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.

A record is made each time you visit a hospital, physician, or other health care provider.  Your symptoms, examination and test results, diagnoses, treatment, and a plan for future care are recorded.  This information is most often referred to as your “health or medical record,” and serves as a basis for planning your care and treatment.  It also serves as a means of communication among any and all other health professionals who may contribute to your care.  Understanding what information is retained in your record and how that information may be used will help you to ensure its accuracy, and enable you to relate to who, what, when, where, and why others may be allowed access to your health information.  This effort is being made to assist you in making informed decisions before authorizing the disclosure of your medical information to others.

Your health record is the physical property of the health care practitioner or facility that compiled it but, the content is about you and therefore belongs to you.  You have the right to request restrictions on certain uses and disclosures of your information, and to request, amendments are made to your health record.  Your rights include being able to review or obtain a paper copy of your health information and to be given an account of all disclosures.  You may also request communications of your health information be made by alternative means or to alternative locations.  Other than the activity that has already occurred, you may revoke any further authorizations to use or disclose your health information.

This office is required to maintain the privacy of your health information and to provide you with notice of our legal commitment and privacy practices with respect to the information we collect and maintain about you.  This office is required to abide by the terms of this notice and to notify you if we are unable to grant your requested restrictions or reasonable desires to communicate your health information by alternative means or to alternative locations.

This office reserves the right to change its practices and effect new provisions that enhance the privacy standards of all patient medical information.  In the event that changes are made, this office will notify you at the current address provided on your medical file.  If applicable, this office will post changes on our web site that provides information about our customer service and/or benefits.
 
Other than for reasons described in this notice, this office agrees not to use or disclose your health information without your authorization.

We will use your health information for treatment. For example, information obtained by a healthcare practitioner will be recorded in your record and used to determine the course of treatment that should work best for you.  Your physician will document in your record their expectations of the members of your healthcare team.  Members of your healthcare team will then record the actions they took and their observations (example varies by practitioner type).  We will also provide your physician or a subsequent healthcare provider with copies of various reports that should assist them in treating you.

We will use your health information for payment. For example , a bill may be sent to you or a third-party payer.  The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used. An exception would be an instance in which you have paid for your health care out of pocket, in which case this office must agree to your requested restriction with respect to communications with your health plan.

We will use your health information for regular health operations. For example, members of the medical staff, the risk or quality improvement manager, or members of the quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it.  This information will then be used in an effort to continually improve quality and effectiveness of the healthcare and service we provide.

Business Associates: There may be some services provided in our organization through contracts with Business Associates.  Examples include physician services in the emergency department and radiology, certain laboratory tests, and a copy service we use when making copies of your health record.  When these services are contracted, we may disclose some or all of your health information to our Business Associate so that they can perform the job we’ve asked them to do.  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: Health professionals, using their best judgment, may disclose to a family member, other relatives, close personal friends oar 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 an institution review board that has reviewed the research proposal, and established protocols to ensure the privacy of your health information has approved their research..

Organ procurement organizations: Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.

Marketing: 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): As required by law, we may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.

Workers compensation: We may disclose health information to be 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 tracking birth and deaths, as well as 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.  An inmate does not have the right to the Notice of Privacy Practices.

Law enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.  Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public.

You have the following rights regarding the health information we maintain about you.

Right to Inspect and Copy. You have the right to inspect and copy your health information, such as medical and billing records, that we use to make decisions about your care.  You must submit a written request to [designated privacy official contact] in order to inspect and/or copy your health information.  If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other associated supplies.  We may deny your request to inspect and/or or copy in certain limited circumstances.  If you are denied access to your health information, you may ask that the denial be reviewed.  If law requires such a review, we will select a licensed healthcare professional to review your request and our denial.  The person conducting the review will not be the person who denied your request, and we will comply with the outcome of the review.

Right to Amend.  If you believe health information we have about you is incorrect or incomplete, you may ask us to amend the information.  You have the right to request an amendment as long as the information is kept by this office.

To request an amendment, complete and submit a Medical Record Amendment/Correction Form to the Privacy Officer.  We may deny your request for an amendment if it is not in writing or does not include a reason to support the request.

In addition, we may deny your request if you ask us to amend information that:

a)  We did not create, unless the person or entity that created the information is no longer available to make the   amendment.
b)    Is not part of the health information that we keep.
c)    You would not be permitted to inspect and copy.
d)    Is accurate and complete.

Right to an Accounting of Disclosure. You have the right to request an “accounting of disclosures.” This is a list of the disclosures we made of medical information about you for purposes other than treatment, payment and healthcare operations. To obtain this list, you must submit your request in writing to the Privacy Officer. It must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper or electronically). We may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

Right to Request Restrictions. You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment or healthcare operations.  You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for it, like a family member or friend.  For example, you could ask that we not use or disclose information about a surgery you had.

We are Not Required to Agree to Your Request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.

To request restrictions, you may complete and submit the Request for Restriction On Use/Disclosure of Medical Information to the Privacy Officer.

Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location.  For example, you can ask that we only contact you at work or by mail.

To request confidential communications, you may complete and submit the Request for Restriction on Use/Disclosure of Medical Information and/or Confidential Communication to the Privacy Officer.  We will not ask you the reason for your request.  We will accommodate all reasonable requests. Must specify how or where you wish to be contacted.

This notice will be prominently posted where registration occurs.  Patients will be provided a hard copy, if so desired and the notice will be maintained on our Web site (if applicable Web site exists) for downloading

THIS OFFICE MUST NOTIFY ANY AFFECTED INDIVIDUALS OF BREACHES OF THEIR PROTECTED HEALTH INFORMATION.

If you have questions and would like additional information, you may contact the practice’s Privacy Officer at 410-583-1000.  

If you believe your rights have been violated, you can file a complaint with the center’s Privacy Officer, or with the Office for Civil Rights, U.S. Department of Health and Human Services.  There will be no retaliation for filing a complaint with either the Privacy Officer or the Office for Civil Rights.  The address for the Office of Civil Rights is listed below: