Notice of Privacy Practices for Protected Health Information
Effective Date: 10.01.2013
This Notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please read carefully.
This office is permitted by federal privacy laws to make uses and disclosures of your Protected Health Information (PHI) for the purposes of treatment, payment and health care operations. Protected health information is the information we create and obtain in providing services to you. Such information may include documenting your symptoms, examinations and test results, diagnoses, treatment, and applying for future care or treatment. It also includes billing documents of those services. Included in this information is information about your mental health, drug and alcohol use, and exposure or infection with certain reportable diseases. In these last instances, you have the right to request this specific information not be shared.
Examples of Use of Your Health Information for Treatment Purposes are:
An office employee obtains treatment information about you and records this in the health record
A consultation is needed and the information you provide is sent to the consultant
Appointment reminders
Examples of Use of Your Health Information for Payment Purposes:
We submit requests for payment to your health insurance company. The insurance company (or other business associate or governmental agency) requests information from us regarding the medical care given. We will provide only the necessary information requested to insure your bills are paid in accordance with your insurance contract, and our negotiated rate of payment.
Examples of Use of Your Information for Health Care Operations:
We obtain services from our insurers or other business associates such as quality assessment, quality improvement, outcome evaluation, protocol and clinical guideline development, training programs, credentialing, medical review, legal services and insurance. We will provide information about you with such insurers or other associates as necessary to obtain services. IF THIS INFORMATION IS PROVIDED FOR PRACTICE EVALUATION OR CREDENTIALING REVIEWS, YOUR INFORMATION WILL BE DE-IDENTIFIED. THAT IS, YOUR IDENTITY WILL NOT BE KNOWN TO THE REVIEWING AGENCY.
Your Health Information Rights
The health and billing records we maintain are the physical property of the office. This information in the record, however, belongs to you. You have the right to:
· Request a restriction on certain uses and disclosures of your health information by delivering the request to the office-we are not required to grant the request, but we will comply with any request made;
· Obtain a paper or electronic copy of this current Notice of Privacy Practices for Protected Health Information by making a written request at the office;
· Obtain an electronic or paper copy of your health record by making a written request at the office;
· Request that you be allowed to inspect and copy your health and billing records by delivering a written request to the office;
· Appeal a denial of access to your protected health information, except in certain circumstances;
・Request that information not be disclosed to your health plan for purposes of payment or health care operations if you pay for the items or service out of pocket;
· Request that your health records be amended to correct incomplete or incorrect information. If you use the Patient Portal, much of your information will be delivered to you automatically, you should immediately inspect this information for errors so they may be corrected in a timely manner. We may deny the access or appeal, as noted above, if you ask us to amend or deliver information that:
Was not created by us, unless the person or entity that created the information is no longer available to make the amendment (in which case, a note will be attached to the record stating you believe the information is not correct rather than make a change to the document itself);
Is not part of the health information kept by or for the office;
Is not part of the information you would be permitted to inspect or copy;
Is accurate and complete.
If your request is denied, you will be informed of the reason for the denial and will have an opportunity to submit a statement of disagreement to be maintained with your record.
· Request that communication of your health information be made by alternative means or at an alternative location by delivering a written request to the office.
· Obtain an accounting of any of your health information disclosures by written request to the office. The maintenance of this disclosure information is required by law and is part of your record. An accounting will not include uses and disclosures of information for treatment, payment, or operations; disclosures or uses made to you or made at your request; uses or disclosers made pursuant to an authorization signed by you; uses or disclosures made in a facility directory or to a family members or friends relevant to that person’s involvement in your care or in payment for such care or, uses or disclosures to notify family or other responsible for you care at your location, or on condition of your death.
· Revoke authorizations that you made previously to use or disclose information or action that has already been taken.
If you wish to exercise any of the above rights, please contact Byers Peak Family Medicine, P O Box 1312, 78878 Highway 40, Winter Park, Colorado, 80482, in person or in writing during regular business hours. You will be informed of the necessary steps to exercise your rights.
Our Responsibilities
The office is required to:
Maintain the privacy of your health information as required by law
Provide you with a notice as to our duties and privacy practices related to the information we collect and maintain for you
Obtain your signature stating that you have reviewed these policies
Abide by the terms of this Notice of Privacy Practices
Accommodate your reasonable requests regarding methods of communicating your health information with you and others
Provide your information (in a timely and effective manner) to other health care providers, insurers, and other interested parties as designated by you, or in your best interest
Notify any individuals, covered under this agreement, of breaches in confidentiality that we believe have or may have occurred.
We reserve the right to amend, change, or eliminate provisions in our Notice of Privacy Practices and to enact new provisions regarding the protected health information we maintain. If our information practices change, we will amend our notice. You are entitled to receive a revised copy of the Notice by calling, writing or visiting the office. A copy will be made available to you.
To Request Information or File a Complaint About Health Information or Our Practices
If you have questions, would like additional information, or want to report a problem regarding the handling of your information, you may contact us at; Byers Peak Family Medicine at the address listed above, during normal business hours.
Additionally, if you believe your privacy rights have been violated, you may file a written complaint to our office at the address listed above. You also have the right to file a complaint, by mail or email, to the Secretary of Health and Human Services, whose address is: Office of Civil Rights, US Depart of Health and Human Services, HHH Building, 200 Independence Avenue SW, Room 509F, Washington DC, 20201
· We cannot, and will not, require you to waive the right to file a complaint with the Secretary of Health and Human Services as a condition of receiving treatment from the office
· We cannot, and will not, retaliate against you for filing a complaint with the Secretary of Health and Human Services
Other Disclosures and Uses
Communication with Family
Due to HIPPA law, we are restricted from disclosing any PHI to family members, other relatives, close friends or any other person unless you allow this information to be shared and identify them to us. This includes leaving messages, appointment reminders, lab results, or other protected information on common phones or email accounts. We will use our best judgment in conveying this information to these individuals for emergency care or if you have designated them as responsible for payment.
Notification
Unless you object, we may use or disclose your PHI to notify, or assist in notifying a family member, personal representative, or other person responsible for your care, about your location, and about you general condition, or your death.
Research, Quality Reporting, and Credentialing
We may disclose information to researchers, governmental agencies, review boards, state-licensing boards, and professional boards for review. In all cases the information will be de-identified. All established research information safety practices would be followed to protect your PHI.
Disaster Relief
We may use or disclose your PHI to assist in disaster relief and recovery efforts.
Organ Procurement Organizations
Consistent with applicable law, we may disclose your PHI to organ procurement organizations or other entities engaged in the procurement, banking or transplanting of organs for the purpose of tissue donation and transplant if you have agreed to participate in these activities either as an elective living donor or at your death.
Food and Drug Administration (FDA)
We are required and may disclose to the FDA your PHI relating to adverse events with respect to food, supplements, products and product defects, or for post marketing surveillance information to enable product safety, recalls, repairs, or replacements.
Workers Compensation Claims
If you are seeking compensation through Workers Compensation, we may disclose your PHI to the extent necessary to comply with the laws relating to Workers Compensation
Public Health
As authorized by law, we may be required or need to disclose your PHI to the Public Health Agencies charged with preventing or controlling disease, injury, or disability; to report reactions to medication or problems with products; to notify patients of recalls; to notify a person who may have been exposed to a disease or who is at risk for contracting or spreading a disease or condition.
Abuse and Neglect
We may disclose your PHI to public authorities as allowed and or required by law to report abuse or neglect.
Correctional Institutions
If you are an inmate of a correctional institution, we may disclose to the institution or its agents your PHI necessary for you health and the health and safety of other individuals in the institution.
Law Enforcement
We may disclose your PHI for law enforcement purposes as required by law, such as when required by a court order, or in cases involving felony prosecution, or the event an individual is in custody and their safety or the safety of others is in question.
Health Oversight
Federal Law allows us to release your PHI to appropriate health oversight agencies or for other health oversight activities.
Judicial/Administrative Proceedings
We may disclose your PHI in the course of any judicial or administrative proceeding as allowed or required by law, with your authorization, or as directed by a proper court order.
Serious Threat
To avert a serious threat to the health or safety, we may disclose your PHI consistent with applicable law to prevent or lessen a serious, imminent threat to the health or safety of a person or the public.
For Specialized Government Functions
We may disclose your PHI for specialized governmental functions as authorized by law such as to armed forces personnel, for national security, or the public assistance program personnel, and perhaps health exchanges.
Coroners, Medical Examiners, and Funeral Directors
We may release your PHI to a coroner or medical examiner. This may be necessary to identify a deceased person or determine the cause of death. We may also release your PHI to funeral directors to protect them for contagion, or to allow them to complete their duties and completion of Death Certificates
Other uses
Other uses and disclosures, besides those identified in this Notice will be made only as otherwise required by law or with your written constant. You may revoke this consent at any time as previously provided in this Notice under “Your Health Information Rights.”
Website
This Notice will be available on any website maintained by the practice.
