I. OUR PLEDGE TO PROTECT YOUR PRIVACY.
The physicians and staff of the Medical Center are committed to protecting the privacy of your protected health information (PHI). PHI is the information we obtain and the record we create of the care and services you receive. We understand that the medical information about you and your health is personal. This record is also used to comply with certain legal requirements.
This Notice will tell you about the ways in which we may use and disclose medical information about you. These are examples only and do not represent a complete list. We also describe your rights and certain obligations we have regarding the use and disclosure of your PHI. We are required by law to protect the privacy of your health information. We are also required by law to give you this Notice of our legal duties and privacy practices with respect to your PHI, make a good faith effort to obtain your acknowledgment of receipt of this notice and follow the terms of the Notice that is currently in effect. You will be asked to sign a printed acknowledgment of your receipt of the Notice of Privacy Practices.
We reserve the right to change this Notice of Privacy Practice and to make the revised or changed Notice effective for medical information we already have about you as well as any information we obtain in the future. A copy of the current notice will be posted in a prominent location at each of our facilities. A copy of the Notice will be made available to any person upon request.
II. HOW WE MAY USE AND DISCLOSE YOUR PHI.
The following categories describe different ways that we are permitted to use and disclose your PHI without authorization from you.
For Treatment.
We may use and disclose your PHI to provide you with medical treatment or services. During the course of your treatment, your physician may consult with another healthcare provider outside of the Medical Center. We may disclose your PHI to coordinate your care with other departments or for laboratory, radiology or pharmaceutical services within or outside of the Medical Center.
For Payment.
We may use and disclose your PHI so that the treatment and services you receive may be billed to and payment may be collected from you, an insurance company or other third party. We may disclose treatment information to your health plan or a clearinghouse to determine eligibility, authorization to provide services or to determine medical necessity. We may also disclose your PHI through our family billing statement sent to you at an address designated by you, to a clearinghouse or to a collection agency.
For Health Care Operations.
We may use and disclose your PHI for the daily operation of our clinics. These uses and disclosures are necessary to provide health services to our patients, conduct coding audits, respond to patient complaints or for cost management and reporting purposes. We may use and disclose your PHI for quality improvement activities and for the education and training of our staff and medical students. We may also disclose information to pharmacies, nursing homes, others involved in your care or to you by mail, fax or phone. We may disclose medical information about you to another health care provider or health plan with which you also have had a relationship for purposes of that provider’s or plan’s operations.
Appointment Reminders.
We may use and disclose your PHI to contact you by letter, phone or by leaving a message on your answering machine as a reminder that you have an appointment or need to make an appointment for medical care at one of our locations. If you are a new patient, we may send a welcome letter to your home.
Marketing.
We may use your PHI to inform you of or recommend possible treatment options or alternatives that may be of interest to you or to inform you of health-related benefits or services that may be of interest to you.
Family or Friends Involved In Your Care or Payment For Your Care.
Using our best judgement, we may disclose your PHI to a family member, other relative, close personal friend, or any other person you identify relevant to that person’s involvement in your care or in payment for such care or in an emergency if you do not object. You may identify the individuals in writing by completing our request form and delivering it to our office at 1100 North Main.
As Required By Law.
We will use and disclose your PHI when required to do so by federal, state, or local law. |
III. OTHER DISCLOSURES AND USES.
Serious Threat to Health or Safety.
We may use and disclose your PHI when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
Public Health Risks.
We may disclose your PHI for public health activities. These activities generally include the following:
- to prevent or control disease, injury or disability
- to report births and deaths
- to report child abuse or neglect
- to report reactions to medications or problems with products
- to notify people of recalls of products they may be using
- to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition
to notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.
Organ and Tissue Donation.
If you choose to be an organ donor, we may use or disclose your PHI to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
Workers’ Compensation.
We may disclose your PHI for workers’ compensation or similar programs as required by law . These may include disclosures to your employer to conduct evaluations for medical surveillance of the workplace or for a work-related illness or injury.
Health Oversight Activities.
We may disclose your PHI to a health oversight agency for activities authorized by law. These activities may include, audits, investigations, inspections, surveys, licensure, and disciplinary action. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
Lawsuits and Disputes.
If you are involved in a lawsuit or a dispute, we may disclose your PHI in response to a court or administrative order. We may also disclose your PHI in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
Law Enforcement.
We may disclose your PHI if asked to do so by a law enforcement official. The requests may be for the following: (1) in response to a court order, subpoena, warrant, summons or similar process (2) to identify or locate a suspect, fugitive, material witness, or missing person (3) about the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement (4) about a death we believe may be the result of criminal conduct (5) about criminal conduct at our office; and (6) in emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime
Coroners, Medical Examiners and Funeral Directors.
We may disclose a deceased person’s PHI to a coroner or medical examiner. This may be necessary to identify a deceased person or determine the cause of death. We may also disclose a deceased person’s PHI to funeral directors as necessary for them to carry out their duties.
Specialized Government Functions.
If you are a member of the U.S. armed forces, a veteran or foreign military personnel we may disclose your PHI as required by U.S. or foreign military command authorities. We may disclose your PHI to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law. We may disclose your PHI to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or others who conduct special investigations.
Correctional Institutions.
If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may disclose to the institution or law enforcement agency the PHI necessary to protect your health and safety, the health and safety of others and the safety and security of the correctional institution.
Research.
We will use or disclose only de-identified information for research purposes, or a limited data set under a data use agreement.
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