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
This notice of Privacy Practices describes how we may use and disclose
your Protected Health Information (PHI) to carry out treatment, payment or
health care
operations (TPO) and for other purposes that are permitted or required by
law. It also describes your rights to access and control your Protected
Health
Information. Protected Health Information is information about you,
including demographic information that may identify you and relates to
your
past, present or future physical or mental health or condition and related
health care services.
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
Your Protected Health Information may be used and disclosed by your
physician, our office staff and others outside of our office that are
involved in your
care and treatment for the purpose of providing health care services to
you, to pay your health care bills, to support the operation of the
physician's practice, and any other use required by law.
- TREATMENT: We will use and disclose
your Protected Health Information to provide, coordinate, or manage your
health care and any related services. This includes the coordination or
management of your health care with a third party. For example, we
would disclose your Protected Health Information, as
necessary, to a home health agency that provides care to you, or to a
physician to whom you have been referred to ensure that the physician
has the necessary information to diagnose and treat you.
- PAYMENT: Your Protected Health
Information will be used, as needed, to obtain payment for your health
care services. For example, obtaining approval for a hospital stay may
require that your relevant Protected Health Information be disclosed to
the health plan to obtain approval for the hospital admission.
- HEALTH CARE OPERATIONS: We may use or
disclose, as needed, your Protected Health Information in order to
support the business activities of our practice. These activities
include, but are not limited to, quality assessment activities, employee
review activities, training of medical students, licensing,
and conducting or arranging for other business activities. In addition
we may use a sign-in sheet at the registration desk, we may provide you
with appointment reminders and other necessary medical information by
postcards or letters, voicemail messages at home, and requests for a
return telephone
call at your place of employment. We may also call you by name in the
waiting room when your physician is ready to see you.
SPECIAL SITUATIONS
As required by law we will disclose your Protected Health Information
when required to do so by international, federal, state or local
authorities. Such situations include, but are not limited to, Averting a
Serious Threat to Health or Safety of the public; Business Associates
(disclosure to those who perform functions on our behalf, such as our
billing company), Organ and Tissue Donation; Military and Veterans;
Workers Compensation; Public Health Risks; Health Oversight Activities;
Lawsuits and Disputes; Law Enforcement; Coroners, Medical Examiners, and
Funeral Directors; National Security and Intelligence Activities;
Protective Services for the President and Other Authorized Persons;
Inmates or Individuals in Custody.
OTHER PERMITTED AND REQUIRED USES AND DISCLOSURES:
Will be made only with your consent, authorization or opportunity to
object unless required by law. You may revoke this authorization at any
time in writing,
except the extent that your physician or practice has taken an action in
reliance on the use or disclosure indicated in the authorization. YOUR
RIGHTS The following is a statement of your rights with respect to your
Protected Health Information.
- You have the right to inspect and copy
your Protected Health Information that may be used to make decisions
about your care or payment for your care. This includes medical and
billing records. Under Federal Law, however, you may not inspect or
copy the following records: psychotherapy notes, information compiled in
reasonable anticipation of, or use in, a civil, criminal, or
administrative action or proceeding, and protected health information
that is
subject to law that prohibits access to protected health information.
If you request a copy of your Protected Health Information, we may
charge a
reasonable fee for the copying, postage, labor and supplies used in
meeting your request.
- You have the right to request
restrictions of your Protected Health Information which means you have
the right to ask us not to use or disclose any part of
your Protected Health Information for the purposes of treatment, payment
or healthcare operations. You also have the right to request a limit on
the Protected Health Information we disclose to someone involved in your
care or the payment for your care, such as a family member or friend.
To request a restriction, you must make your request in writing to the
Practice Manager. We are not required to agree to your request if the
physician believes it is in your best interest to permit use and
disclosure of your Protected Health
Information. You then have the right to use another Healthcare
Professional.
- You have the right to request
confidential communication regarding medical matters be given to you in
a certain way or at a certain location. This
request must be made in writing to the Practice Manager. Your request
will specify how or where you wish to be contacted. We will accommodate
reasonable requests.
- You have the right to have your
physician amend your Protected Health Information. If you feel that
your Protected Health Information we have is incorrect, 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 or for our
office. This request must be made in writing to our Practice Manager.
You have the right to a paper copy of this notice. You may ask us to
give you a copy of this notice at any time. Even if you have agreed to
receive this
notice electronically, you are still entitled to a paper copy of this
notice.
CHANGES TO THIS NOTICE
We reserve the right to change this notice and make the new notice
apply to Protected Health Information we already have as well as any
information we receive in the future. We will post a copy of our
current notice at our office. The notice will contain the effective
date on the first page, in the top right-hand corner.
COMPLAINTS
If you believe your privacy rights have been violated, you may file
a complaint with Wilson OB/GYN by contacting Robin Boykin, or Leni
Crook, or with the
Secretary of the Department of Health and Human Services. All
complaints must be made in writing. You will not be penalized for filing
a complaint.
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We are required by law to maintain the
privacy of, and provide individuals with, this notice of our legal duties
and privacy practices with respect to Protected
Health Information. If you have any objections to this form, please ask
to speak with our HIPAA Privacy Officer, Robin Boykin, or Deputy Privacy
Officer, Leni Crook in person or by telephone (252) 206-1000 or (800)
775-8765. |
