WellStar Cardiovascular Medicine
Notice
Of Privacy Practices
As Required
by the Privacy Regulations Created as a Result of the Health Insurance
Portability and Accountability Act of 1996 (HIPAA)
|
THIS NOTICE
DESCRIBES HOW HEALTH INFORMATION ABOUT YOU (AS A PATIENT OF THIS PRACTICE)
MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
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PLEASE REVIEW THIS NOTICE CAREFULLY
A. OUR COMMITMENT TO YOUR PRIVACY
Our practice is dedicated to maintaining the
privacy of your protected health information (PHI). In conducting our business, we will create
records regarding you and the treatment and services we provide to you. We are required by law to maintain the confidentiality
of health information that identifies you.
We also are required by law to provide you with this notice of our legal
duties and the privacy practices that we maintain in our practice concerning
your PHI. By federal and state law, we
must follow the terms of the notice of privacy practices that we have in effect
at the time.
We realize that these laws are complicated, but
we must provide you with the following important information:
·
How we may use and disclose
your PHI
·
Your privacy rights in your
PHI
·
Our obligations concerning
the use and disclosure of your PHI
The
terms of this notice apply to all records containing your PHI that are created
or retained by our practice. We reserve
the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will
be effective for all of your records that our practice has created or
maintained in the past, and for any of your records that we may create or
maintain in the future. Our practice
will post a copy of our current Notice in our offices in a visible location at
all times, and you may request a copy of our most current Notice at any time.
B. WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION (PHI)
IN THE FOLLOWING WAYS
The following categories describe the different
ways in which we may use and disclose your PHI.
1. Treatment. Our practice may use your PHI to treat
you. For example, we may ask you to have
laboratory tests (such as blood or urine tests), and we may use the results to
help us reach a diagnosis. We might use
your PHI in order to write a prescription for you, or we might disclose your
PHI to a pharmacy when we order a prescription for you. Many of the people who work for our practice
– including, but not limited to, our doctors and nurses – may use or disclose
your PHI in order to treat you or to assist others in your treatment. Additionally, we may disclose your PHI to
others who may assist in your care, such as your spouse, children or parents.
Finally, we may also disclose your PHI to other health care providers for
purposes related to your treatment.
2. Payment. Our practice may use and disclose your PHI in
order to bill and collect payment for the services and items you may receive
from us. For example, we may contact
your health insurer to certify that you are eligible for benefits for cardiac
catheterization, coronary angioplasy, or other cardiac procedures (and for what
range of benefits), and we may provide your insurer with details regarding your
treatment to determine if your insurer will cover, or pay for, your treatment. We also may use and disclose your PHI to
obtain payment from third parties that may be responsible for such costs, such
as family members. Also, we may use your
PHI to bill you directly for services and items. We may disclose your PHI to other health care
providers and entities to assist in their billing and collection efforts.
3. Health Care Operations. Our practice may use and
disclose your PHI to operate our business.
As examples of the ways in which we may use and disclose your
information for our operations, our practice may use your PHI to evaluate the
quality of care you received from us, or to conduct cost-management and
business planning activities for our practice.
We may disclose your PHI to other health care providers and entities to
assist in their health care operations.
4. Appointment Reminders. Our practice may use and
disclose your PHI to contact you and remind you of an appointment.
5. Treatment Options. Our practice may use and disclose your PHI to
inform you of potential treatment options or alternatives.
6. Health-Related Benefits and Services. Our practice may use and
disclose your PHI to inform you of health-related benefits or services that may
be of interest to you.
7. Release of Information to Family/Friends. Our practice may release your
PHI to a friend or family member that is involved in your care, or who assists
in taking care of you. We may release
your PHI to your personal representative (i.e., empowered under state or other
law to make health related decisions for you) or any other person you identify,
relevant to that person’s involvement in your care or payment related to your
care.
8. Disclosures Required By Law. Our practice will use and
disclose your PHI when we are required to do so by federal, state or local law.
C. USE AND DISCLOSURE OF YOUR PHI IN CERTAIN
SPECIAL CIRCUMSTANCES
The following categories describe unique scenarios in which we may use
or disclose your protected health information:
1. Public Health Risks. Our practice may disclose your
PHI to public health authorities that are authorized by law to collect
information for the purpose of:
·
maintaining vital records,
such as births and deaths
·
reporting child abuse or
neglect
·
preventing or controlling
disease, injury or disability
·
notifying a person regarding
potential exposure to a communicable disease
·
notifying a person regarding
a potential risk for spreading or contracting a disease or condition
·
reporting reactions to drugs
or problems with products or devices
·
notifying individuals if a
product or device they may be using has been recalled
·
notifying appropriate
government agency(ies) and authority(ies) regarding the potential abuse or
neglect of an adult patient (including domestic violence); however, we will
only disclose this information if the patient agrees or we are required or
authorized by law to disclose this information
·
notifying your employer
under limited circumstances related primarily to workplace injury or illness or
medical surveillance.
2. Health Oversight Activities. Our practice may disclose your
PHI to a health oversight agency for activities authorized by law. Oversight activities can include, for
example, investigations, inspections, audits, surveys, licensure and
disciplinary actions; civil, administrative, and criminal procedures or
actions; or other activities necessary for the government to monitor government
programs, compliance with civil rights laws and the health care system in
general.
3. Lawsuits and Similar Proceedings. Our practice may use and
disclose your PHI in response to a court or administrative order, if you are
involved in a lawsuit or similar proceeding.
We also may disclose your PHI in response to a discovery request,
subpoena, or other lawful process by another party involved in the dispute, but
only if we have made an effort to inform you of the request or to obtain an
order protecting the information the party has requested.
4. Law Enforcement. We may release PHI if asked to do so by a law
enforcement official:
·
Regarding a crime victim in
certain situations, if we are unable to obtain the person’s agreement
·
Concerning a death we
believe has resulted from criminal conduct
·
Regarding criminal conduct
at our offices
·
In response to a warrant,
summons, court order, subpoena or similar legal process
·
To identify/locate a
suspect, material witness, fugitive or missing person
·
In an emergency, to report a
crime (including the location or victim(s) of the crime, or the description,
identity or location of the perpetrator)
5. Deceased Patients. Our practice may release PHI to a medical
examiner or coroner to identify a deceased individual or to identify the cause
of death. If necessary, we also may
release information in order for funeral directors to perform their jobs.
6. Organ and Tissue Donation. Our practice may release your
PHI to organizations that handle organ, eye or tissue procurement or
transplantation, including organ donation banks, as necessary to facilitate
organ or tissue donation and transplantation if you are an organ donor.
7. Research. Our practice may use and disclose your PHI
for research purposes in certain limited circumstances. We will obtain your written authorization to
use your PHI for research purposes except when an Institutional Review
Board or Privacy Board has determined that the waiver of your authorization
satisfies the following: (i) the use or
disclosure involves no more than a minimal risk to your privacy based on the
following: (A) an adequate plan to
protect the identifiers from improper use and disclosure; (B) an adequate plan
to destroy the identifiers at the earliest opportunity consistent with the
research (unless there is a health or research justification for retaining the
identifiers or such retention is otherwise required by law); and (C) adequate written
assurances that the PHI will not be re-used or disclosed to any other person or
entity (except as required by law) for authorized oversight of the research
study, or for other research for which the use or disclosure would otherwise be
permitted; (ii) the research could not practicably be conducted without the
waiver; and (iii) the research could not practicably be conducted without
access to and use of the PHI.
8. Serious
Threats to Health or Safety. Our practice may use and disclose your PHI
when necessary to reduce or prevent a serious threat to your health and safety
or the health and safety of another individual or the public. Under these circumstances, we will only make
disclosures to a person or organization able to help prevent the threat.
9. Military. Our practice may disclose your PHI if you are
a member of U.S. or foreign military forces (including veterans) and if
required by the appropriate authorities.
10. National Security. Our practice may disclose your PHI to federal
officials for intelligence and national security activities authorized by
law. We also may disclose your PHI to
federal officials in order to protect the President, other officials or foreign
heads of state, or to conduct investigations.
11. Inmates. Our practice may disclose your PHI to
correctional institutions or law enforcement officials if you are an inmate or
under the custody of a law enforcement official. Disclosure for these purposes would be
necessary: (a) for the institution to provide health care services to you, (b)
for the safety and security of the institution, and/or (c) to protect your
health and safety or the health and safety of other individuals.
12. Workers’ Compensation. Our practice may release your
PHI for workers’ compensation and similar programs.
D. OTHER USES OF MEDICAL INFORMATION
In any other situation not covered by this
notice, we will ask for your written authorization before using or disclosing
medical information about you. If you
chose to authorize use or disclosure, you can later revoke that authorization
by notifying us in writing of your decision.
You understand that we are unable to take back any disclosures we have
already made with your permission, we still continue to comply with laws that
require certain disclosures, and we are required to retain our records of the
care that we provide to you.
E. YOUR PRIVACY RIGHTS
1. In most cases, you have the right to review or get a copy of medical information that we use to make decisions about your care
when you submit a written request. If
you request copies, we may charge a fee for the cost of copying, mailing, or
other related supplies. We will only release copies of records from our office,
not those sent to us by other offices.
If we deny your request to review or obtain a copy, you may submit a
written request for a review of that decision.
2. If you believe that information in your record is incorrect or if
important information is missing, you have the right to request that we correct the records, by submitting a request in writing that
provides your reason for requesting the amendment. We could deny your request to amend a record
if the information was not created by us; if it is not part of the medical
information maintained by us; or if we determine that record is accurate. You may appeal, in writing, a decision by us
not to amend a record.
3. You have the right to a list of those
instances where we have disclosed medical information about you, other than for treatment, payment, health care
operations or where you specifically authorized a disclosure when you submit a
written request. The request must state
the time period desired for the accounting, which must be less than a 6-year
period and starting after April 14, 2003.
You may receive a list or summary in paper or electronic form. We will inform you of the cost before you
incur any costs.
4. You have the right to a paper copy of this
notice even if you agreed to receive it
electronically.
5. You have the right to request that medical
information about you be communicated to you in a confidential manner, such as sending mail to an address other than
your home, by notifying us in writing of the specific way or location for us to
communicate with you.
6. You may request in writing, that we not use
or disclose medical information about you for treatment, payment or healthcare operations or
to persons involved in your care except when specifically authorized by you,
when required by law, or in an emergency.
We will consider your request but we are not legally required to accept it. We will inform you of our decision on your request.
7. All written
requests or appeals
should be submitted to our Privacy Officer listed at the bottom of this notice.
F. COMPLAINTS
If you are concerned
that your privacy rights may have been violated, or you disagree with a
decision we made regarding your protected health information, you may contact
our Privacy Officer (listed below) or designated representative.
Finally, you may send
a written complaint to the U.S. Department of Health and Human Services Office
of Civil Rights. Our Privacy Officer can
provide you with the address.
Under
no circumstance will you be penalized or retaliated against for filing a
complaint.
Privacy Officer:
55 Whitcher Street, Suite 350
Marietta, Georgia 30060
Telephone:
Phone: 770-425-1803 X 2173
Fax: 770-424-2024
Date of
last revision: 3/27/03