COMMUNITY CARE PHYSICIANS, P.C.
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 YOUR
INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION. PLEASE REVIEW
THIS NOTICE CAREFULLY.
A. OUR COMMITMENT TO YOUR PRIVACY
Our practice is dedicated
to maintaining the privacy of your individually identifiable
health information (IIHI). 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 IIHI. By federal
and state law, we must follow the terms of the notice of
privacy practices that we have in effect at thetime.
We realize that these laws are complicated, but
we must provide you with the following important information:
- How we may use and disclose your IIHI
- Your privacy rights in your IIHI
- Our obligations concerning the use and disclosure of
your IIHI
The terms
of this notice apply to all records containing your IIHI 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. IF YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE
CONTACT:
Michael O'Connor, Esq.
Privacy Officer, Operations Manager
711 Troy-Schenectady Road Suite 201
Latham, NY 12110
(518) 782-3767
C. WE MAY USE AND DISCLOSE YOUR INDIVIDUALLY
IDENTIFIABLE
HEALTH INFORMATION (IIHI) IN THE FOLLOWING WAYS
The following
categories describe the different ways in which we may use
and disclose your IIHI. The uses are for Treatment, Payment,
and Operations (TPO).
1. Treatment. Our practice may use your
IIHI 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 IIHI
in order to write a prescription for you, or we might disclose
your IIHI 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 IIHI in order to treat you or to assist
others in your treatment. Additionally, we may disclose your
IIHI to others who may assist in your care, such as your
spouse, children or parents.
Finally, we may also disclose
your IIHI to other health care providers for purposes related to your
treatment.
2. Payment. Our practice may use and disclose
your IIHI 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 (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 IIHI to obtain payment from
third parties that may be responsible for such costs, such
as family members. Also, we may use your IIHI to bill you
directly for services and items. We may disclose your IIHI
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 IIHI
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 IIHI 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 IIHI to other health care
providers and entities to assist in their health care operations.
4. Appointment Reminders. Our practice
may use and disclose your IIHI to contact you and remind you
of an appointment.
5. Treatment Options. Our
practice may use and disclose your IIHI to inform you of potential
treatment options or alternatives.
6. Health-Related
Benefits and Services. Our practice may use and
disclose your IIHI to inform you of health-related benefits
or services that may be of interest to you. We will not sell
your data to an outside entity, nor will we permit an outside
entity from accessing your information for purposes of informing you
of health-related benefits or services.
7. Release of Information to Family/Friends. Our
practice may release your IIHI to a friend or family member
that is involved in your care, or who assists in taking care
of you in some limited circumstances. For example, a parent
or guardian may ask that a babysitter take their child to
the pediatrician’s office for treatment
of a cold. In this example, the babysitter may have access to this
child’s
medical information.
8. Disclosures Required By Law. Our practice
will use and disclose your IIHI when we are required to do
so by federal, state or local law.
D. USE AND
DISCLOSURE OF YOUR IIHI IN CERTAIN SPECIAL CIRCUMSTANCES
The following categories describe unique scenarios
in which we may use or disclose your identifiable health information:
1. Public Health Risks. Our
practice may disclose your IIHI 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 IIHI 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 IIHI in response to a court or administrative
order, if you are involved in a lawsuit or similar proceeding.
We also may disclose your IIHI 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
IIHI 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. Research. Our practice may use and disclose
your IIHI for research purposes in certain limited circumstances.
We will obtain your written authorization to use your IIHI
for research purposes except when an IRB 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 the individual’s 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.
6. Serious Threats to Health
or Safety. Our practice may use and disclose your IIHI
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.
7. Military. Our practice may disclose
your IIHI if you are a member of U.S. or foreign military
forces (including veterans) and if required by the appropriate
authorities.
8. National Security. Our practice
may disclose your IIHI to federal officials for intelligence
and national security activities authorized by law. We also
may disclose your IIHI to federal officials in order to protect
the President, other officials or foreign heads of state,
or to conduct investigations.
9. Inmates. Our practice may
disclose your IIHI 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.
10. Workers’ Compensation. Our practice
may release your IIHI for workers’ compensation and
similar programs.
E. YOUR RIGHTS REGARDING YOUR IIHI
Although your health records
are the physical property of the health care provider who
completed it, you have the following rights with regard to
the information contained therein and the following rights
regarding the IIHI that we maintain about you:
1. Confidential Communications. You have
the right to request that our practice communicate with you
about your health and related issues in a particular manner
or at a certain location. For instance, you may ask that
we contact you at home, rather than work. In order to request
a type of confidential communication, you must make a written
request to your physician specifying the requested method
of contact, or the location where you wish to be contacted.
Our practice will accommodate reasonable requests.
You do not need to give a reason for your request.
2. Requesting Restrictions. You have the
right to request a restriction in our use or disclosure of
your IIHI for treatment, payment or health care operations.
Additionally, you have the right to request that we restrict our
disclosure of your IIHI to only certain individuals involved
in your care or the payment for your care, such as family
members and friends. We are not required to agree
to your request; however,
if we do agree, we are bound by our agreement except when otherwise
required by law, in emergencies, or when the information is necessary
to treat you. In order to request a restriction in our use or disclosure
of your IIHI, you must make your request in writing to your physician.
Your request must describe in a clear and concise
fashion:
(a) the information you wish restricted;
(b) whether you are requesting to limit our practice’s use, disclosure
or both; and
(c) to whom you want the limits to apply.
3. Inspection and Copies. You have the
right to inspect and obtain a copy of the IIHI that may be
used to make decisions about you, including patient medical
records and billing records, but not including psychotherapy
notes. You must submit your request in writing to your physician
in order to inspect and/or obtain a copy of your IIHI. Our
practice may charge a fee for the costs of copying, mailing,
labor and supplies associated with your request. Our practice
may deny your request to inspect and/or copy in certain limited
circumstances; however, you may request a review of our denial.
Another licensed health care professional chosen by us will
conduct reviews.
4. Amendment. You may ask us to amend your
health information if you believe it is incorrect or incomplete,
and you may request an amendment for as long as the information
is kept by or for our practice. To request an amendment,
your request must be made in writing and submitted to your
physician. You must provide us with a reason that supports
your request for amendment. Our practice will deny your request
if you fail to submit your request (and the reason supporting your request)
in writing. Also, we may deny your request if you ask us
to amend information that is in our opinion: (a) accurate
and complete; (b) not part of the IIHI kept by or for the
practice; (c) not part of the IIHI which you would be permitted
to inspect and copy; or (d) not created by our practice,
unless the individual or entity that created the information
is not available to amend the information.
5. Accounting of Disclosures. All of our
patients have the right to request an “accounting of
disclosures.” An “accounting of disclosures” is
a list of certain nonroutine disclosures our practice has made of your
IIHI for non-treatment or operations purposes. Use of your
IIHI as part of the routine patient care in our practice
is not required to be documented. For example, the doctor
sharing information with the nurse; or the billing department
using your information to file your insurance claim. In order
to obtain an accounting of disclosures, you must submit your
request in writing to your physician. All requests for an “accounting
of disclosures” must
state a time period, which may not be longer than six (6) years from the
date of disclosure and may not include dates before April
14, 2003. The first list you request within a 12-month period
is free of charge, but our practice may charge you for additional
lists within the same 12- month period. Our practice will
notify you of the costs involved with additional requests,
and you may withdraw your request before you incur any costs.
6.
Right to a Paper Copy of This Notice. You are
entitled to receive a paper copy of our notice of privacy
practices. You may ask us to give you a copy of this notice
at any time. To obtain a paper copy of this notice, contact Michael
O'Connor, Esq. at (518) 782-3767.
7. Right to File a Complaint. If you believe
your privacy rights have been violated, you may file a complaint
with our practice or with the Secretary of the Department
of Health and Human Services. To file a complaint with our
practice, contact Michael O'Connor, Esq. at (518) 782-3767. All complaints
must be submitted in writing. You will not be penalized for filing
a complaint.
8. Right to Provide an Authorization
for Other Uses and Disclosures. Our practice will
obtain your written authorization for uses and disclosures
that are not identified by this notice or permitted by
applicable law. Any authorization you provide to us regarding
the use and disclosure of your IIHI may be revoked at any
time in
writing.
After you revoke your authorization, we will no longer use or disclose your
IIHI for the reasons described in the authorization. Please
note, we are required to retain records of your care. Again,
if you have any questions regarding this notice or our
health information privacy policies, please contact Michael
O'Connor, Esq. (518) 782-3767.
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