Notice of Privacy Practices
Obstetrics & Gynecology Specialists,PC
(OBGYN)
NOTICE OF PRIVACY PRACTICES
April 14th
2003
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY
BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS
INFORMATION.
PLEASE REVIEW IT CAREFULLY.
The privacy of your health information is very important to
us. We are required by law to:
• Maintain the
privacy of your health information:
• Give you this Notice of our legal duties and privacy
practices;
• Follow the terms of this Notice.
This Notice will remain in effect until we revise it. We
reserve the right to change our privacy practices and terms
of this Notice. Any changes we make will apply to all of
the health information about you we maintain. We will make
you aware of any changes by:
• Posting the
revised Notice in our office;
• Making copies of the revised Notice available upon your
request (either at our office or through the contact person
listed in this Notice);
• Posting the revised Notice on our Web site.
WHAT IS HEALTH INFORMATION?
Your health information is information
that identifies you and relates to:
• Your past,
present or future physical or mental health or condition;
• The treatment we provide to you; or
• Payment for your past, present or future health care.
Your health information includes your name, address, Social
Security number and other demographic information.
Typically, we keep your health information in our medical
record and our billing records.
USES AND DISCLOSURES OF YOUR HEALTH
INFORMATION
How may we use and
disclose your health information?
We use your
health information to make sure we can appropriately treat
you, receive payment for our services and conduct our
necessary health care operations. Some examples are:
Treatment:
The doctors, nurses and other
staff of OBGYN will use your health information to
determine the medical care, tests, procedures and
medications you may need. We may disclose your health
information to coordinate or manage your health care. For
example, we may disclose your information to another health
care provider to order a referral, prescriptions, lab work
or an X-ray for you.
Appointment reminders
and other contacts: We
may use your health information to contact you with
reminders about your appointments, alternative treatments
you may want to consider, or other of our services that may
be of interest to you.
Payment:
We will use your health
information to check your eligibility for insurance
coverage and prepare a bill to send to you or your
insurance company. We will disclose your health information
to others to bill and collect payment for our services. For
example, in order to bill an insurance company, we will
have to disclose information about when you were treated,
the conditions you were treated for, and the type of
treatment you received.
Health care
operations: We may use
and disclose your health information to allow us to perform
functions necessary for our business of health care. For
example, within our organization, we may use your
information to help us train new staff and conduct quality
improvement activities. We may disclose your information to
consultants and other business associates who help us with
billing, computer and transcription services. In limited
situations, we may disclose information to allow other
health care organizations to perform their health care
operations. For example, we may disclose your information
to your insurance company to allow them to conduct quality
improvement activities.
Fundraising:
We may use or disclose your
demographic in formation and dates of treatment to contact
you to raise money for OBGYN.
Research:
We may use or disclose your
health information for research purposes if a review board
has determined that your privacy will be appropriately
protected.
Required by law:
We will disclose your health
information when we are required to do so by law.
Workers’
compensation: We will
disclose your health information to comply with workers’
compensation and similar laws that provide benefits for
work-related injuries and illnesses.
Public policy:
There are several situations
in which the law permits or requires us to use or disclose
your health information for public policy purposes. These
are:
*Public health
concerns: We may
disclose your health information to public health
authorities for certain public health activities such as
reporting births or deaths, preventing or controlling
disease, and notifying persons who may have been exposed to
a disease or may be at risk for spreading a disease.
*Health oversight
activities: We may
disclose your health information to a health oversight
agency to conduct audits, investigations, inspections and
other activities necessary for the government to
appropriately monitor the health care system.
Special
situations: There are
some situations that occur rarely, but may require or
permit us to use or disclose your health information. These
include:
*Abuse, neglect or
domestic violence: We
may disclose your health information to the appropriate
authorities if necessary to report suspected abuse, neglect
or domestic violence.
*Serious threats to
health or safety: We
may use or disclose your health information when necessary
to avert a serious threat to the health or safety of you,
another person or the public.
*Organ donation:
We may disclose your health
information to an appropriate organization to facilitate
organ or tissue donation or transplantation.
*Problems with
products: We may use
or disclose your health information to report problems with
medical devices or other products that are regulated by the
Food and Drug Administration or to allow for product
recalls, repairs or replacements.
*Legal
proceedings: If you
are involved in a lawsuit or dispute, we may disclose your
health information in response to a court or administrative
order. We may also disclose your health information in
response to a subpoena, discovery request, other lawful
process by someone else involved in the dispute, but only
if efforts have been made to tell you about the request or
obtain a court order protecting your information.
*Law
Enforcement: We may
disclose your health information for law enforcement
purposes, as long as we follow specific requirements and
restrictions. For example, we may disclose your information
to comply with the laws that require the reporting of
certain types of injuries, to help identify or locate a
criminal suspect, or to provide information about the
victim of crime.
*Coroners, medical
examiners and funeral directors: We may disclose your health information
to a coroner, medical examiner or funeral director to allow
them to perform their duties.
*Specialized government
functions: We may
disclose your health information as it relates to some
specialized government functions, such as military or
veterans activities or national security.
*Inmates:
If you are an inmate of a
correctional institution or in the custody of a law
enforcement official, we may disclose your health
information to the institution as necessary to provide you
with health care, protect the health and safety of you or
others, and maintain the safety and security of the
institution.
When may we make other
disclosures of your health information?
For some
purposes, we will give you the opportunity to agree or
object to a disclosure of your health information. These
purposes are:
*Persons involved in
your care: If you are
present, we may disclose your health information to a
relative or other person involved in your treatment or
payment for your treatment, but only if you have had an
opportunity to agree or object to that disclosure. For
example, you may indicate that you don’t mind us disclosing
your information to a friend or a family member by allowing
them to join in your meeting with your doctor. If you are
not present to agree or object, we will use our
professional judgment to determine if disclosing your
health information is in your best interests.
*Notification:
We may disclose your location
and general condition to notify a family member, personal
representative or other person responsible for your care.
*Facility
directory: Unless you
notify us that you object, we will use your name, location
in the facility, general condition and religious
affiliation to maintain a facility directory. This
information may be provided to members of the clergy and,
except for religious affiliation, to other people who ask
about you by name.
Other uses and
disclosures of your health information not covered in this
Notice will by made only with your written
authorization. If you
authorize us to use or disclose your health information,
you may revoke that authorization in writing at any time.
If you revoke your authorization, we will no longer use or
disclose your information for the purpose covered by your
authorization. You must understand, however, that we are
unable to take back any disclosures we have already made in
reliance on your authorization.
YOUR RIGHTS
REGARDING YOUR HEALTH INFORMATION
You have several important rights with
regard to your health information. The following explains
those rights and how you may exercise them.
Right to inspect and
copy: You have the
right to inspect and copy your health information. We ask
that you submit your request to inspect or copy in writing.
We may charge you a reasonable fee. In some limited
circumstances, we may deny your request to inspect or copy
your information. If that happens, you may ask that the
denial be reconsidered. Your request and the denial will
then be reviewed by a different licensed health care
professional- not the one who originally denied your
request. We will comply with the decision that professional
makes.
Right to request
amendment: If you
believe that health information we have about you is
incorrect or incomplete, you may ask us in writing to amend
the information. You must explain the reasons for your
request. We may deny your request if the information you
are asking us to change:
*Was not created by us (unless the person that created the
information is no longer available to make the amendment);
*Is not part of the health information kept by or for us;
*Is not part of the information you are permitted to
inspect and copy; or
*Is already accurate and complete.
If we deny your request, you have the right to file a
statement of disagreement with us. Your statement will
include in any disclosures of your information we make in
the future.
Right to request
restrictions on uses and disclosures of your health
information: You have
the right to ask us to limit how we use and disclose your
health information for your treatment or our payment and
business operations purposes. You may also ask that we not
disclose your health information to family members or
friends involved in your treatment or payment of your
treatment. We are not required to agree to your request for
a restriction. However, if we do agree, we will comply with
our agreement unless there is an emergency or we are
otherwise required to use or disclose the information.
Right to request
confidential communications from us: You have the right to ask us to
communicate with you about health maters in a specific way
or at a specific location. For example, you may ask that we
only contact you at work or by mail. We ask that you make
your request for confidential communication in writing. We
will comply with reasonable requests.
Right to receive an
accounting of certain disclosures of your health
information we have made: You have the right to ask us to give you
an accounting of certain disclosures of your health
information we may have made. This accounting will not
include all disclosures. For example, it will not include
disclosures made:
• For your
treatment;
• For payment for your treatment;
• For your business operations purposes;
• To, or authorized by, you;
• To others involved in your care or payment for your care.
We ask that you submit your request for
an accounting in writing. You may ask for up to six-years
of disclosures, but the accounting will not include
disclosures made before April 14, 2003. One accounting
within any 12-month period will be free of charge. We may
change a reasonable fee for additional accountings, but we
will notify you of the fee and allow you to withdraw or
modify your request before we process it.
Right to receive a copy
of this notice: You
have the right to receive a paper copy of this Notice, even
if you have agreed to receive it electronically.
IF YOU HAVE
COMPLAINTS OR QUESTIONS
If you have questions about any of this
information in this Notice, please contact our office @
563-355-1853.
If you think your privacy rights have been violated, you
may file a complaint with us by contacting our office.
We support your right to the privacy of your health
information. We will not retaliate in any way if you file a
complaint with us or with the Department of Health and
Human Services.