Notice Of Privacy Practices For Protected Health Information

Effective March 4, 2014: 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.

Sustaina Center for Women is permitted by federal privacy laws to make, use, and disclose your health information for purposes of treatment, payment, and health care operations. Protected health information is the information we create and obtain in providing our services to you. This information includes documenting your symptoms, examination, and test results; diagnosis, treatment, and planning future care or treatment; and includes billing information.

 

EXAMPLES OF USES OF YOUR HEALTH INFORMATION FOR TREATMENT PURPOSES:

  • A nurse obtains treatment information about you and records it in a health record.
  • During the course of your treatment, the physician or other designated health provider determines a need to consult with another specialist in the area. They will share the information with such specialist and obtain their input.
  • In the process of providing care, your health information may be discussed in our office in the following locations: reception desk, check-out desk, nurses’ stations, exam rooms, laboratory, an conference room.

 

EXAMPLES OF USES OF YOUR HEALTH INFORMATION FOR PAYMENT PURPOSES:

  • We submit requests for payment to your health insurance company. The health insurance company (or other business associate helping us obtain payment) requests information from us regarding medical care given. We will provide information to them about you and the care given.

 

EXAMPLES OF USES OF YOUR HEALTH 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 share information about you with such insurers or other business associates as necessary to obtain these services.
  • You may obtain a record of disclosures of your health information as required by law by delivering a request to our office. This record will not include uses and disclosures of health information for treatment, payment or operations; disclosures or uses made at your request with a signed authorization; disclosure or uses to notify family or others legally responsible for your location, care, and/or death.
  • You may revoke previous authorizations with a written revocation to our office. The revocation will be effective when received in our office and will not be effective for information or actions already taken under previous authorizations.

 

YOUR HEALTH INFORMATION RIGHTS

 

THE HEALTH AND BILLING RECORDS WE MAINTAIN ARE PROPERTY OF THE PRACTICE.  THE INFORMATION IN IT, HOWEVER, BELONGS TO YOU, SUBJECT TO OUR RIGHT TO USE YOUR INFORMATION FOR THE PURPOSES OUTLINED IN THIS NOTICE. YOU HAVE A RIGHT TO:

  • Submit a written request to receive a copy of your health record and billing record; we are permitted by HIPAA law to charge a fee for processing your request.
  • Obtain a paper copy of the current Notice of Privacy Practices for Protected Health Information (“Notice”) by making a request at our office.
  • Request a restriction on certain uses and disclosures of your health information by delivering the request to our office – we are not required to grand the request, but we will comply with any request granted.
  • Appeal a denial of access to your protected health information, except in certain circumstances (i.e. examples above).
  • Request the transfer of copies of your health information to another practice.
  • Request that communication of your health information be made by alternate means or at an alternative location by delivering the request in writing to our office.
  • Request a restriction on disclosures of medical information to a health plan for purposes of carrying out payment or health care operations ( and is not for purposes of carrying out treatment; and the PHI pertains solely to a health care service for which the provider has been paid out of pocket in full)- we must comply with this request.
  • Request that your health care record be amended to correct incomplete or incorrect information by delivering a request to our office. 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 the office.
    • Is not part of the information that you would be permitted to inspect and 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 records.

If you want to exercise any of the above rights, please contact the Privacy Officer for Sustaina Center for Women, in person or in writing, during regular business hours.

 

OUR RESPONSIBILITIES

 

  • Maintain the privacy of your health information as required by law.
  • Provide you with a notice as to our duties and privacy practices as to the information we collect and maintain about you.
  • Abide by the terms of this notice and any future Notice.
  • Notify you if we cannot accommodate a requested restriction or request.
  • Accommodate your reasonable requests regarding methods to communicate health information with you.

We reserve the right to amend, change, or eliminate provisions in our privacy practices and access practices and enact new provisions regarding the protected health information we maintain. If our information practices change, we will amend our Notice without prior notification to you. You are entitled to receive a copy of the current Notice by calling and requesting a copy of our Notice or by visiting our office and picking up a copy.

 

 

OTHER DISCLOSURES AND USES

 

COMMUNICATION WITH FAMILY:

Unless specifically directed by you, OR in an emergency, we will use our best judgment and may disclose to a family member, other relative, close personal friend, or any other person you identify, health information relevant to that person’s involvement in your care or in payment of such care.

RESEARCH:

We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information.

ABUSE AND NEGLECT:

We may disclose your protected health information to public authorities as required by law to report suspected abuse or neglect.

LAW ENFORCEMENT:

We may disclose your protected health information for law enforcement purposes as required by law, such as when required by a court order, or in cases involving felony prosecution, or to the extent an individual is in the custody of law enforcement.

 

 

COMPLAINTS

 

Complaints about this Notice of Privacy Practices or how this medical practice handles your health information should be directed to our Privacy Official.

If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint to:

   

Office of Civil Rights

U.S. Department of Health and Human Services

999 18th Street, Suite 417

Denver, CO 80202

Voice Phone (800) 368-1019

FAX (303) 844-2025

TDD: (800) 537-7697

OCRMail@hhs.gov