Notice of Privacy Practices for Protected Health
Information
_________________________________________________________________
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU
MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO
THIS INFORMATION. PLEASE READ IT CAREFULLY.
_________________________________________________________________
The office is permitted by federal privacy laws to make
uses
and disclosures of 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. Each time you visit a
physician
or healthcare provider, the provider makes a record of your
visit.
Typically, this record contains your health history,
current
symptoms, examination and test results, diagnoses,
treatment, and
a plan for future care or treatment. This information,
often
referred to as your medical record serves as:
--basis for planning your care and treatment
--means of communication among the many health
professionals
who contribute to your care.
--legal document describing the care you received.
--means by which you or a third-party payer can verify that
you
actually received the services billed for.
-- a source of information for public health officials
charged
with improving the health of the regions they serve.
--a tool to assess the appropriateness and quality of care
you
received.
--a tool to improve the quality of healthcare and achieve
better patient outcomes.
Examples of uses of your health information for treatment
purposes
are:
-- A nurse obtains treatment information about you and
records
it in a health record.
--During the course of your treatment, the physician
determines
he/she will need to consult with another specialist in the
area. He/she will share the information with such
specialist
and obtain his/her input.
An example of use of your health information for payment
purposes:
--We submit a request for payment to your health insurance
company.
--The health insurance company requests information
from us regarding medical care given. We will provide
information to them about you and the care given.
An example of use of your health information for health
care
operations:
--The state licensing authority wants to review records to
assure that we have acted consistent with state laws
regarding your care. In doing so, it wants to take a
sampling
which includes review of your chart. At the licensing
authority's request, we will provide it with a copy of your
record.
Your Rights Under the Federal Privacy Standard
The health record we maintain and billing records are the
physical
property of the office. The information in it, however,
belongs to
you. You have a right to:
--Request a restriction on uses and disclosures of your
health information for treatment, payment, and health
care operations. Health care operations consist of
activities that are necessary to carry out the operations
of the provider, such as quality assurance and peer
review. The right to request restriction does not extend
to uses or disclosures permitted or required under
164.502(a)(2)(i)(disclosures to you), 164.510(a)(for
facility directories, but not that you have the right to
object to such uses), or 164.512(uses and disclosures not
requiring a consent or an authorization). The latter
uses and disclosures include, for example, those required
by law, like mandatory communicable disease reporting.
In those cases, you do not have a right to request
restriction. Even in those cases in which you do have
the right to request restriction, we do not have to agree
to the restriction. If we do, however, we will adhere to
it unless you request otherwise or we give you advance
notice.
You may also ask us to communicate with you by alternate
means and, if the method of communication is reasonable
we must grant the alternate communication request.
-- Receive and keep a copy of this notice of information
practices. Although we have posted a copy in prominent
locations throughout the facility, if you access those
copies, you nonetheless have a right to a hard copy on
request. The law requires us to ask you to acknowledge
receipt of your copy.
--Inspect and copy your health information upon request.
Again, this right is not absolute. In certain
situations, such as if access would cause harm, we can
deny access. You do not have a right of access to the
following:
--Psychotherapy notes. Such notes comprise those
that are recorded in any medium by a healthcare
provider who is a mental health professional
documenting or analyzing a conversation during
a private counseling session or a group, joint,
or family counseling session and that are
separated from the rest of your medical record.
--Information compiled in reasonable anticipation
of or for use in civil, criminal, or
administrative actions or proceedings.
--Any of your health information that is subject
to the Clinical Laboratory Improvement Amendments
of 1988 (CLIA), 42 U.S.C. 263a., the extent that
the provision of access to the individual would be
prohibited by law.
--Information was obtained from someone other than
a healthcare provider under a promise of
confidentiality and the access requested would
be reasonably likely to reveal the source of the
information.
In other situations, the provider may deny you access but,
if
he/she does, the provider must provide you with a review of
the
decision denying access. These reviewable grounds for
denial
include:
--When a licensed healthcare professional has
determined, in the exercise of professional
judgment, that the access is reasonably
likely to endanger the life or physical
safety of the individual or person.
--When the PHI makes reference to another
person (other than a healthcare provider)
and a licensed healthcare provider has
determined, in the exercise of professional
judgment, that the access is reasonably
likely to cause substantial harm to such
other person.
--The request is made by the individual's
personal representative and a licensed
healthcare professional has determined,
in the exercise of professional judgment,
that the provision of access to such
personal representative is reasonably
likely to cause substantial harm to the
individual or another person.
For these reviewable grounds, another licensed professional
must review the decision of the provider denying access
within 60
days. If we deny you access, we will explain why and what
your
rights are, including how to seek review.
If we grant access, we will tell you what, if anything, you
have to do to get access. We reserve the right to charge a
reasonable, cost-based fee for making copies.
Request amendment/correction of your health information
We do not have to grant the request if:
--We did not create the record. If, as in the case of a
consultation report from another provider, we did not
create the record, we cannot know whether it is accurate
or not. Thus, in such cases, you must seek amendment/
correction from the party creating the record. If they
amend or correct the record, we will put the corrected
record in our records.
--The records are not available to you as discussed
immediately above.
--The record is accurate and complete.
If we deny your request for amendment/correction, we will
notify you why, how you can attach a statement of
disagreement to
your records (which we may rebut), and how you can complain
to our
complaint official or to the Department of Health and Human
Services. If we grant the request, we will make the
correction and
distribute the correction to those who need it and those
you
identify to us that you want to receive the corrected
information.
Obtain an accounting of non-routine uses and disclosures
other than for treatment, payment, and health care
operations, or of protected health information about them.
We do not need to provide an accounting for:
--For disclosures to you.
--For disclosures authorized by you.
--For disclosures of limited data sets (partially
de-identified data used for research, public health,
or health care operations).
--For the facility directory or to persons involved
in your care or for other notification purposes as
provided in 164.510(uses and disclosures requiring an
opportunity for the individual to agree or to object,
including notification to family members, personal
representatives, or other persons responsible for the
care of the individual, of the individual's location,
general condition, or death).
--For national security or intelligence purposes under
164.512(k)(2) (disclosures not requiring consent,
authorization, or an opportunity to object.
--To correctional institutions or law enforcement
officials under 164.512(k)(5) (disclosures not
requiring consent, authorization, or an opportunity
to object).
--That occurred before April 14, 2003.
We must provide the accounting within 60 days. The
accounting
must include:
--Date of each disclosure.
--Name and address of the organization or person who
received the protected health information.
--Brief description of the information disclosed.
--Brief statement of the purpose of the disclosure
that reasonably informs you of the basis for the
disclosure or, in lieu of such statement, a copy
of your written authorization, or a copy of the
written request for disclosure.
The first account in any 12 month period is free.
Thereafter, we
reserve the right to charge a reasonable, cost-based fee.
Revoke your consent or authorization to use or disclose
health information except to the extent that we have
already
taken action in reliance on the consent or authorization.
Our Responsibilities Under the Federal Privacy Standard
In additional to providing you your rights, as detailed
above,
the privacy standard requires us to:
--Maintain the privacy of your health information,
including
implementing reasonable and appropriate physical,
administrative, and technical safeguards to protect the
information.
--Provide you with this notice as to our legal duties and
privacy practices with respect to individually
identifiable health information we collect and maintain
about you.
--Abide by the terms of this notice.
--Train our personnel concerning privacy and
confidentiality.
--Implement a sanction policy to discipline those who
breach
privacy/confidentiality or our policies with regard
thereto.
--Mitigate (lessen the harm of) any breach of
privacy/confidentiality.
WE RESERVE THE RIGHT TO CHANGE OUR PRACTICES AND
TO MAKE THE NEW PROVISIONS EFFECTIVE FOR ALL
INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION WE
MAINTAIN. SHOULD WE CHANGE OUR INFORMATION
PRACTICES, WE WILL MAIL A REVISED NOTICE TO THE
ADDRESS YOU HAVE SUPPLIED US.
We will not use or disclose your health information without
your
[consent or] authorization, except as described in this
notice or
otherwise required by law.
How to Get More Information or to Report a Problem.
If you have questions and/or would like additional
information,
you may contact Donna Stuteville, privacy officer at
913-432-3732.
EXAMPLES OF DISCLOSURES FOR TREATMENT,
PAYMENT, AND HEALTH OPERATIONS
Treatment: With the regulatory consent granted by the
Department
of Health and Human Services we may use or disclose your
health
information for treatment.
Example: A physician, nurse, or other member of your
healthcare
team will record information in your record to diagnose
your
condition and determine the best course of treatment for
you.
The primary caregiver will give treatment orders and
document
what he or she
expects other members of the healthcare team to do to treat
you. Those
other members will then document the actions they took and
their
observations. In that way, the primary
caregiver will know how you are responding to treatment.
We will also provide your physician, other healthcare
professionals, or a subsequent healthcare provider with
copies
of your records to assist them in treating you once we are
no
longer treating you.
Payment: With the regulatory consent granted by the
Department
of Health and Human Services we may use or disclose your
health
information for payment.
Example: We may send a bill to you or to a third-party
payer,
such as a health insurer. The information on or
accompanying
the bill may include information that identifies you, your
diagnosis, treatment received, and supplies used.
Health Operations: With the regulatory consent granted by
the
Department of Health and Human Services we may use or
disclose
your health information for health operations (see
definition above).
Example: Members of the medical staff, the risk or quality
improvement manager, or members of the quality assurance
team may
use information in your health record to assess the care
and the
outcomes in your cases and the competence of the
care-givers. We
will use
this information in an effort to continually improve the
quality and effectiveness of the healthcare and services we
provide.
Use and Disclosures Other than for Treatment, Payment, or
Health
Care Operations
Business Associates: We provide some services through
contracts
with business associates. Examples include certain
diagnostic
tests. When we use these services, we may disclose your
health
information to the business associate so that they can
perform the
function(s) we have contracted with them to do and bill you
or your
third-party payer for services rendered. To protect your
health
information, however, we require the business associate to
appropriately safeguard your information.
Notification: We may use or disclose information to notify
or
assist in notifying a family member, personal
representative, or
another person responsible for your care, your location,
and
general condition.
Communication with family: Unless you object, health
professionals, using their best judgment, 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 payment related to your 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 health information.
Funeral directors: We may disclose health information to
funeral
directors consistent with applicable law to enable them to
carry
out their duties.
Marketing/continuity of care: We may contact you to provide
appointment reminders or information about treatment
alternatives
or other health-related benefits and services that may be
of
interest to you.
Food and Drug Administration (FDA): We may disclose to the
FDA
health information relative to adverse effects with respect
to
food, drugs, supplements, product or product defects, or
post
marketing surveillance information to enable product
recalls,
repairs, or replacement.
Workers compensation: We may disclose health information to
the
extent authorized by and to the extent necessary to comply
with
laws relating to workers compensation or other similar
programs
established by law.
Public health: As required by law, we may disclose your
health
information to public health or legal authorities charged
with
preventing or controlling disease, injury, or disability.
Correctional institution: Should you be an inmate of a
correctional institution, we may disclose to the
institution or
agents thereof health information necessary for your health
and
the health and safety of other individuals.
Law enforcement: We may disclose health information
purposes as
required by law or in response to a valid subpoena.
Health oversight agencies and public health authorities: If
a
member of our work force or a business associate believes
in good
faith that we have engaged in unlawful conduct or otherwise
violated professional or clinical standards and are
potentially
endangering one or more patients, workers or the public,
they
may disclose your health information to health oversight
agencies
and/or public health authorities, such as the department of
health.
The Federal Department of Health and Human Services (DHHS)
as
necessary for them to determine our compliance with those
standards.
Complaints. Patients may file a formal complaint regarding
the
privacy practices of a covered provider. Such complaints
can be
made directly to the covered provider or to HHS' Office for
Civil
Rights (OCR), which is charged with investigating
complaints and
enforcing the privacy regulation at
http://www.hhs.gov/ocr/hipaa
or by calling (866) 627-7748.
Effective Date: April 14, 2003
Name of entity: Sunflower Medical Group, PA