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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 Dr. Corser
at 513.721.9600
This Notice of Privacy Practices 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. "Protected health information"
is information about you, including demographic information, that
may identify you and that 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
both before and after the change. Upon your request, we will provide
you with any revised Notice of Privacy Practices by 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.
1. Uses and Disclosures of Protected Health Information
Uses and Disclosures of Protected Health Information
You will be asked by your physician to sign this Notice of Privacy
Practices. We will make a good faith effort to obtain a written acknowledgement
that you received this Notice of Privacy Practices for Protected Health
Information the first time we provide services to you after April
14, 2003 or as soon as reasonably practicable under the circumstances.
Your protected health information may be used and disclosed 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 obtain payment for your health care
bills 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 that the physician's office is permitted
to make. Theses 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 may need 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. 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.
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.
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, training of medical students,
licensing, and conducting or arranging for other business activities.
For example, we may disclose your protected health information to
medical school students that see patients at our office. In addition,
we may use a sign-in sheet at the registration desk where you will
be asked to sign your name and indicate your physician. 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 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 Privacy
Contact to request that these materials not be sent to you.
We may use or disclose your demographic information and the dates
that you received treatment from your physician, as necessary, in
order to contact you for fundraising activities supported by our office.
If you do not want to receive these materials, please contact our
Privacy Contact and request that these fundraising materials not be
sent 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 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
without Your Authorization or Opportunity to Object
We may use and disclose your protected health information in the following
instances. 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.
Facility Directories.
Unless you object, we will use and disclose in our facility directory
your name, the location at which you are receiving care, your condition
(in general terms), and your religious affiliation. All of this information,
except religious affiliation, will be disclosed to people that ask
for you by name. Members of the clergy will be told your religious
affiliation.
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.
Emergencies.
We may use or disclose your protected health information in an emergency
treatment situation. If this happens, your physician shall try to
obtain your acknowledgement of our Privacy Practices as soon as reasonably
practicable after the delivery of treatment. If your physician or
another physician in the practice is required by law to treat you
and the physician has attempted to obtain your acknowledgement, but
is unable, he or she may still use or disclose your protected health
information for treatment, payment, and health care operations.
Communication Barriers.
We may use and disclose your protected health information if your
physician or another physician in the practice attempts to obtain
an acknowledgement of our Privacy Practices from you, but is unable
to do so due to substantial communication barriers.
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 acknowledgement 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.
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.
We may also disclose your protected health information, if directed
by the public health authority, to a foreign government agency that
is collaborating with the public health authority.
Communicable Diseases.
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.
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.
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.
Food and Drug Administration.
We may disclose your protected health information to a person or
company required by the Food and Drug Administration to report adverse
events, product defects or problems, biologic product deviations;
track products; to enable product recalls; to make repairs or replacements;
or to conduct post marketing surveillance, as required.
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.
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 his/her 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.
Military Activity and National Security.
When the appropriate conditions apply, we may use or disclose protected
health information of individuals who are Armed Forces personnel:
(1) for activities deemed necessary by appropriate military command
authorities; (2) for the purpose of a determination by the Department
of Veterans Affairs of your eligibility for benefits; or (3) to
foreign military authority if you are a member of that foreign military
services. 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.
Your protected health information may be disclosed by us as authorized
to comply with workers' compensation laws and other similar legally
established programs.
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.
Required Uses and Disclosures.
Under the law, we must 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 federal regulations that protect the privacy of your protected
health information.
2. 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 Privacy Contact 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 healthcare 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 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 a 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 submitting
a written request to our Privacy Contact.
You have the right to request to receive confidential communications
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 Privacy Contact
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 and valid authorizations or incidental
disclosures 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 care, or for notification
purposes. You have the right to receive specific information regarding
these disclosures that occurred after April 14, 2003. You may request
a shorter 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.
3. 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 Privacy Contact of
your complaint. We will not retaliate against you for filing a complaint.
You may contact Dr. Corser, at 513.721.9600 for further information
about the complaint process.
This notice was published and becomes effective on April 14, 2003.
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