Notice of Privacy Practices
This notice
describes how medical information about you may be used and disclosed and how
you can obtain access to this information. Please review it carefully.
If you have
any questions about this Notice please contact: our Privacy Office (contact information
included at the end of this notice).
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
information that may identify you and that relates to your past, present or
future physical or mental health; or a condition and related healthcare
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. If we make a
change the new notice will be effective for all protected health information
that we maintain at that time. Upon your request, we will provide you with any
revised Notice of Privacy Practices. You may obtain a copy by calling the
office and requesting that a revised copy be sent to you in the mail or by
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 Based Upon Your Written Consent
You will be asked by your physician to sign a consent form. By
signing the consent form you will have consented to the use and disclosure of
your protected health information for treatment, payment and health care
operations. Your physician will use or
disclose your protected health information as described in this Section. 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 pay your health
care bills and to support the operation of your 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 once you have signed our consent form. These examples are not meant to
be exhaustive, but to describe the types of uses and disclosures that may be
made by our office once you have provided consent.
§
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 has already obtained your permission to
have 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 when we have the
necessary permission from you to disclose that information. 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 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 marketing activities, 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 display protected health
information on the cover of your chart in order to verify your identity,
communicate certain health conditions such as allergies and to verify insurance
information. 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.
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 With Your Consent,
Authorization or
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.
§
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 consent as
soon as reasonable 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 consent but is unable to obtain your
consent, he or she may still use or disclose your protected health information
to treat you.
§
Communication Barriers: We may use
and disclose your protected health information if your physician or another
physician in the practice attempts to obtain consent from you but is unable to
do so due to substantial communication barriers and the physician determines,
using professional judgment, that you intend to consent to use or disclosure
under the circumstances.
Other
Permitted and Required Uses and Disclosures That May Be Made Without Your
Consent, Authorization or
We may use or disclose your protected health information in the
following situations without your consent or authorization. These situations
include:
§
Required By Law: We may use
or disclose your protected health information to the extent that law requires
the use or disclosure. 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 as 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), and 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 as 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) a medical
emergency (not on the Practice’s premises) in which 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 their
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 or when required
by the Secretary of the Department of Health and Human Services to investigate
or determine our compliance with the requirements of Section 164.500 et. seq.
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. A
fee to cover the costs associated with processing your request may be charged
and we may require that you make the request in writing.
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 Office 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
request. If your 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 completing a
Designation of Restriction Form and returning it to the office.
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 Office.
You may have
the right to have your physician amend your protected health information. This means you may request, in writing, 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 Office to determine 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 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
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 Office of your complaint. We
will not retaliate against you for filing a complaint. For further information
about the complaint process, you may contact our Privacy Office.
Gateway Medical Associates’ Privacy Office can be reached at (610) 594-7590, extension 15 or privacy@gatewaydoctors.com or Gateway Medical Associates, ATTN: Privacy
Office,
This notice was published and becomes
effective on