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HIPPA PRIVACY PRACTICE
NOTICE OF PRIVACY PRACTICES
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.
Effective Date: 04/01/2003
This notice describes our office’s practices and that of any health care professional authorized to enter information into your file or record, all employees, staff and other personnel.
We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive in our office. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all records of your care.
This notice will tell you about the ways in which we may use and disclose medical information about you. It also describes your rights and certain obligations we have regarding the use and disclosure of medical information.
The following categories describe different ways that we use and disclose protected medical information. For each category of uses or disclosures we will explain what we mean. Not every use and 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 protected health information about you to provide you with medical treatment or services. We may disclose protected medical information about you to doctors, nurses, technicians, medical students, pharmacists, or other personnel who are involved in taking care of you. Different departments of our practice may also share medical information about you in order to coordinate the different things you need, such as appointments, prescriptions, lab work and x-rays. We may also disclose protected medical information about you to people outside the practice that may be involved in your medical care, such as family members, nursing home personnel, home health care agencies, interpreters or anyone we use to provide services that are part of your care.
For payment: We may use and disclose protected medical information about you so that the treatment and services you receive may be billed to and payment may be collected from you, an insurance company or a third party. For example, we may need to give your health plan information about a treatment you received so your health plan will pay us or reimburse you. 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. We may also use and disclose your information to obtain payment from third parties that may be responsible for such costs, such as family members, attorneys, employers, workers’ compensation and special funding programs. We may also use your information to bill you directly for services and items, which would include disclosing your protected medical information to agencies, attorneys, or clearinghouses that assist our office with collection procedures
Appointment Reminders: We may use and disclose protected medical information to contact you as a reminder about an appointment for treatment or medical care.
Treatment Alternatives: We may use and disclose protected medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
Health-Related Benefits and Services: We may use and disclose protected medical information to tell you about health-related benefits or services that may be of interest to you.
Individuals Involved in Your Care or Payment for Your Care: We may release protected medical information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. We may also tell family members, friends, nursing home personnel, home health care agencies, interpreters or others we use to provide services that are part of your care about your condition. We may disclose protected medical information about you to an entity assisting in a disaster relief effort so that your family can be notified of your condition, status and location. In addition, we may use and disclose protected medical information for the purpose of routine business operations, such as transcription, after-hours answering services, audit functions, and quality assessment reviews.
Research: Under certain circumstances, we may use and disclose protected medical information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another, for the same condition. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of medical information, trying to balance the research needs with the patients’ need for privacy of their medical information. Before we use or disclose medical information for research, the project will have been approved through this research approval process, but we may, however, disclose medical information about you to people preparing to conduct a research project, for example, to help them look for patients with specific medical needs. We will almost always ask for your specific permission if the researcher will have access to your name, address, or other information that reveals who you are, or will be involved in your care in our practice.
As Required By Law: We will disclose protected medical 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 protected medical 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.
Organ and Tissue Donation: If you are an organ donor, we may release protected medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
Military and Veterans: If you are a member of the armed forces, we may release protected medical information about you as required by military command authorities. We may also release protected medical information to a foreign military authority, if you are in their service.
Workers’ Compensation: We may release protected medical information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness. Release of such information is controlled by state and/or federal law.
Public Health Risks: We may disclose protected medical information about you for public health activities. These activities generally include the following:
Health Oversight Activities: We may disclose protected medical 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 protected medical 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 to obtain an order protecting the information requested.
Law Enforcement: We may release protected health information if asked to do so by a law enforcement official:
Medical Examiners and Funeral Directors: We may release protected medical information to a medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release protected medical information about patients to funeral directors as necessary to carry out their duties.
National Security and Intelligence Activities: We may release protected medical 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 protected medical 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 protected medical information about you to the correctional institution or law enforcement official. This release would be necessary for this practice to provide you with health care; to protect your health and safety or the health and safety of others; or for the safety and security of the correctional institution.
You have the following rights regarding protected medical information we maintain about you:
Right to Inspect and Copy: You have the right to inspect and copy medical information that may be used to make decisions about your care. This includes medical and billing records, but does not include psychotherapy notes.
To inspect and/or copy your medical information you must submit your request to the Privacy Officer in our office. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. Once received, our office will have 30 days to respond to any request to inspect or copy medical information.
Right to Amend: If you feel that medical information we have about you is not correct or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by our practice.
To request an amendment, your request must be made in writing and submitted to the Privacy Officer. A Request for Amendment Form is available in our office. In addition, you must provide a reason that supports your amendment request. Once received, our office will have 30 days to respond to any 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:
Right to an Accounting of Disclosures: You have the right to request an “accounting of disclosures”. This is a list of the non-routine disclosures we have made of your medical information.
To request an accounting of disclosures, you must submit your request in writing to the Privacy Officer in our office. Your request must state a time period, which may not be longer than six years and may not include dates prior to April 14, 2003. A request form is available in our office. The first list you request within each 12-month period will be free. For additional requests, we may charge you for the cost 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. Once received, our office will have 30 days to respond to any request for an Accounting of Disclosures.
Right to Request Restrictions: You have the right to request a restriction or limitation on the protected medical information we use or disclose about you for treatment, payment or health care operations. However, we must receive your restriction in writing before we have made such disclosures. Also, if you restrict our right to use your protected medical information for treatment, payment or health care operations, we reserve the right to immediately withdraw our services from you and terminate the physician-patient relationship.
You also have the right to request a limit on the protected medical information we disclose about you to someone who is involved in your care or the payment of your care, such as a family member or friend. For example, you could ask that we not use or disclose information about a surgery to your family.
We are not required to agree to your request. If we do agree, we will comply with your request unless needed to provide you emergency treatment.
When requesting a restriction, you must make your request in writing to the Privacy Officer in our office. In your restrictions request, you must tell us what information you want to limit; whether you want to limit our use, disclosure or both, and to whom you want the limits to apply, for example, disclosures to your spouse. A form for requesting a restriction is available in our office. Once received, our office will have 30 days to respond to any request for a restriction.
Right to Request Confidential Communications: You have the right to request that we communicate with you about your medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work, or at home, or by mail, or by phone.
To request confidential communications, you must make your request in writing to the Privacy Officer in our office. 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 Copy of This Notice:You have the right to a copy of this notice. You may ask us to give you a copy of this notice at any time. You may obtain a copy of this notice at our website, www.acenta.com.
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for protected medical information we already have about you as well as any information we receive in the future. We will post and you may request a copy of a revised Notice of Privacy Practices from this office.
If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services. To file a complaint with our office, contact the Privacy Officer, PO Box 1745, Fort Smith, AR 72902. All complaints should be in writing. Our office will have 30 days to respond to any complaint made. You will not be penalized for filing a complaint.
Other uses and disclosures of protected medical 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 protected medical 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 protected medical 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.
For more information about HIPAA or to file a complaint:
The US Department of Health & Human Services
Office of Civil Rights
200 Independence Avenue, S.W.
Washington, DC 20201
For more information about this notice or to file a complaint with our office:
A C E N T A
Arkansas Center for Ear, Nose, Throat & Allergy
Privacy Officer
7805 Phoenix Ave
Fort Smith, AR 72903
