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Privacy Notice
YOUNG
MEDICAL/TOLEDO I.V. CARE NOTICE OF PRIVACY PRACTICES
As
required by the Privacy Regulations Promulgated Pursuant to the Health Insurance
Portability and Accountability Act of 1996 (HIPAA). THIS NOTICE DESCRIBES HOW
HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET
ACCESS TO YOUR IDENTIFIABLE HEALTH INFORMATION.
PLEASE REVIEW THIS NOTICE CAREFULLY.
A.
OUR COMMITMENT TO YOUR PRIVACY
Our organization is dedicated to maintaining the privacy of your
identifiable health information. In
conducting our business, we will create records regarding you and the treatment
and services we provide to you. We
are required by law to maintain the confidentiality of health information that
identifies you. We also are required
by law to provide you with this notice of our legal duties and privacy practices
concerning your identifiable health information.
By law, we must follow the terms of the notice of privacy practices that
we have in effect at the time.
To summarize, this notice provides you with the following important
information:
·
How we may use and disclose your identifiable health information
·
Your privacy rights in your identifiable health information
·
Our obligations concerning the use and disclosure of your identifiable
health information.
The
terms of this notice apply to all records containing your identifiable health
information that are created or retained by our practice.
We reserve the right to revise or amend our notice of privacy practices.
Any revision or amendment to this notice will be effective for all of
your records our practice has created or maintained in the past, and for any of
your records we may create or maintain in the future.
Our organization will post a copy of our current notice in our offices in
a prominent location, and you may request a copy of our most current notice
during any office visit.
B.
IF YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT:
James Frederick, Compliance Officer, (419) 930-1401
C. WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION IN THE
FOLLOWING
WAYS
The following categories describe the different ways
in which we may use and disclose your identifiable health information.
1.
Treatment. Our
organization may use your identifiable health information to treat you.
For example, we may ask you to undergo laboratory tests (such as blood or
urine tests), and we may use the results to help us reach a diagnosis. Many of
the people who work for our organization may use or disclose your identifiable
health information in order to treat you or to assist others in your treatment.
Additionally, we may disclose your identifiable health information to
others who may assist in your care, such as your physician, therapists, spouse,
children or parents.
2. Payment.
Our organization may use and disclose your identifiable health
information in order to bill and collect payment for the services and items you
may receive from us. For example, we
may contact your health insurer to certify that you are eligible for benefits
(and for what range of benefits), and we may provide your insurer with details
regarding your treatment to determine if your insurer will cover, or pay for,
your treatment. We also may use and
disclose your identifiable health information to obtain payment from third
parties that may be responsible for such costs, such as family members.
Also, we may use your identifiable health information to bill you
directly for services and items.
3. Health Care Operations.
Our organization may use and disclose your identifiable health
information to operate our business. As
examples of the ways in which we may use and disclose your information for our
operations, our organization may use your health information to evaluate the
quality of care you received from us, or to conduct cost-management and business
planning activities for our practice.
4. Appointment Reminders.
Our organization may use and disclose your identifiable health
information to contact you and remind you of visits/deliveries.
5. Health-Related Benefits and
Services.
Our organization may use and disclose your identifiable health
information to inform you of health-related benefits or services that may be of
interest to you.
6. Release of Information to Family/Friends.
Our organization may release your identifiable health information to a
friend or family member that is helping you pay for your health care, or who
assists in taking care of you.
7. Disclosures Required By
Law.
Our organization will use and disclose your identifiable health
information when we are required to do so by federal, state or local law.
D.
USE AND DISCLOSURE OF YOUR IDENTIFIABLE HEALTH INFORMATION IN CERTAIN
SPECIAL
CIRCUMSTANCES
The following categories describe unique scenarios in which we may use or
disclose your identifiable health information:
1. Public Health Risks.
Our organization may disclose your identifiable health information to
public health authorities that are authorized by law to collect information for
the purpose of:
1.) Maintaining vital records, such as births and deaths, 2.) Reporting
child abuse or neglect, 3.) Preventing or controlling disease, injury or
disability, 4.) Notifying a person regarding potential exposure to a
communicable disease, 5.) Notifying a person regarding a potential risk for
spreading or contracting a disease or condition, 6.) Reporting reactions to
drugs or problems with products or devices, 7.) Notifying individuals if a
product or device they may be using has been recalled, 8.) Notifying appropriate
government agency(ies) and authority(ies) regarding the potential abuse or
neglect of an adult patient (including domestic violence); however, we will only
disclose this information if the patient agrees or we are required or authorized
by law to disclose this information, and 9.) Notifying your employer under
limited circumstances related primarily to workplace injury or illness or
medical surveillance.
2. Health Oversight Activities. Our
organization may disclose your identifiable health information to a health
oversight agency for activities authorized by law.
Oversight activities can include, for example, investigations, equipment
recalls, inspections, audits, surveys, licensure and disciplinary actions;
civil, administrative, and criminal procedures or actions; or other activities
necessary for the government to monitor government programs, compliance with
civil rights laws and the health care system in general.
3. Lawsuits and Similar
Proceedings.
Our organization may use and disclose your identifiable health
information in response to a court or administrative order, if you are involved
in a lawsuit or similar proceeding. We
also may disclose your identifiable health information in response to a
discovery request, subpoena, or other lawful process by another party involved
in the dispute, but only if we have made an effort to inform you of the request
or to obtain an order protecting the information the party has requested.
Law Enforcement.
We may release identifiable health information if asked to do so by a law
enforcement official:
( 1.)
Regarding a crime victim in certain situations, if we are unable to obtain the
person’s agreement ( 2.) Concerning
a death we believe might have resulted from criminal conduct. (
3.) Regarding criminal conduct at our offices. (
4.) In response to a warrant, summons, court order, subpoena or similar
legal process. ( 5.) To
identify/locate a suspect, material witness, fugitive or missing person. ( 6.)
In an emergency, to report a crime (including the location or victim(s) of the
crime, or the description, identity or location of the perpetrator.
5.
Serious Threats to Health or Safety.
Our organization may use and disclose your identifiable health
information when necessary to reduce or prevent a serious threat to your health
and safety or the health and safety of another individual or the public.
Under these circumstances, we will only make disclosures to a person or
organization able to help prevent the threat.
6.
Military. Our organization may
disclose your identifiable health information if you are a member of
U.S.
or foreign military
forces (including veterans) and if required by the appropriate military command
authorities.
7. National Security. Our organization may
disclose your identifiable health information to federal officials for
intelligence and national security activities authorized by law.
We also may disclose your identifiable health information to federal
officials in order to protect the President, other officials or foreign heads of
state, or to conduct investigations.
8. Inmates.
Our organization may disclose your identifiable health information to
correctional institutions or law enforcement officials if you are an inmate or
under the custody of a law enforcement official.
Disclosure for these purposes would be necessary: (a) for the institution
to provide health care services to you, (b) for the safety and security of the
institution, and/or (c) to protect your health and safety or the health and
safety of other individuals.
9. Workers’ Compensation.
Our organization may release your identifiable health information for
workers’ compensation and similar programs.
E.
YOUR RIGHTS REGARDING YOUR IDENTIFIABLE HEALTH INFORMATION
You have the following rights regarding the identifiable health
information that we maintain about you:
1. Confidential Communications. You
have the right to request that our organization communicate with you about your
health and related issues in a particular manner or at a certain location.
For instance, you may ask that we contact you at home, rather than work.
In order to request a type of confidential communication, you must make a
written request to James Frederick,
Compliance Officer, (419) 930-1401 specifying the requested method of
contact, or the location where you wish to be contacted.
Our organization will accommodate reasonable
requests. You do not need to give a
reason for your request.
2.
Requesting Restrictions.
You have the right to request a restriction in our use or disclosure of
your identifiable health information for treatment, payment or health care
operations. Additionally, you have
the right to request that we limit our disclosure of your identifiable health
information to individuals involved in your care or the payment for your care,
such as family members and friends. We
are not required to agree to your
request; however, if we do agree, we are bound by our agreement except when
otherwise required by law, in emergencies, or when the information is necessary
to treat to you. In order to request
a restriction in our use or disclosure of your identifiable health information,
you must make your request in writing to [James
Frederick, Compliance Officer, (419) 930-1401, or title, and telephone number of
a person or office to contact for further information]. Your request must
describe in a clear and concise fashion: (a) the information you wish
restricted; (b) whether you are requesting to limit our practice’s use,
disclosure or both; and (c) to whom you want the limits to apply.
3.
Inspection and Copies.
You have the right to inspect and obtain a copy of the identifiable
health information that may be used to make decisions about you, including
patient medical records and billing records, but not including psychotherapy
notes. You must submit your request
in writing to James Frederick, Compliance
Officer, (419) 930-1401 in order to inspect and/or obtain a copy of your
identifiable health information. Our
organization may charge a fee for the costs of copying, mailing, labor and
supplies associated with your request. Our
practice may deny your request to inspect and/or copy in certain limited
circumstances; however, you may request a review of our denial.
Reviews will be conducted by another licensed health care professional
chosen by us.
4.
Amendment. You
may ask us to amend your health information if you believe it is incorrect or
incomplete, and you may request an amendment for as long as the information is
kept by or for our organization. To
request an amendment, your request must be made in writing and submitted to James
Frederick, Compliance Officer, (419) 930-1401.
You must provide us with a reason that supports your request for
amendment. Our organization
will deny your request if you fail to submit your request (and the reason
supporting your request) in writing. Also,
we may deny your request if you ask us to amend information that is: (a)
accurate and complete; (b) not part of the identifiable health information kept
by or for the organization; (c) not part of the identifiable health information
which you would be permitted to inspect and copy; or (d) not created by our
organization, unless the individual or entity that created the information is
not available to amend the information.
5.
Accounting of Disclosures.
All of our patients have the right to request an “accounting of
disclosures.” An “accounting of
disclosures” is a list of certain disclosures our organization has made of
your identifiable health information. In
order to obtain an accounting of disclosures, you must submit your request in
writing to James Frederick, Compliance Officer, (419) 930-1401.
All requests for an “accounting of disclosures” must state a time
period which may not be longer than six years and may not include dates before
April 14, 2003
.
The first list you request within a 12 month period is free of charge,
but our practice may charge you for additional lists within the same 12 month
period. Our organization will notify
you of the costs involved with additional requests, and you may withdraw your
request before you incur any costs.
6.
Right to a Paper Copy of This Notice.
You are entitled to receive a paper copy of our notice of privacy
practices. You may ask us to give
you a copy of this notice at any time. To
obtain a paper copy of this notice, contact James
Frederick, Compliance Officer, (419) 930-1401.
7.
Right to File a Compliant.
If you believe your privacy rights have been violated, you may file a
complaint with our organization or with the Secretary of the Department of
Health and Human Services. To file a
complaint with our organization, contact James Frederick, Compliance Officer, (419) 930-1401.
All complaints must be submitted in writing. You
will not be penalized for filing a complaint.
8.
Right to Provide an Authorization for Other Uses and Disclosures. Our organization will
obtain your written authorization for uses and disclosures that are not
identified by this notice or permitted by applicable law.
Any authorization you provide to us regarding the use and disclosure of
your identifiable health information may be revoked at any time in writing.
After you revoke your authorization, we will no longer use or disclose your
identifiable health information for the reasons described in the authorization.
Please note, we are required to retain records of your care.
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