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 important to us.
Effective Date: April 14, 2003
Privacy Officer: Angela Bower
For 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 that has
already obtained your permission to have access to your protected health
information. For example, we would disclose your protected health information,
as necessary, to a home health agency that provides care to you. We will also
disclose protected health information to other physicians who may be treating
you when we have the necessary permission from you to disclose your protected
health information. For example, your protected health information may be
provided to a physician to whom you have been referred to ensure that the
physician has the necessary information to diagnose or treat you.
In addition, we may disclose your protected health
information from time-to-time to another physician or health care provider
(e.g., a specialist or laboratory) who, at the request of your physician,
becomes involved in your care by providing assistance with your health care
diagnosis or treatment to your physician.
For Payment: Your protected health information will be used, as needed, to obtain
payment for your health care services. This may include certain activities that
your health insurance plan may undertake before it approves or pays for the
health care services we recommend for you such as; making a determination of
eligibility or coverage for insurance benefits, reviewing services provided to
you for medical necessity, and undertaking utilization review activities. 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.
For Healthcare Operations: We will use and disclose your health information to
conduct the business activities of this office. These activities include, but
are not limited to, quality assessment and improvement activities, review of the
performance and qualifications of employees, evaluating practitioner and
provider performance, training medical residents, conducting training programs
of staff, accreditation, certification, licensing or credentialing activities.
We may use a sign-in sheet at the registration desk where
you will be asked to sign your name. We may also call you by name in the waiting
room when we are ready to begin your treatment.
We will share your protected health information with
business associates that perform specific functions for our practice such as
transcription and collections. When a business arrangement of this type requires
the use of your information, we will have a written contract with the third
party to protect the privacy of your protected health information.
Others Involved in Your Health Care: We must disclose your health information to you as
described in the Patient Rights section of this Notice. We may disclose your
health information to a family member or other person to the extent necessary to
help with your health care or with payment for your health care, but only if you
agree. If we determine it is in your best interest based on our professional
judgment or experience with common practices, we may allow another person to
pick up filled prescriptions, medical supplies, x-rays or other forms of health
information. We may use or disclose protected health information to notify or
assist in notifying a family member, a personal representative or any other
person responsible for your care of your location, your general condition or
death. If you are present prior to the use or disclosure of your protected
health information, we will provide you with the opportunity to object to such
uses or disclosures. Finally, we may use or disclose your protected health
information to an authorized public or private entity to assist in disaster
relief efforts and to coordinate uses and disclosures to family members or
others involved in your health care.
Emergencies: In the event of your incapacity or in emergency circumstances, we may use or
disclose your protected health information to treat you
Communication Barriers: We may use and disclose your protected health information
if your physician or another physician in the practice attempts to obtain
consent from you but is unable to do so due to substantial communication
barriers and the physician determines, using professional judgment, that you
intend to consent to use or disclosure under the circumstances.
Other Permitted and Required Uses and Disclosures That May
Be Made Without Your Consent, Authorization or Opportunity to Object
We may use or disclose your protected health information
in the following situations without your consent or authorization. These
situations include:
Required By Law: We may use or disclose your protected health information
to the extent that law requires the use or disclosure. The use or disclosure
will be made in compliance with the law and will be limited to the relevant
requirements of the law.
We must make disclosures to you and, when required, to the
Secretary of the Department of Health and Human Services to investigate or
determine our compliance with the requirements of the Privacy Rule, Section
164.500 et. seq.
Public Health: We may disclose your protected health information for public health
activities and purposes to a public health authority that is permitted by law to
collect or receive the information. The disclosure will be made for the purpose
of controlling disease, injury or disability. Additionally, we may disclose your
protected health information, if authorized by law, to a person who may have
been exposed to a communicable disease or may otherwise be at risk of
contracting or spreading the disease or
condition.
We may disclose protected health information to a health
oversight agency for activities authorized by law, such as audits,
investigations, and inspections. Oversight agencies seeking this information
include government agencies that oversee the health care system, the Federal
Drug Administration, government benefit programs, other government regulatory
programs and civil rights laws.
Abuse or Neglect: We may disclose your protected health information to a
public health authority that is authorized by law to receive reports of child
abuse or neglect. In addition, we may disclose your protected health information
if we believe that you have been a victim of abuse, neglect or domestic violence
to the governmental entity or agency authorized to receive such information. In
this case, the disclosure will be made consistent with the requirements of
applicable federal and state laws.
Legal Proceedings: We may disclose protected health information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request or other lawful process.
Law Enforcement: We may also disclose protected health information, so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include (1) legal processes and otherwise required by law, (2) limited information requests for identification and location purposes, (3) pertaining to victims of a crime, (4) suspicion that death has occurred as a result of criminal conduct, (5) in the event that a crime occurs on the premises of the practice, and (6) medical emergency (not on the Practice’s premises) and it is likely that a crime has occurred.
Military Activity and National Security: When the appropriate conditions apply, we may disclose,
to military authorities, protected health information of individuals who are
Armed Forces personnel. We may also disclose your protected health information
to authorized federal officials for conducting national security and
intelligence activities including for the provision of protective services to
the President or others legally authorized.
Workers’ Compensation: we may disclose your protected health information as authorized to comply with workers’ compensation laws and other similar legally established programs.
Coroners, Funeral Directors, and Organ Donation: We may disclose protected health information to a coroner
or medical examiner for identification purposes, determining cause of death or
for the coroner or medical examiner to perform other duties authorized by law.
We may also disclose protected health information to a funeral director, as
authorized by law, in order to permit the funeral director to carry out their
duties. We may disclose such information in reasonable anticipation of death.
Protected health information may be used and disclosed for cadaveric organ, eye
or tissue donation purposes.
Research: We may disclose your protected health 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.
Criminal Activity: Consistent with applicable federal and state laws, we may
disclose your protected health information, if we believe that the use or
disclosure is necessary to prevent or lessen a serious and imminent threat to
the health or safety of a person or the public. We may also disclose protected
health information if it is necessary for law enforcement authorities to
identify or apprehend an individual.
Inmates: We may use or disclose your protected health information
if you are an inmate of a correctional facility and your physician created or
received your protected health information in the course of providing care to
you.
Uses and
Disclosures of Protected Health Information Based upon Your Written
Authorization: Other uses and disclosures of your protected health
information will be made only with your written authorization, unless otherwise
permitted or required by law as described below. You may revoke this
authorization, at any time, in writing, except to the extent that an action has
already been taken in reliance on the authorization
Your rights with
respect to your protected health information and how you may exercise those
rights are outlined below.
You have a right
to obtain a copy and/or inspect your health information: Health information includes treatment records, billing
records and any other records used by us to make decision about your treatment.
You may obtain a form from our office to request access. A reasonable cost-based
fee will be charged for expenses such as staff time, copies and postage. Contact
us as indicated at the end of this Notice to obtain information about our fees
or if you have any questions about your access.
You have a right
to request a restriction on the use and disclosure of your protected health
information: You may ask us not to use or disclose some part of your
protected health information for the purposes of treatment, payment or
operations. You may also request that we not disclose some part of your
information to family and others who may be involved in your care or for
notification purposes as otherwise described in this Notice. We are not required
to agree to the restrictions but if we do, we are obligated to abide by the
agreement except in cases of emergency. You may request a restriction by sending your request in
writing to our Privacy Contact.
You have a right to request to receive confidential
communications by alternative means or at an alternative location. We will accommodate reasonable requests. We may also
condition this accommodation by asking you for information as to how payment
will be handled or specification of an alternative address or other method of
contact. We will not request an explanation from you as to the basis for the
request. Please make this request in writing to our Privacy Contact.
You may have the right to request an amendment to your
protected health information.
You may request that we amend protected health information about you. Your
request must be in writing with an explanation as to why the information should
be amended. In certain cases, we may deny your request for an amendment. If we
deny your request for amendment, you have the right to file a statement of
disagreement with us. We may prepare a rebuttal to your statement and will
provide you with a copy of any such rebuttal.
You have the right to receive an accounting of certain
disclosures we have made, if any, of your protected health information. This right applies to disclosures made by our Business
Associates or us. It excludes
disclosures for treatment, payment or healthcare operations as described in this
Notice of Privacy Practices, to you, to family members or friends involved in
your care, for notification purposes or as a result of an authorization signed
by you. You have the right to receive specific information regarding these
disclosures that occurred after April 14, 2003 for up to the previous 6 years.
You may request a shorter timeframe. The right to receive this information is
subject to certain exceptions, restrictions and limitations. If you request an
accounting more than once in a 12 month period, we will charge you a reasonable
cost-based fee for responding to the additional request.
You have the right to obtain a paper copy of this notice
from us, upon
request, even if you have agreed to accept this notice electronically.
You may complain to us or to the Secretary of Health and
Human Services if you believe your privacy rights have been violated by us. You
may file a complaint with us by notifying our privacy contact of your complaint.
We will not retaliate against you for filing a complaint.
You may contact our Privacy Contact, Angela T. Bower at
704)289-2561 for further information about the complaint process.
This notice was published and becomes effective on
April 14, 2003.
This Notice describes how we may use and disclose your
protected health information to provide treatment, obtain payment and conduct
health care operations and for other purposes permitted or required by law. It
also describes your rights concerning 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.
We are required to abide by the terms of this Notice of
Privacy Practices. We may change the terms of our notice, at any time. The new
notice will be effective for all protected health information that we maintain
at that time. Upon your request, we will provide you with any revised Notice of
Privacy Practices by accessing this web site www.EdwardBowerMD.com, calling
the office and requesting that a revised copy be sent to you in the mail or
asking for one at the time of your next appointment .
Copyright © 1998 Edward B. Bower. All rights
reserved.
Revised: March 19, 2003
