NOTICE OF PRIVACY PRACTICES
Explanation of HIPPA
The Notice of
Privacy Practices (NPP) is the Practice’s fundamental privacy
document. The NPP will inform the patient of all the basic uses
this Practice will make of their Protected Health Information (PHI)
in the ordinary course of treatment, seeking payment for care to patient and the Practice’s health care operations. It will also
apprise the patient of other instances in which their PHI may be
released.
The NPP also
advises patients of certain special rights they have: (1) to revoke
an authorization they may have given to the Practice to disclose
their PHI, (2) to request special limits or conditions on the use of
their PHI, (3) to receive communications from the Practice by more
confidential means or at alternate locations, (4) to inspect and
copy their PHI, and (5) to amend their PHI.
This NPP should
be acknowledged by all patients receiving service after the
compliance date for the Privacy Rule, April 14, 2003. The Practice
must make a good faith effort to obtain the patient’s
acknowledgement of receipt of the NPP. If the patient is unable or
unwilling to acknowledge receipt of the NPP, the Practice may then
document that it attempted to obtain this acknowledgement, but the
patient would not or could not acknowledge its receipt.
The NPP will be conspicuously posted in the Practice’s office and additional copies are to be made available to patients upon request.
Notice of Privacy Practices
Abridged Edition
Effective April
14, 2003, the Department of Health & Human Services has implemented
protection for patient health care information. It outlines who we
may disclose information to without your authorization and how we
can disclose your protected health information with your
authorization as well as how you can gain access to your personal
health information or to make a complaint to the Department of
Health & Human Services if you feel your protected health
information was used in an improper way. This notice will give you
a brief description of our entire privacy practices.
Uses and Disclosures of Protected Health Information
So that this
office can treat you, receive payment for that treatment and run our
health care operation, we may use your protected health information
without your authorization to send to third party payers,
administrators, etc.
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USES AND DISCLOSURES OF PROTECTED
HEALTH INFORMATION THAT MAY BE MADE WITH YOUR WRITTEN AUTHORIZATION
With your signed
authorization we may make communications with you to promote
products and services that may not be for a specific purpose of
providing treatment advice. You have the right to revoke this
authorization. Other permitted and required uses and disclosures
that may be made without your authorization or opportunity to object
– we may disclose to a member of your family, a relative, a close
friend or other person you identify, your protected health
information that directly relates to that person’s involvement in
your health care. We may also disclose your protected health
information to an authorized public or private entity as required by
law.
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:
Required by law
-
Health Oversight
-
Legal Proceedings
-
Research
Your rights – You
may inspect or obtain a copy of your protected health information
for as long as we maintain that information unless protected by
federal law.
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RIGHT TO REQUEST A RESTRICTION OF YOUR
PROTECTED HEALTH INFORMATION
You may ask us
not to use or disclose any part of your protected health information
for the purpose of treatment, payment or health care operation.
Also, you may request that any part of your protected health
information not be disclosed to your family members or friends who
may be involved in your care. Your request must be in writing and
state specific restrictions requested and to whom it applies.
RIGHT TO REQUEST TO RECEIVE
CONFIDENTIAL COMMUNICATION FROM US BY ALTERNATIVE MEANS OR AT AN
ALTERNATIVE LOCATION
You may request
that you receive these communications from us at an alternative
location or by alternative means than is normally provided to other
patients.
RIGHT TO AMEND YOUR PROTECTED HEALTH
INFORMATION
You may request
an amendment to your protected health information for as long as we
maintain your protected health information. In certain cases we may
deny your request for an amendment.
RIGHT TO RECEIVE AN ACCOUNTING OF
CERTAIN DISCLOSRUES WE HAVE MADE
You have the
right to receive an accounting if we receive a request for
disclosure of information for purposes other than treatment, payment
and health care operations.
RIGHT TO OBTAIN A PAPER COPY OF THIS
NOTICE
You have the
right to receive a complete copy of our privacy practices by paper
or electronically.
COMPLAINTS
If you believe your privacy rights
have been violated, you may complain to us or to the Secretary of
Health & Human Services.
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This notice was published and becomes
effective April 15, 2003.
Practice Letterhead
Notice of Privacy Practices
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.
If you have any questions about this Notice,
please contact Melissa Hatt of our office, who is our privacy
contact.
This Notice of Privacy Practices describes how
we may use and disclose your protected health information to carry
out your treatment, collect payment for your care and manage the
health care operations of this office. It also describes our
policies concerning the use and disclosure of this information 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, that
relates to your past, present or future physical or mental health or
condition and related health care services.
We are required by federal law 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. You
may obtain revisions to our Notice of Privacy Practices by calling
the office or accessing our website and requesting that a revised
copy be sent to you in the mail or asking for one at the time of
your next appointment.
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USES AND DISCLOSURES OF PROTECTED
HEALTH INFORMATION
Uses and Disclosures of Protected Health
Information Based Upon Your Implied Consent
By applying to be treated in our office, you
are implying consent to the use and disclosure of your protected
health information 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. Your
protected health information may also be used and disclosed to bill
for your health care and to support the operation of the physician’s
practice.
Following are examples of the types of uses and
disclosures of your protected health care information we will make,
based on this implied consent. These examples are not meant to be
exhaustive but to describe the types of uses and disclosures that
may be made by our office.
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 another physician who
may be treating you. 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.
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 service provided to you for medical necessity, and
undertaking utilization review activities. For example, obtaining
approval for chiropractic care may require that your relevant
protected health information be disclosed to the health plan to
obtain approval for those services.
Healthcare Operations: We may use or
disclose, as needed, your protected health information in order to
support the business activities of your physician’s practice. These
activities include, but are not limited to, quality assessment
activities, employee review activities and conducting or arranging
for other business activities.
For example, we may use a sign-in sheet at the
registration desk where you will be asked to sign your name and
indicate your physician. Communications between you and the doctor
or his assistants or interns, etc., may be recorded to assist us in
accurately capturing your responses. We may also call you by name
in the waiting room when your physician is ready to see you. We may
use or disclose your protected health information, as necessary, to
contact you to remind you of your appointment.
We will share your protected health information
with third party “business associates” that perform various
activities (e.g., billing, transcription services) for the
practice. Whenever an arrangement between our office and a business
associate involves the use or disclosure of your protected health
information, we will have a written contract with that business
associate that contains terms that will protect the privacy of your
protected health information.
We may use or disclose your protected health
information, as necessary, to provide you with information about
treatment alternatives or other health-related benefits and services
that may be of interest to you. We may also use and disclose your
protected health information for other marketing activities. For
example, your name and address may be used to send you a newsletter
about our practice and the services we offer. We may also send you
information about products or services that we believe may be
beneficial to you. You may contact our staff members to request
that these materials not be sent to you.
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USES AND
DISCLOSURES OF PROTECTED HEALTH INFORMATION THAT MAY BE MADE WITH
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.
For example, with your written, signed
authorization, we may make communication with you to promote
products or services that may not be for the specific purpose
providing treatment advice.
You may revoke any of these authorizations at
any time, in writing, except to the extent that your physician or
the physician’s practice has taken an action in reliance on the use
or disclosure indicated in the authorization.
OTHER PERMITTED AND REQUIRED USES AND
DISCLOSURES THAT MAY BE MADE WITH YOUR AUTHORIZATION OR OPPORTUNITY
TO OBJECT
In the following instance where we may use and
disclose your protected health information, you have the opportunity
to agree or object to the use or disclosure of all or part of your
protected health information. If you are not present or able to
agree or object to the use or disclosure of the protected health
information, then your physician may, using professional judgment,
determine whether the disclosure is in your best interest. In this
case, only the protected health information that is relevant to your
health care will be disclosed.
Others Involved in Your Healthcare:
Unless you object, we may disclose to a member of your family, a
relative, a close friend or any other person you identify, your
protected health information that directly relates to that person’s
involvement in your health care. If you are unable to agree or
object to such a disclosure, we may disclose such information as
necessary if we determine that it is in your best interest based on
our professional judgment. We may use or disclose protected health
information to notify or assist in notifying a family member,
personal representative or any other person that is responsible for
your care of your location, general condition or death. 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 or other
individuals involved in your health care.
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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 the use or
disclosure is required by law. The use or disclosure will be made
in compliance with the law and will be limited to the relevant
requirements of the law. You will be notified, as required by law,
of any such uses or disclosures.
- Health Oversight: 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, government
benefit programs, other government regulatory programs and civil
rights 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.
- Research: We may disclose your
protected health information to researchers when an institutional
review board has approved their research and that review board has
reviewed the research proposal and established protocols to ensure
the privacy of your protected health information.
- Required Uses and Disclosures: Under
the law, we much make disclosures to you and when required by the
Secretary of the Department of Health and Human Services to
investigate or determine our compliance with the requirements of
Section 164.500 et. seq.
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YOUR RIGHTS
Following is a statement of your rights with
respect to your protected health information and a brief description
of how you may exercise these rights.
You have the right to inspect and copy your
protected health information. This means you may inspect and
obtain a copy of protected health information about you that is
contained in a designated record set for as long as we maintain the
protected health information. A “designated record set” contains
medical and billing records and any other records that your
physician and the practice uses for making decisions about you.
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. Depending on the circumstances, a
decision to deny access may be reviewable. In some circumstances,
you may have a right to have this decision reviewed. Please contact
our staff members if you have questions about access to your medical
record.
You have the right to request a restriction
of your protected health information. This means you may ask us
not to use or disclose any part of your protected health information
for the purposes of treatment, payment or health care operations.
You may also request that any part of your protected health
information not be disclosed to family members or friends who may be
involved in your care or for notification purposes as described in
this Notice of Privacy Practices. Your request must be in writing
and state the specific restriction requested and to whom you want
the restriction to apply.
Your physician is not required to agree to a
restriction that you may request. If your physician believes it is
in your best interest to permit use and disclosure of your protected
health information, your protected health information will not be
restricted. If your physician does agree to the requested
restriction, we may not use or disclose your protected health
information in violation of that restriction unless it is needed to
provide emergency treatment. With this in mind, please discuss any
restriction you wish to request with your physician. You may
request a restriction by presenting your request, in writing to a
staff member. A simple sentence, “do not use my PHI (protected
health information) for education of Chiropractic Students.” Or “Do
not send any communication to my home address.” Sign and date your
request. Ask that the staff provide you with a photocopy of your
request initialed by them. This copy will serve as your receipt.
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You have the right to request to receive
confidential communication from us 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 have your
physician amend your protected health information. This means
you may request an amendment of protected health information about
you in a designated record set for as long as we maintain this
information. 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 and we may prepare
a rebuttal to your statement and will provide you with a copy of any
such rebuttal. Please contact our staff members to determine if you
have questions about amending your medical record.
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 for
purposes other than treatment, payment or healthcare operations as
described in this Notice of Privacy Practices. It excludes
disclosures we may have made to you, for a facility directory, to
family members or friends involved in your case, pursuant to a duly
executed authorization or for notification purposes. You have the
right to receive specific information regarding theses disclosures
that occurred after April 14, 2003. You may request a short
timeframe. The right to receive this information is subject to
certain exceptions, restrictions and limitations.
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.
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COMPLAINTS
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 staff members of your complaint. We will not retaliate against
you for filing a complaint.
You may contact any staff member, including
your physician at ( 517 ) 347-2222 for further information
about the complaint process.
This notice was published and becomes effective
on April 15, 2003.
ADDITIONAL EXAMPLES FOR NOTICE OF
PRIVACY
THAT MAY BE ADDED TO YOUR NOTICE OF
PRIVACY
NOTICE OF PRIVACY PRACTICES
Open Treatment Rooms – You will have
the opportunity to talk to your doctor and staff members in
private. However, this practice provides treatment in an open
area. This means that statements made by you or practice
employees during treatment may be overheard by others. If you
have comments you wish to make privately when you are brought to
the treatment area or during treatment, please inform the doctor
or staff and we will accommodate your request.
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PATIENT AUTHORIZATION TO USE AND
DISCLOSE PROTECTED HEALTH INFORMATION (PHI)
Explanation
The Privacy Rule
describes a number of areas where this Practice may use and disclose
Protected Health Information (PHI) without the patient’s express
authorization. For example, to disclose a patient’s PHI for
treatment, payment and health care operations of this Practice.
Privacy Rules describe a number of situations where the Practice
must disclose a patient’s Protected Health Information (PHI)
pursuant to government orders, investigations and judicial process
or to avert a serious threat to health or safety.
Privacy Rules
require this Practice to obtain from the patient written approval in
the form of an executed authorization to use and disclose the
patient’s PHI for any other purposes. However, the Practice may
never make the patient’s agreement to execute such an authorization
a condition of care.
he most common
use of an authorization by this Practice might be to provide the
patient’s PHI to a person or entity that sells items or services,
especially health care items or services, which the patient might be
interested in.
This form is not
needed if we intend to advise the patient of services or products
that we can provide to aid in the patient’s care. It is only needed
if we intend to provide the patient’s PHI to another business, so
that they may, themselves, market the product or service.
The Practice’s
form authorization should be used if this Practice intends to
provide a patient’s PHI to some other person or entity for marketing
purposes or any other purpose not permitted by the Privacy Rule or
state law without such an authorization.
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