HIPAA NOTICE OF PRIVACY PRACTICES
Effective Date: April 14, 2003
This notice describes how health information about you may be used and
disclosed and how you can access this information. PLEASE REVIEW IT
CAREFULLY. If you have any questions about this notice, please contact
Linda Nickerson, our Office Manager at (302) 424-0600.
OUR PLEDGE REGARDING HEALTH INFORMATION:
We understand that health information about you and your health care is
personal. We are committed to protecting health information about you. We
create a record of the care and services you receive from us. We need
this record to provide you with quality care and to comply with certain
legal requirements. This notice applies to all of the records of your
care generated by this health care practice, whether made by your
personal doctor or others working in this office. This notice will tell
you about the ways in which we may use and disclose health information
about you. We also describe your rights to the health information we keep
about you, and describe certain obligations we have regarding the use and
disclosure of your health information. We are required by law to:
? make sure that health information that identifies you is kept private;
? give you this notice of our legal duties and privacy practices with
respect to health information about you; and
? follow the terms of the notice that is currently in effect.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU.
The following categories describe different ways that we use and disclose
health information. For each category of uses or disclosures we will
explain what we mean and try to give some examples. Not every use or
disclosure in a category will be listed. However, all of the ways we are
permitted to use and disclose information will fall within one of the
categories.
For Treatment: We may use health information about you to provide you
with health care treatment or services. We may disclose health
information about you to doctors, nurses, technicians, health students,
or other personnel who are involved in taking care of you. They may work
at our offices, at the hospital if you are hospitalized under our
supervision, or at another doctor's office, lab, pharmacy, or other
health care provider to whom we may refer you for consultation, to take x-
rays, to perform lab tests, to have prescriptions filled, or for other
treatment purposes. For example, a doctor treating you for a broken leg
may need to know if you have diabetes because diabetes may slow the
healing process. In addition, the doctor may need to tell the dietitian
at the hospital if you have diabetes so that we can arrange for
appropriate meals. We may also disclose health information about you to
an entity assisting in a disaster relief effort so that your family can
be notified about your condition, status and location.
For Payment: 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.
For Health Care Operations: We may use and disclose health information
about you for operations of our health care practice. These uses and
disclosures are necessary to run our practice and make sure that all of
our patients receive quality care. For example, we may use health
information to review our treatment and services and to evaluate the
performance of our staff in caring for you. We may also combine health
information about many patients to decide what additional services we
should offer, what services are not needed, whether certain new
treatments are effective, or to compare how we are doing with others and
to see where we can make improvements. We may remove information that
identifies you from this set of health information so others may use it
to study health care delivery without learning who our specific patients
are.
Appointment Reminders: We may use and disclose health information to
contact you as a reminder that you have an appointment. Please let us
know if you do not wish to have us contact you concerning your
appointment, or if you wish to have us use a different telephone number
or address to contact you for this purpose.
As Required By Law. We will disclose health information about you when
required to do so by federal, state, or local law.
To Avert a Serious Threat to Health or Safety. We may use and disclose
health information about you when necessary to prevent a serious threat
to your health and safety or the health and safety of the public or
another person. Any disclosure, however, would only be to someone able to
help prevent the threat.
Military and Veterans. If you are a member of the armed forces or
separated/discharged from military services, we may release health
information about you as required by military command authorities or the
Department of Veterans Affairs as may be applicable. We may also release
health information about foreign military personnel to the appropriate
foreign military authorities.
Workers' Compensation. We may release health information about you for
workers' compensation or similar programs. These programs provide
benefits for work-related injuries or illness.
Public Health Risks. We may disclose health information about you for
public health activities. These activities generally include the
following:
? to prevent or control disease, injury or disability;
? to report births and deaths;
? to report child abuse or neglect;
? to report reactions to medications or problems with products;
? to notify people of recalls of products they may be using;
? to notify person or organization required to receive information on FDA-
regulated products
? to notify a person who may have been exposed to a disease or may be at
risk for contracting or spreading a disease or condition;
? to notify the appropriate government authority if we believe a patient
has been the victim of abuse, neglect, or domestic
violence.
We will only make this disclosure if you agree or when required or
authorized by law.
Health Oversight Activities. We may disclose health information to a
health oversight agency for activities authorized by law. These oversight
activities include, for example, audits, investigations, inspections, and
licensure. These activities are necessary for the government to monitor
the health care system, government programs, and compliance with civil
rights laws.
Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we
may disclose health information about you in response to a court or
administrative order. We may also disclose health information about you
in response to a subpoena, discovery request, or other lawful process by
someone else involved in the dispute, but only if efforts have been made
to tell you about the request or to obtain an order protecting the
information requested.
Law Enforcement. We may release health information if asked to do so by a
law enforcement official:
? in reporting certain injuries, as required by law, gunshot wounds,
burns, injuries to perpetrators of crime;
? in response to a court order, subpoena, warrant, summons or similar
process;
? to identify or locate a suspect, fugitive, material witness, or missing
person:
? Name and address
? Date of birth or place of birth;
? Social security number;
? Blood type or rh factor;
? Type of injury;
? Date and time of treatment and/or death, if applicable; and
? A description of distinguishing physical characteristics.
?about the victim of a crime, if the victim agrees to disclosure or under
certain limited circumstances, we are unable
to obtain the person's
agreement;
? about a death we believe may be the result of criminal conduct;
? about criminal conduct at our facility; and
? in emergency circumstances to report a crime; the location of the crime
or victims; or the identity, description, or location of the person who
committed the crime.
Coroners, Health Examiners and Funeral Directors. We may release health
information to a coroner or health examiner. This may be necessary, for
example, to identify a deceased person or determine the cause of death.
We may also release health information about patients to funeral
directors as necessary to carry out their duties.
National Security and Intelligence Activities. We may release health
information about you to authorized federal officials for intelligence,
counterintelligence, and other national security activities authorized by
law.
Protective Services for the President and Others. We may disclose health
information about you to authorized federal officials so they may provide
protection to the President, other authorized persons or foreign heads of
state or conduct special investigations.
Inmates. If you are an inmate of a correctional institution or under the
custody of a law enforcement official, we may release health information
about you to the correctional institution or law enforcement official.
This release would be necessary (1) for the institution to provide you
with health care; (2) to protect your health and safety or the health and
safety of others; or (3) for the safety and security of the correctional
institution.
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU.
You have the following rights regarding health information we maintain
about you:
Right to Inspect and Copy: You have the right to inspect and copy health
information that may be used to make decisions about your care. Usually,
this includes health and billing records. To inspect and copy health
information that may be used to make decisions about you, you must submit
your request in writing to Bonnie Chase, our Office Manager. If you
request a copy of the information, we may charge a fee for the costs of
copying, mailing or other supplies and services associated with your
request. We may deny your request to inspect and copy in certain very
limited circumstances. If you are denied access to health information,
you may request that the denial be reviewed. Another licensed health care
professional chosen by our practice will review your request and the
denial. The person conducting the review will not be the person who
denied your request. We will comply with the outcome of the review.
Right to Amend. If you feel that health information we have about you is
incorrect or incomplete, you may ask us to amend the information. You
have the right to request an amendment for as long as we keep the
information. To request an amendment, your request must be made in
writing, submitted to Bonnie Chase, our Office Manager, and must be
contained on one page of paper legibly handwritten or typed in at least
10 point font size. In addition, you must provide a reason that supports
your request for an amendment.
We may deny your request for an amendment if it is not in writing or does
not include a reason to support the request. In addition, we may deny
your request if you ask us to amend information that:
? was not created by us, unless the person or entity that created the
information is no longer available to make the amendment;
? is not part of the health information kept by or for our practice;
? is not part of the information which you would be permitted to inspect
and copy; or
? is accurate and complete.
Any amendment we make to your health information will be disclosed to
those with whom we disclose information as previously specified.
Right to an Accounting of Disclosures. You have the right to request a
list accounting for any disclosures of your health information we have
made, except for uses and disclosures for treatment, payment, and health
care operations, as previously described. To request this list of
disclosures, you must submit your request in writing to Bonnie Chase, our
Office Manager. Your request must state a time period, which may not be
longer than six years and may not include dates before January 1, 2003.
The first list you request within a 12-month period will be free. For
additional lists, we may charge you for the costs of providing the list.
We will notify you of the cost involved and you may choose to withdraw or
modify your request at that time before any costs are incurred. We will
mail you a list of disclosures in paper form within 30 days of your
request, or notify you if we are unable to supply the list within that
time period and by what date we can supply the list; but this date will
not exceed a total of 60 days from the date you made the request.
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. You also
have the right to request a limit on the health information we disclose
about you to someone who is involved in your care or the payment for your
care, such as a family member or friend. For example, you could ask that
we restrict a specified nurse from use of your information, or that we
not disclose information to your spouse about a surgery you had.
We are not required to agree to your request for restrictions if it is
not feasible for us to ensure our compliance or believe it will
negatively impact the care we may provide you. If we do agree, we will
comply with your request unless the information is needed to provide you
emergency treatment. To request a restriction, you must make your request
in writing to Bonnie Chase, Office Manager. In your request, you must
tell us what information you want to limit and to whom you want the
limits to apply; for example, use of any information by a specified
nurse, or disclosure of specified surgery to your spouse.
Right to Request Confidential Communications. You have the right to
request that we communicate with you about health matters in a certain
way or at a certain location. For example, you can ask that we only
contact you at work or by mail to a post office box. To request
confidential communications, you must make your request in writing to
Bonnie Chase, Office Manager. We will not ask you the reason for your
request. We will accommodate all reasonable requests. Your request must
specify how or where you wish to be contacted.
Right to a Paper Copy of This Notice. You have the right to obtain a
paper copy of this notice at any time. To obtain a copy, please request
it from Bonnie Chase, our Office Manager.
CHANGES TO THIS NOTICE. We reserve the right to change this notice. We
reserve the right 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 in
our facility. The notice will contain on the first page, in the top right-
hand corner, the effective date. In addition, each time you register for
treatment or health care services, we will offer you a copy of the
current notice in effect.
COMPLAINTS
If you believe your privacy rights have been violated, you may file a
complaint with us or with the Secretary of the Department of Health and
Human Services. To file a complaint with us, contact Bonnie Chase, Office
Manager. All complaints must be submitted in writing. You will not be
penalized for filing a complaint.
OTHER USES OF HEALTH INFORMATION.
Other uses and disclosures of health information not covered by this
notice or the laws that apply to us will be made only with your written
permission. 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.
Acknowledgement of Receipt of this Notice
We will request that you sign a sticker acknowledging you have received a
copy of this notice. This acknowledgement will be filed with your
records.
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