We are required by law to protect the privacy of medical information about you and that identifiesyou. This medical information may be information about health care we provide to you or payment forthe health care provided to you. It may also be information about your past present or future medicalcondition. We are also required by law to provide you with these Notice of Privacy Practices explainingour legal duties and privacy practices with respect to medical information. We are legally required tofollow the terms of this Notice. In other words, we are only allowed to use and disclose medicalinformation in the manner that we have described in this notice. We may change the terms of this Noticein the future. We reserve the right to make changes and to make new Notices effective for all medicalinformation that we maintain. If we make changes to the notice, we will post the new Notice in a waitingarea and make copies of the new Notice available upon request. If at any time you have any questionsabout information in this Notice or about our privacy policies, procedures, or practices, you can contactour office.
We use and disclose medical information about patients every day. We may use and disclose thisinformation about you to provide you with healthcare, obtain payment for the care, and operate ourbusiness efficiently. Medical information includes information about your illness, treatment, andcondition as well as information about where we can contact you, your social security number, and otherinformation necessary for the above activities. The following summarizes some of the most common useswe have for your medical and other protected health information.
Uses and Disclosure for Treatment, Payment, and Health Care Operations
1. Treatment. We will use and disclose medical information about you to provide health caretreatment to you. This includes communicating with other health care providers regarding yourtreatment. These other health care providers may or may not be our employees. Examples: Yourmedical information may be needed to obtain authorization from your insurance company toschedule your appointment. A lab technician may use medical information to process and reviewtest results. Medical information may be shared with physicians, radiologists, and other alliedhealthcare professionals to make sure you receive the highest quality of care. If you receivecertain devices, such as pacemakers, hip replacements, or other implants, information about youis given to the manufacturer for tracking product expiration, recalls, etc.
2. Payment. We will use and disclose medical information about you to obtain payment for thehealth care services that you receive. This will include your insurance company and may includea collection of agency and consumer reporting agencies. In some instances, we may disclosemedical information about you to an insurance plan before you receive health care servicesbecause, for example, we may need to know whether your insurance plan will pay for a particularservice.
Examples: Certain services, for example, mammograms, are covered only once per year. This isdate specific and we need to verify your eligibility based on the last date you received the service.Your insurance company may request a copy of your medical record to verify that all the serviceswe provided were necessary for your treatment. In addition, the bill we provide your insurancecompany has medical information in it.
3. Health care operations. We may use and disclose medical information about you in performing avariety of business activities that we call “health care operations”. These activities allow us to, forexample, improve the quality of care we provide and reduce health care costs. For example, wemay use or disclose medical information about you in performing the following activities:
a. Reviewing and evaluating the skills, qualifications, and performance of the health care provider taking care of you. b. Providing training programs for students, trainees, health care providers, or non-healthcare professionals to help them practice or improve their skills. c. Cooperating with outside organizations that evaluate, certify, or license our facility. d. Reviewing and improving the quality, efficiency, and cost of care. e. Improving healthcare and lowering costs for a group of people who have similar health problems and helping manage and coordinate the care for these groups of people. f. Planning for our organization’s future operations. g. Resolving grievances within our organization. h. Reviewing our activities and using or disclosing medical information in the event that control of our organization significantly changes. i. Working with others (such as lawyers, accountants, consultants, and other providers) who assist us in complying with this Notice and other laws. j. Our medical committees, such as the pharmacy committee, may review your medical information, in connection with other patients receiving the same treatment as you, to determine the effectiveness of our protocol. If you have a complaint about the care you receive, the appropriate individuals within our organization may review your medical information in order to evaluate the quality of care that you received. We may also disclose your health information to third parties with whom we contract to perform services on our behalf.
The rest of this Notice will discuss how we may use and disclose medical information about you;explain your rights with respect to medical information about you; describe how and where you may filea privacy-related complaint.
Other Uses and Disclosures for Which Authorization is Not Required.
Required by law. We will use and disclose medical information about you whenever we are required bylaw to do so. There are many state and federal laws that require us to use and disclose medicalinformation. Examples: State law requires us to report gunshot wound(s) to the police, highly contagiousdiseases such as sexually transmitted diseases and tuberculosis, and other test results to the AlabamaDepartment of Public Health and to report known or suspected child abuse or neglect to the Departmentof Social Services. We are also required to maintain various registries (e.g. cancer, trauma) for the Stateof Alabama.
National priority uses and disclosures. When permitted by law, we may use or disclose medicalinformation about you without your permission for various activities that are recognized as “nationalpriorities”. In these instances, the government has determined that it is so important to disclose medicalinformation and that it is acceptable to disclose medical information without the individual permission.We will only disclose medical information about you in the following circumstances when we arepermitted to do so by law.
Below are brief descriptions of the national priority activities recognized by law.
Threat to health or safety. We may use or disclose medical information about you if we believe itis necessary to prevent or lessen a serious threat to your health or safety.
Public Health Activities. We may use or disclose medical information about you for public healthactivities. Public health activities require the use of medical information for various activities,including, but not limited to, activities related to investigating diseases, reporting child abuse and neglect, monitoring drugs or devices regulated by the Food and Drug Administration, andmonitoring work-related illnesses or injuries. For example, if you have been exposed to acommunicable disease (such as a sexually transmitted disease) *, we may report it to the Stateand take other actions to prevent the spread of the disease.
Research organizations. We may use or disclose medical information about you to researchorganizations if the organization has satisfied certain conditions about protecting the privacy ofmedical information.
Appointment reminders. We may use and/or disclose medical information about you to send youreminders about an appointment.
Abuse, neglect, or domestic violence. We may disclose medical information about you to agovernment authority (such as the Department of Social Services) if you are an adult and wereasonably believe that you may be a victim of abuse, neglect, or domestic violence.
Health oversight activities. We may disclose medical information about you to a health oversightagency – which is basically an agency responsible for overseeing the health care system or certaingovernment programs. For example, a government agency may request information from uswhile they are investigating possible insurance fraud.
Court proceedings. We may disclose medical information about you to a court or an officer of the court (such as an attorney). For example, we would disclose medical information about you to acourt if a judge orders us to do so.
Law enforcement. We may disclose medical information about you to a law enforcement officialfor specific law enforcement purposes. For example, we may disclose limited medical informationabout you to a police officer if the officer needs the information to help find or identify a missingperson.
Coroners and others. We may disclose medical information about you to a coroner, medicalexaminer, or funeral director or to organizations that help with organ, eye, and tissue transplants.
Workers’ compensation. We may disclose medical information about you in order to comply withworkers’ compensation laws.
Certain government functionality. We may use or disclose medical information about you forcertain governmental functions, including but not limited to military and veterans’ activities andnational security and intelligence activities. We may also use or disclose medical informationabout you to a correctional institution in some instances.
Treatment alternatives. We may use and/or disclose medical information about you in order toinform you of or recommend new treatment or different methods for treating a medical conditionthat you have or to inform you of other health-related benefits and services that may be ofinterest to you. Examples. you are a patient newly diagnosed with diabetes. we have developedan educational program to help diabetes patients manage their diets. We may send you aninformational flyer about the program. Alternately, you may need a referral to a home healthagency, we have a program or hospice. information about you will be shared with these otherservice providers.
Uses and Disclosures That May Be Made With Your Agreement or Opportunity to Object.
Hospital patient directory. We may use your name, your room number, your condition, and your religiousaffiliation to maintain a patient directory. we made disclose this information to visitors who ask for youby name and to members of the clergy. You have the right to opt out of this directory. To opt-out of thisdirectory alert the admissions clerk when you are registering or the Privacy and Security Officer Duringyour visit.
Persons involved in your care. We may disclose medical information about you to a relative, close personalfriend, or any other person you identify if that person is involved in your care and the information isrelevant to your care, such as a disaster relief organization (e.g. Red Cross) If we need to notify someoneabout your location or condition. You may ask us at any time not to disclose medical information aboutyou to persons involved in your care. If the patient is a minor, we may disclose medical information aboutthe minor to a parent, guardian, or other responsible for the minor except in limited circumstances. wewill agree to your request except in certain limited circumstances (such as emergencies) or if the patientis a minor. If the patient is a minor, we may or may not be able to agree to your request. Example. yourspouse or parent may be present in your room When your medical information is discussed. you have theright to ask to have your medical information discussed with you in private.
Uses and Disclosures of PHI for Which Authorization is Required.
Authorization. Other than the uses and disclosures described above, we will not use or disclose medicalinformation about you without the authorization (signed permission) of you or your personalrepresentative. In some instances, we may wish to use our disclosed medical information about you, andwe may contact you to ask you to sign an authorization form. In other instances, you may contact us toask us to disclose medical information, and we will ask you to sign an authorization form.
Revocation. if you sign a written authorization allowing us to disclose medical information about you, youmay later revoke (or cancel) your authorization in writing (except in very limited circumstances related toobtaining insurance coverage). If you would like to revoke your authorization, you may write us a letterrevoking your authorization sorry fill out an Authorization Revocation Form. If you revoke yourauthorization, we will follow your instructions except to the extent that we have already relied upon yourauthorization and taken some action.
Regulatory Requirements. We are required by law to maintain the privacy of your Protected HealthInformation (PHI), to provide individuals with notice of its legal duties and privacy practices with respectto PHI, and to abide by the terms described in this notice which is currently in effect. we reserve the rightto change the terms of this notice and its privacy policies and to make the new terms applicable to theentire PHI it maintains.
Individual Rights. You have several rights with respect to medical information about you. This section ofthe notice will briefly mention each of these rights. if you would like to know more about your rights,please contact our office.
Right to a copy of this notice. You have a right to have a paper copy of our Notice of PrivacyPractices at any time.
Right of access to inspect and copy. You have the right to see or review and receive a copy ofmedical information how about you that we maintain certain sets of records. If you would like toinspect or receive a copy of medical information about you, you must provide us with a requestin writing. You may write us a letter requesting access or fill out a Release of Information Form.We may deny your request in certain circumstances. If we deny your request, we will explain ourreason for doing so in writing. We will also inform you in writing if you have the right do you haveour decision reviewed by another person. If you would like a copy of your health information,contact the Medical Record Department for more information on these services, requiredresponse times, and any additional fees.
Right to have medical information amended. You have the right to request an amendment (whichmeans correct or supplement) to the medical information about you that we maintain in certaingroups of records. If you believe that we have information that is either inaccurate or incomplete,we may amend the information to indicate the problem and notify others who have copies of theinaccurate or incomplete information. If you would like us to amend the information, you mustprovide us with a request in writing and explain why you would like us to amend the information.you may either write us a letter requesting an amendment or fill out an Amendment RequestForm. We or your physician may deny your request in certain circumstances. If we deny yourrequest, we will explain our reason for doing so in writing. You will have the opportunity to sendus a statement explaining why you disagree with our decision to deny your amendment requestand we will share your statement whenever we disclose the information in the future.
Right to an accounting of disclosures we have made. You have the right to receive a listing ofdisclosures we have made for the previous six (6) years. if you would like to receive an accounting,you may send us a letter making your request, fill out a Disclosure Request Form, or contact ourPrivacy and Security Officer. the accounting will not include several types of disclosures, includingdisclosures for treatment, payment, or healthcare operations. it will also not include disclosuresmade prior to April 14, 2003. If you request an accounting more than once in a twelve (12) monthperiod, we will charge you a fee to cover the costs of preparing the accounting.
Right request restrictions on uses and disclosures. You have the right to request that we limit theuse and disclosure of medical information about you for treatment, payment, and healthcareoperations. We are not required to agree to your request. If we do agree to your request, we mustfollow your restrictions (except if the information is necessary for emergency treatment). You maycancel the restrictions either in writing or verbally at any time. In addition, we may cancel as arestriction at any time as long as we notify you of the cancellation and continue to apply therestriction to information collected before the cancellation.
Right to request an alternative method of contact. You have the right to request to be contactedat a different location or by a different method. For example, you may prefer to have all writteninformation mailed to your work address rather than to your home address. We will agree to anyreasonable request for alternative methods of contact. your request must include information asto how your payment will be handled and whether your alternate contact address is theappropriate contact location for payment information. your request must be specific and inwriting for completion of an Alternative Contact Request Form. if you cannot provide us withinformation that is adequate to ensure our ability to obtain payment on your account, we maydeny your request. We may not require an explanation from you about why you wish to use analternative address or method of contact.
Logging a privacy concern. if you believe that your privacy rights have been violated or if you aredissatisfied with our privacy policies or procedures, you may file a complaint either with us or withthe Federal Government. We will not take any action against you or change our treatment of youin any way if you file a complaint.
To file a written complaint with us, you may mail it to IRVING PEDIATRICS, Attention:Privacy and Security Officer, Muhammad Haq.
To file a written complaint with the Federal Government, send your complaint to RegionIV, Office for Civil Rights, U.S. Department of Health and Human Services, Atlanta Federal Center,Suite 3B70, 61 Forsyth Street, SW, Atlanta, GA 30303-8909.
COMPLAINTS AND QUESTIONS ABOUT THE USE OR DISCLOSURE OF YOUR INFORMATION:
If you believe your privacy rights have been violated, contact the agency.You may contact the agency if you:(1) have questions about this notice,(2) need more information about your privacy rights,(3) need a physical address for the agency, or(4) are requesting a copy of health information from the agency
If you believe the agency has violated your privacy rights, you can also file a complaint with the:Secretary Office of Civil Rights Region VI U.S. Department of Health and Human Services1301 Young St., Suite 1169 Dallas, Texas, 75202Voice Phone (800) 368-1019FAX (214) 767-0432TDD (800) 537-7697
For complaints about a violation of your right to confidentiality by an alcohol or drug abusetreatment program, Contact the United States Attorney’s Office for the judicial district in which theviolation occurred. The agency prohibits retaliation against you for filing a complaint.
Who this notice applies to. This notice describes IRVING PEDIATRICS practices and those of Any healthcare professional authorized to enter information into our consult your medical record.
All entities who access your PHI follow the terms of this notice and are acting as an organized health carearrangement for purposes of HIPAA. In addition, these entities may share health information with eachother for treatment payment or healthcare operations purposes described in this Notice.