at theregistration desk where you will be asked to sign your name and indicate yourphysician.
We may also call youby name in the waiting room when your physician is ready to see you. We may useor disclose your protected health information, as necessary, to contact you toremind you of your appointment.
We will share yourprotected health information with third party "business associates"that perform various activities (e.g., billing, transcription services) for thepractice. Whenever an arrangement between our office and a business associateinvolves the use or disclosure of your protected health information, we will havea written contract that contains terms that will protect the privacy of yourprotected health information.
We may use ordisclose your protected health information, as necessary, to provide you withinformation about treatment alternatives or other health-related benefits andservices that may be of interest to you. We may also use and disclose yourprotected health information for other marketing activities. For example, yourname and address may be used to send you a newsletter about our practice andthe services we offer. We may also send you information about products orservices that we believe may be beneficial to you. You may contact our PrivacyContact to request that these materials not be sent to you.
We may use ordisclose your demographic information and the dates that you received treatment from your physician, as necessary,in order to contact you for fundraising activities supported by our office. Ifyou do not want to receive these materials, please contact our Privacy Contactand request that these fundraising materials not be sent to you.
Uses and Disclosures of Protected HealthInformation Based upon Your Written Authorization
Other uses and disclosures of your protectedhealth information will be made only with your written authorization, unlessotherwise permitted or required by law as described below. You may revoke this authorization, atany time, in writing, except to the extent that your physician or thephysician's practice has taken an action in reliance on the use or disclosureindicated in the authorization.
Other Permitted and Required Uses andDisclosures That May Be Made With Your Consent, Authorization or Opportunity toObject
We may use and dis clo se your protected healthinformation in the following instances. You have the opportunity to agree orobject to the use or disclosure of all or part of your protected health information .
If you are notpresent or able to agree or object to the use or disclosure of the protectedhealth information, then your physician may, using professional judgment, determine whether the disclosure isin your best interest. In this case, only the protected health information that is relevant to your health care will bedis closed .
Facility Directories:Unless you object, we will use and disclose in our facility directory yourname, the location at which you are receiving care, your condition (in generalterms), and your religious affiliation. All of this information, exceptreligious affiliation, will be disclosed to people that ask for you by name.Members of the clergy will be told your religious affiliation.
Others Involved in Your Healthcare:Unless you object, we may disclose to a member of your family, a relative, aclose friend or any other person you identify, your protected healthinformation that directly relates to that person's involvement in your healthcare. If you are unable to agree or object to such a disclosure, we maydisclose such information as necessaryif we determine that it is in your bestinterest based on our professional judgment. We may use or disclose protectedhealth information to notify or assist in notifying a family member, personalrepresentative or any other person that is responsible for your care of yourlocation, general condition or death. Finally, we may use or disclose yourprotected health information to an authorized public or private entity toassist in disaster relief efforts and to coordinate uses and disclosures to family or otherindividuals involved in your healthcare.
Emergencies: We may use ordisclose your protected health information in an emergency treatment situation.If this happens, your physician shall try to obtain your consent as soon asreasonably practicable after the delivery of treatment. If your physician oranother physician in the practice is required by law to treat you and thephysician has attempted to obtain your consent but is unable to obtain yourconsent, he or she may still use ordisclose your protected healthinformation to treat you.
Communication Barriers:We may use and disclose your protected health information if your physician oranother physician in the practice attempts to obtain consent from you but isunable to do so due to substantial communication barriers and the physiciandetermines, using professional judgment, that you intend to consent to use ordisclosure under the circumstances.
Other Permitted and Required Uses andDisclosures That May Be Made Without Your Consent, Authorization or Opportunityto Object
We may use or disclose your protected healthinformation in the following situations without your consent or authorization.These situations include:
Required By Law:We may use or disclose your protected health information to the extent that theuseor disclosure is required by law. The use or disclosure will be made incompliance with the law and will belimited to the relevant requirements of the law. You will be notified, asrequired by law, of any such uses or disclosures.
Public Health:We may disclose your protected health information for public health activitiesand purposes to a public health authority that is permitted by law to collector receive the information. The disclosure will be made for the purpose ofcontrolling disease, injury or disability. We may also disclose your protectedhealth information, if directed by the public health authority, to a foreigngovernment agency that is collaborating with the public health authority.
Communicable Diseases:We may disclose your protected health information, if authorized by law, to aperson who may have been exposed to a communicable disease or may otherwise beat risk of contracting or spreading the disease or condition.
Health Oversight:We may disclose protected health information to a health oversight agency foractivities authorized by law, such as audits, investigations, and inspections.Oversight agencies seeking this information include government agencies thatoversee the health care system, government benefit programs, other governmentregulatory programs and civil rights laws.
Abuse or Neglect:We may disclose your protected health information to a public health authority that isauthorized by law to receive reports ofchild abuse or neglect. In addition, we may disclose your protected healthinformation if we believe that you have been a victim of abuse, neglect ordomestic violence to the governmental entity or agency authorized to receive such information. In this case, the disclosure will be madeconsistent with the requirements of applicable federal and state laws.
Food and Drug Administration:We may disclose your protected health information to a person or companyrequired by the Food and Drug Administration to report adverse events, productdefects or problems, biologic product deviations, track products; to enableproduct recalls; to make repairs or replacements, or to conduct post marketingsurveillance, as required.
Legal Proceedings:We may disclose protected health information in the course of any judicial oradministrative proceeding, in response to an order of a court or administrativetribunal (to the extent such disclosure is expressly authorized), in certainconditions in response to a subpoena, discovery request or other lawfulprocess.
Law Enforcement:We may also disclose protected health information, so long as applicable legalrequirements are met, for law enforcement purposes. These law enforcementpurposes include (1) legal processes and otherwise required by law, (2) limited information requests for identification and locationpurposes, (3) pertaining to victims of a crime, (4) suspicion that death hasoccurred as a result of criminal conduct, (5) in the event that a crime occurson the premises of the practice, and
(6) medical emergency (not on the Practice'spremises) and it is likely that a crime has occurred.
Coroners, Funeral Directors, and OrganDonation: We may disclose protected health informationto a coroner or medical examiner for identification purposes, determining causeof death or for the coroner or medical examiner to perform other dutiesauthorized by law. We may also disclose protected health information to a funeral director, as authorized by law,in order to permit the funeral director to carry out their duties. We maydisclose such information inreasonable anticipation of death.Protected health information may be used and disclosed for cadaveric organ, eyeor tissue donation purposes.
Research:We may disclose your protected health information to researchers when theirresearch has been approved by an institutional review board that has reviewedthe research proposal and established protocols to ensure the privacy of yourprotected health information.
Criminal Activity:Consistent with applicable federal and state laws, we may disclose yourprotected health information, if we believe that the use or disclosure isnecessary to prevent or lessen a serious and imminent threat to the health orsafety of a person or the public. We may also disclose protected healthinformation if it is necessary for law enforcement authorities to identify or apprehendan individual.
Military Activity and National Security:When the appropriate conditions apply, we may use or disclose protected healthinformation of individuals who are Armed Forces personnel (1) for activitiesdeemed necessary by appropriate military command authorities; (2) for thepurpose of a determination by the Department of Veterans Affairs of youreligibility for benefits, or (3) to foreign military authority if you are amember of that foreign military services.
We may also discloseyour protected health information to authorized federal officials forconducting national security and intelligence activities, including for theprovision of protective services to the President or others legally authorized.
Workers' Compensation:Your protected health information may be disclosed by us as authorized tocomply with workers' compensation laws and other similar legally-establishedprograms.
Inmates: Wemay use or disclose your protected health information if you are an inmate of acorrectional facility and your physician created or received your protectedhealth information in the course of providing care to you.
Required Uses and Disclosures:Under the law, we must make disclosures to you and when required by the Secretaryof the Department of Health and Human Services to investigate or determine ourcompliance with the requirements of Section 164.500 et. seq.
2. Your Rights
Following is a statement of your rights withrespect to your protected health information and a brief description of how youmay exercise these rights.
You have the right to inspect and copyyour protected health information. This means you mayinspect and obtain a copy of protected health information about you that iscontained in a designated record set for as long as we maintain the protectedhealth information. A "designated record set" contains medical andbilling records and any other records that your physician and the practice use for making decisions about you.
Under federal law,however, you may not inspect or copy the following records; psychotherapynotes; information compiled in reasonable anticipation of, or use in, a civil,criminal, or administrative action or proceeding, and protected healthinformation that is subject to law that prohibits access to protected healthinformation. Depending on the circumstances, a decision to deny access may bereviewable. In some circumstances, you may have a right to have this decisionreviewed. Please contact our Privacy Contact if you have questions about accessto your medical record.
You have the right to request arestriction of your protected health information. This means you may ask us not to use or disclose any part of yourprotected health information for the purposes of treatment, payment or healthcare operations.
You may also requestthat any part of your protected health information not be disclosed to familymembers or friends who may be involved in your care or for notificationpurposes as described in this Notice of Privacy Practices. Your request muststate the specific restriction requested and to whom you want the restrictionto apply.
Your physician is notrequired to agree to a restriction that you may request. If physician believesit is in your best interest to permit use and disclosure of your protectedhealth information, your protected health information will not be restricted.If your physician does agree to the requested restriction, we may not use ordisclose your protected health information in violation of that restrictionunless it is needed to provide emergency treatment. With this in mind, pleasediscuss any restriction you wish to request with your physician. You mayrequest a restriction by notifying this office in writing via certified US Mail
You have the right to request to receiveconfidential communications from us by alternative means or at an alternativelocation. We will accommodate reasonable requests. Wemay also condition this accommodation by asking you for information as to howpayment will be handled or specification of an alternative address or othermethod of contact. We will not request an explanation from you as to the basisfor the request. Please make this request in writing to our Privacy Contact.
You may have the right to have yourphysician amend your protected health information.This means you may request an amendment of protected health information aboutyou in a designated record set for as long as we maintain this information. Incertain cases, we may deny your request for an amendment. Ifwe deny yourrequest for amendment, you have the right to file a statement of disagreementwith us and we may prepare a rebuttal to your statement and will provide youwith a copy of any such rebuttal. Pleasecontact our Privacy Contact to determine if you have questions about amending your medical record.
You have the right toreceive an accounting of certain disclosures we have made, if any, of yourprotected health information. This right applies to disclosures for purposesother than treatment, payment or healthcare operations as described in thisNotice of Privacy Practices. It excludes disclosures we may have made to you,for a facility directory, to family members or friends involved in your care,or for notification purposes. You have the right to receive specificinformation regarding these disclosures that occurred after April 14, 2003. Youmay request a shorter timeframe. The right to receive this information issubject to certain exceptions, restrictions and limitations.
You have the right to obtain a paper copyof this notice from us. upon request, even if you have agreed to accept thisnotice electronically.
3. Complaints
Please contact the Privacy Officer for anycomplaints. If you are unable to resolve them with Powers Pediatrics you may make acomplaint below
You may also complainto the Secretary of Health and Human Services if you believe your privacyrights have been violated by us. You may file a complaint with us by notifyingour privacy contact of your complaint. We will not retaliate against you forfiling a complaint.
PLEASE CONTACT THEPRIVACY OFFICER OR OFFICE MANAGER
