Notice of Privacy Practice

NOTICE  OF  PRIVACY  PRACTICES

Center for Prevention and Treatment of Infections            

Effective Date:1/1/10

 

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.              

 

 

We respect patient confidentiality and only release personal health information about you in accordance with the State and Federal Law.  This Notice will provide you with information regarding our privacy practices and applies to all of your health information created and/or maintained in our office.

 

We will abide by the terms of this Notice, including any future revisions that we may make to the Notice as required or authorized by law.  We reserve the right to change this Notice and to make the revised or changed Notice effective for health information we already have about you as well as any information we receive in the future.  We will post a copy of the current Notice, which will identify its effective date, in our office.

 

 

In order to effectively provide you care, there are times when we will need to share personal health information with

others beyond our office.  This includes for:

 

1.      Treatment.  We may use your health information to provide you with health care treatment and services.  We may disclose your health information to doctors, nurses, nursing assistants,  or other personnel who are involved in your health care. 

2.      Payment.  We may use or disclose your health information to obtain payment for treatment and services provided.  This will include contacting your health plan for prior approval of treatment or for billing purposes. 

3.      Health Care Operations.  We may use or disclose your health information in order to perform the necessary administrative, educational, quality assurance, and business functions of our office. 

 

 

We may use or disclose your health information in certain special situations as described below.  For these situations, you have the right to limit these uses and disclosures as provided for in this Notice.

 

1.      Appointment Reminders.  We do make appointment reminder calls.  When we call, we will give the date and time of appointment.  We will also leave a phone number to return the call if there are any questions.  We do identify it is for a doctor’s appointment but we do not leave the doctor’s name.

 

2.      Family Members and Friends.  We may disclose your health information to individuals, such as family members and friends, who are involved in your care and who you have given us permission to discuss your care with.   We may also make such disclosures when we can infer from the circumstances that you would not object to such disclosures.  For example, if your spouse comes into the exam room with you, we will assume that you agree to our disclosure of your information while your spouse is present in the room.

 

 

There are certain instances in which we may be required or permitted by law to use or disclose your health information without your permission.  These instances are as follows:

 

1.      As required by law.  We may disclose your health information when required by federal, state, or local law to do so. 

This would include situations where we have a subpoena, court order, or are mandated to provide public health information, such as communicable diseases or suspected abuse and neglect such as child abuse, elder abuse, or institutional abuse.

2.      Health Oversight Activities.  We may disclose your health information to a health oversight agency that is authorized by law to conduct health oversight activities, including audits, investigations, inspections, or licensure and certification surveys.  These activities are necessary for the government to monitor the persons or organizations that provide health care to individuals and to ensure compliance with applicable state and federal laws and regulations.

3.      Coroners, Medical Examiners, or Funeral Directors.  We may disclose your health information to a coroner,  medical examiner or funeral director for the purpose of  carrying out his/her duties.

4.      Organ Procurement Organizations or Tissue Banks.  If you are an organ donor, we may disclose your health information to organizations that handle organ procurement, transplantation, or tissue banking for the purpose of facilitating organ or tissue donation or transplantation.

5.      To Avert a Serious Threat to Health or Safety.  We may use or disclose your health information when necessary to prevent a serious threat to the health or safety of you or other individuals.

6.      Military and Veterans.  If you are a member of the armed forces, we may use or disclose your health information as required by military command authorities.

7.      National Security and Intelligence Activities.  We may use or disclose your health information to authorized federal officials for purposes of intelligence, counterintelligence, and other national security activities, as authorized by law.

8.      Inmates.  If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may use or disclose your health information to the correctional institution or to the law enforcement official as may be necessary (i) for the institution to provide you with health care; (ii) to protect the health or safety of you or another person; or (iii) for the safety and security of the correctional institution.

 

 

Except for the purposes identified in Sections B through D, we will not use or disclose your health information for any other purposes unless we have your specific written authorization.  You have the right to revoke a written authorization at any time as long as you do so in writing.  If you revoke your authorization, we will no longer use or disclose your health information for the purposes identified in the authorization, except to the extent that we have already taken some action in reliance upon your authorization.

 

 

You have the following rights regarding your health information.  You may exercise each of these rights, in writing, by providing us with a completed form that you can obtain from our Privacy Officer.  In some instances, we may charge you for the cost(s) associated with providing you with the requested information.  

 

1.      Right to Inspect and Copy.  You have the right to inspect and copy your health information record.

2.    Right to Amend.  You have the right to request an amendment of your health information record. We may, however,  deny your request.  If we deny your request, you may file a statement that you disagree. That statement along with our response will be filed in your record  

3.    Right to an Accounting of Disclosures.  You have the right to request a list of the disclosures of your health information made by us.  This list may not include disclosures of health information that we made for purposes of treatment, payment or health care operations.

4.    Right to Request Restrictions.  You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment, or health care operations.  However, we are not required to agree to the request.

5.    Right to Request Confidential Communications.  You have the right to request that we communicate with you about your health care in a certain way or at a certain location provided it is a  reasonable request.

6.    Right to a Paper Copy of this Notice.  You have the right to receive 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.

 

 

If you have any questions regarding this Notice or wish to receive additional information about our privacy practices, please contact our Privacy Officer.  If you believe your privacy rights have been violated, you may file a complaint with our office.  All complaints must be submitted in writing.  You will not be penalized for filing a complaint.

 

I HAVE READ THIS NOTICE OR HAVE HAD IT EXPLAINED TO ME.  I UNDERSTAND THIS NOTICE AND HAVE HAD THE CHANCE TO ASK QUESTIONS ABOUT ANY MATTERS I DON’T  UNDERSTAND.

 

 

________________________________________      __________________

Signature                                                                       Date

 

 

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