THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU GET ACCESS TO THIS INFORMATION.
PLEASE READ IT CAREFULLY.
This Notice of Privacy Practices is being provided to you as a requirement of the Health Insurance Portability and Accountability Act (HIPPA). This Notice describes how we may use and disclose your protected health information to carry out treatment, payment, or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information in some cases. Your “protected health information” means any of your written and oral health information, including demographic data that can be used to identify you. This is health information that is created or received by your health care provider, and that relates to your past, present, or future physical or mental health or condition.
The provider may use your protected health information for purposes of providing treatment, obtaining payment for treatment, and conducting health care operations. Your protected health information may be used or disclosed only for these purposes unless the Provider has obtained your authorization, or the use or disclosure is otherwise permitted by the HIPPA Privacy Regulations or State law. Disclosures of your protected health information for the purposes described in this Notice may be made in writing, orally, or by facsimile.
Treatment. We may use and disclose your protected health information for our treatment purposes as well as the treatment purposes of other health care providers. Treatment includes the provision, coordination, or management of health care services to you by one or more health care provider. Some examples of treatment uses and disclosures include:
* During an office visit, practice physician and other staff involved in your care may review your medical record and share and discuss your medical information with each other.
* We may share information to a pharmacy to fulfill a prescription.
* We may share information with a laboratory or x-ray department to order testing.
* We may share information with a home health agency, durable medical equipment agency that is providing care in your home.
* We may share and discuss your medical information with an outside physician to whom we have referred you for care.
* We may share and discuss your medical information with an outside physician with whom we are consulting regarding you.
* We may share and discuss your medical information with a hospital or other health care facility where we are admitting or treating you.
* We may page patients in the waiting room when it is time for them to go to an examining room.
* We may contact you to provide appointment reminders or appointment cancellations.
* We may mail you prescriptions, lab slips, hospital orders, diets.
Payment. We may use and disclose your protected health information for our payment purpose as well as the payment purposes of other health plans. Payment uses and disclosures include activities conducted to obtain payment for the care provided to you or so that you can obtain reimbursement for that care, for example, from our health insurer. Some examples of payment uses and disclosures include:
* Sharing information with your health insurer to determine whether you are eligible for coverage or whether proposed treatment is a covered service.
* Submission of a claim form to your health insurer.
* Providing supplemental information to your health insurer so that your health insurer can obtain reimbursement from another health plan under coordination of benefits (COB) clause in your subscriber agreement.
* Sharing your demographic information with other health care providers who seek this information to obtain payment for health care services provided to you.
* Mailing you bills in envelopes with our practice name and return address.
* Provision of a bill to a family member or other person designated as responsible for payment for services rendered to you.
* Providing medical records and other documentation to your health insurer to support the medical necessity of a health service.
* Allowing your health insurer access to your medical record for medical necessity or quality review audit.
Operations. We may use and disclose your protected health information for our health care operation purposes as well as certain health care operation purposes of other health care providers and health plans. Some examples of health care operation purposes include:
* Quality assessment and improvement activities.
* Employee review activities.
* Training programs including those in which students, trainees, or practitioners in health care learn under supervision.
* Accreditation, certification, licensing or credentialing activities.
* Review and auditing, including compliance reviews, medical reviews, legal services and maintain compliance programs.
Federal privacy rules allow us to use or disclose your protected health information without your permission or authorization for several reasons including the following:
When Legally Required. We will disclose your protected health information when we are required to do so by any Federal, State or local law.
When There Are Risks to Public Health. We may disclose your protected health information for the following public activities and purposes:
* To prevent, control, or report disease, injury or disability as permitted by law.
* To report vital events such as birth or death as permitted or required by law.
* To conduct public health surveillance, investigations, and interventions as permitted or required by law.
* To collect or report adverse events and product defects, tract FDA regulated products, enable product recalls, repairs or replacements to the FDA and to conduct post marketing surveillance.
* To notify a person who has been exposed to a communicable disease or who may be at risk of contracting or spreading a disease as authorized by law.
* To report to an employer information about an individual who is a member of the workforce as legally permitted or required.
To Report Abuse, Neglect Or Domestic Violence. We may notify government authorities if we believe that a patient is the victim of abuse, neglect or domestic violence. We will make this disclosure only when specifically required or authorized by law or when the patient agrees to the disclosure.
To Conduct Health Oversight Activities. We may disclose your protected health information to a health oversight agency for activities including audits; civil, administrative, or criminal investigations, proceedings, or actions; inspections; licensure or disciplinary actions; or other activities necessary for appropriate oversight as authorized by law. We will not disclose your health information if you are subject of an investigation and your health information is not directly related to your receipt of health care or public benefits.
In Connection with Judicial And Administrative Proceedings. We may disclose your protected health information in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal as expressly authorized by such order or in response to a subpoena in some circumstances.
For Law Enforcement Purposes. We may disclose your protected health information to a law enforcement official for law enforcement purposes as follows:
* As required by law for reporting of certain types of wounds or other physical injuries.
* Pursuant to court order, court-ordered warrant, subpoena, summons or similar process.
* For the purpose of identifying or locating a suspect, fugitive, material witness or missing person.
* Under certain limited circumstances, when you are the victim of a crime.
* To a law enforcement official if the provider has a suspicion that your death was the result of criminal conduct.
* In an emergency in order to report a crime.
To Coroners, Funeral Directors, and for Organ Donation. We may disclose protected health information to a coroner or medical examiner for identification purposes, to determine 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.
For Research Purposes. We may use or disclose your protected health information for research when the use or disclosure for research has been approved by an institutional review board or privacy board that has reviewed the research proposal and research protocols to address the privacy of your protected health information.
In the Event of A Serious Threat To Health Or Safety. We may, consistent with applicable law and ethical standards of conduct, use or disclose your protected health information if we believe, in good faith, that such use or disclose is necessary to prevent or lessen a serious and imminent threat to your health or safety or to the health and safety of the public.
For Specified Government Functions. In certain circumstances, the Federal regulations authorize the provider to use or disclose your protected health information to facilitate specified government functions relating to military and veterans’ activities, national security and intelligence activities, protective services for the President and others, medical suitability determinations, correctional institutions, and law enforcement custodial situations.
For Worker’s Compensation. The provider may release your health information to comply with worker’s compensation laws or similar programs.
We may disclose your protected health information to your family member or a close personal friend if it is directly relevant to the person’s involvement in your care or payment related to your care. We can also disclose your information relating to trying to locate or notify family members or others involved in your care concerning your location, condition or death.
You may object to these disclosures. If you do not object to these disclosures or we can infer from circumstances that you do not object or we determine, in the exercise of our professional judgment, that it is in your best interests for us to make disclosure of information that is directly relevant to the person’s involvement with your care, we may disclose your protected health information as described.
Other than as stated above, we will not disclose your health information other than with your written authorization. You may revoke your authorization in writing at any time except to the extent that we have acted in reliance upon the authorization. The following disclosures require your authorization.
Psychotherapy notes: These are the notes of a mental health professional that are kept separate from record itself.
Protected information that the office uses for marketing.
You have the following rights regarding your health information:
The right to inspect and copy your protected health information. You may inspect and obtain a copy of your protected health information 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 provider 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 for use in, a civil, criminal, or administrative action or proceeding; and protected health information that is subject to a law that prohibits access to protected health information. Depending on the circumstances, you may have the right to have a decision to deny access reviewed.
We may deny your request to inspect or copy your protected health information if, in our professional judgment, we determine that the access requested is likely to endanger your life or safety or that of another person, or that it is likely to cause substantial harm to another person referenced within information. You have the right to request a review of this decision.
To inspect and copy your medical information, you must submit a written request to the Privacy Officer whose contact information is listed on the last pages of this Notice. If your records are maintained in electronic format, you may request a copy in an electronic format, or designate that we send your records to a third party in electronic format. If you request a copy of your information, we may charge you a fee for the costs of copying, mailing or other costs incurred by us in complying with your request.
Please contact our Privacy Officer if you have questions about access to your medical record.
The right to request a restriction on uses and disclosures of your protected health information. You may ask us not to use or disclose certain parts of your protected health information for the purposes of treatment, payment or health care operations. You may also request that we not disclose your health information 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 state the specific restriction requested and to whom you want the restriction to apply.
The provider is not required to agree to a restriction that you may request. We will notify you if we deny your request to a restriction. If the provider 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. Under certain circumstances, we may terminate our agreement to a restriction. You may request a restriction by contacting the Privacy Officer.
If you pay for a service in full out of pocket you can request that the office not disclose any information about that service to an insurance company, the request must be in writing and must identify what information is to be restricted and what insurance company is not to receive.
The right to request to receive confidential communications from us by alternative means or at an alternative location. You have the right to request that we communicate with you in certain ways. We will accommodate reasonable requests. We may 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 require you to provide an explanation for your request. Requests must be made in writing to our Privacy Officer.
The right to have your physician amend your protected health information. 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 an 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. Requests for amendment must be in writing and must be directed to our Privacy Officer. In this written request, you must also provide a reason to support the requested amendments.
The right to receive an accounting. You have the right to request an accounting of certain disclosures of your protected health information made by the provider. This right applies to disclosures of purposes other than treatment, payment or health care operations as described in this Notice of Privacy Practices. We are also not required to account for disclosures that you requested, disclosures that you agreed to by signing an authorization form, disclosures for a facility directory, to friends or family members involved in your care, or certain other disclosures we are permitted to make without your authorization. The request for an accounting must be made in writing to our Privacy Officer. The request should specify the time period sought for the accounting. We are not required to provide an accounting for disclosures that take place prior to April 14,2003. Accounting requests may not be made for periods of time in excess of six years. We will provide the first accounting you request during any 12-month period without charge. Subsequent accounting requests may be subject to a reasonable cost-based fee.
The right to opt out of fundraising. You can opt out of receiving fundraising communications from the office.
The right to obtain a paper copy of this notice. Upon request, we will provide a separate paper copy of this notice even if you have already received a copy of the notice or have agreed to accept this notice electronically.
The provider is required by law to maintain the privacy of your health information and to provide you with this Notice of our duties and privacy practices. We are required to abide by terms of the Notice as may be amended from time to time. We reserve the right to change the terms of this Notice and to make the new Notice provisions effective for all protected health information that we maintain. If the provider changes its Notice, we will provide a copy of the revised Notice by sending a copy of the Revised Notice via regular mail or through in-person contact.
You have the right to express complaints to the provider and to the Secretary of Health and Human Services if you believe that your privacy rights have been violated. You may complain to the provider by contacting the provider’s Privacy Officer verbally or in writing, using the contact information below. We encourage you to express any concerns you may have regarding the privacy of your information. You will not be retaliated against in any way for filing a complaint.
The office will notify patients in writing in the event of an unauthorized use or disclosure of your health information
occurs. Notice of any such use or disclosure will be made in accordance with state and federal regulations.
The provider’s contact person for all issues regarding patient privacy and your rights under the Federal privacy standards
is the Privacy Officer. Information regarding matters covered by this Notice can be requested by contacting Privacy
Office. Complaints against the provider can be mailed to the Privacy Officer by sending it to:
Privacy Officer
200 Renaissance Drive
Suite 103
Butler, PA 16001-7612
The Privacy Officer can be contacted by telephone at 724-256-9606.
This notice is effective April 14, 2003
Notice updated December 31, 2017
