Notice
of Privacy Practices
for Protected Health Information
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!
Our
office is permitted by federal privacy laws to make uses and
disclosures of your health information for purposes of treatment,
payment, and health care operations. Protected health information
is the information we create and obtain in providing our services
to you. Such information may include documentation of your symptoms,
examination and test results, diagnoses, treatment, and application
for future care or treatment. It also includes billing documents
for those services.
Examples
of uses or disclosures of your health information for treatment
purposes:
- A
nurse obtains treatment information about you and records
it in a health record.
- During
the course of your treatment, the physician determines he/she
will need to consult with another specialist in the area.
He/she will share the information with such specialist and
obtain his/her input.
Example
of use or disclosure of your health information for payment
purposes:
-
We submit requests for payment to your health insurance
company. The health insurance company or business associate
helping us obtain payment requests information from us regarding
your medical care given. We will provide information to
them about you and the care given.
Example
of use or disclosure of your information for health care
operations:
- We
may obtain services from business associates that perform
various activities for the practice such as quality assessment,
quality improvement, outcome evaluation, protocol and clinical
guidelines development, training programs, credentialing,
medical review, legal services, and insurance. We will share
information about you with such business associates as necessary
to obtain these services.
Your
Health Information Rights
The
health and billing records we maintain are the physical property
of the doctor’s office. You have the following rights
with respect to your Protected Health Information
- Right
to request a restriction on certain uses and disclosures
of your health information by delivering the request in
writing to our office, we are not required to grant the
request but we will comply with any request that we have
granted;
- Right
to obtain a paper copy of the Notice of Privacy Practices
for Protected Health Information ("Notice") by
making a request at our office
- Right
to inspect and copy your health record and billing record,
with limited exceptions you may exercise this right by delivering
the request in writing to our office using the form we provide
to you upon request; you may appeal a denial of access to
your protected health information except in certain circumstances
- Right
to request that your health care record be amended to correct
incomplete or incorrect information by delivering a written
request which provides the reason to support the requested
amendment to our office using the form we provide to you
upon request; we are not required to make such amendments;
you may file a statement of disagreement if your amendment
is denied, and require that the request for amendment and
any denial be attached in all future disclosures of your
protected health information
- Right
to receive an accounting of disclosures of your health information
as required to be maintained by law by delivering a written
request to our office using the form we provide to you upon
request; an accounting will not include internal uses of
information for treatment, payment, or operations, disclosures
made to you or made at your request, or disclosures made
to family members or friends in the course of providing
care; and
- Right
to confidential communication by requesting that communication
of your health information be made by alternative means
or at an alternative location by delivering the request
in writing to our office using the form we give you upon
request.
If
you want to exercise any of the above rights, please contact
Gary Holden, 423-697-6454, in person or in writing, during normal
hours. He will provide you with assistance on the steps to take
to exercise your rights.
Our
Responsibilities
The
office is required to:
- Maintain
the privacy of your health information as required by law;
- Provide
you with a notice as to our duties and privacy practices
as to the information we collect and maintain about you;
- Abide
by the terms of this Notice;
- Notify
you if we cannot accommodate a requested restriction or
amendment; and
- Accommodate
your reasonable requests regarding methods to communicate
health information with you; and
- Accommodate
your request for an accounting of disclosures subject to
certain exceptions, restrictions and limitations.
- We
reserve the right to amend, change, or eliminate provisions
in our privacy practices and access practices and to enact
new provisions regarding all the protected health information
we maintain at that time. If our information practices change,
we will amend our Notice. You are entitled to receive a
revised copy of the Notice by calling and requesting a copy
of our "Notice" or by visiting our office and
picking up a copy.
To
Request Information or File a Complaint
If
you have questions or would like additional information about
this Notice of Privacy Practices, or want to report a problem
regarding the handling of your information, you may contact
Gary Holden, Privacy Officer, 423-697-6454.
Additionally,
if you believe your privacy rights have been violated, you may
file a written complaint at our office by delivering the written
complaint to Gary Holden. You may also file a complaint by mailing
it or e-mailing it to the Secretary of Health and Human Services
whose street address and telephone number is U.S. Department
of Health and Human Services, 200 Independence Avenue, SW, Washington,
DC 20201, 1-877-696-6775.
- We
cannot, and will not, require you to waive the right to
file a complaint with the Secretary of Health and Human
Services (HHS) as a condition of receiving treatment from
the office.
- We
cannot, and will not, retaliate against you for filing a
complaint with the Secretary of Health and Human Services.
Patient
Contact
We
may contact you to provide you with appointment reminders, with
information about treatment alternatives, or with information
about other health-related benefits and services that may be
of interest to you. We may contact you as part of a fund raising
effort.
Notification
— Opportunity to Agree or Object
Unless
you object we may use or disclose your protected health information
to notify, or assist in notifying, a family member, personal
representative, or other person responsible for your care, about
your location, and about your general condition, or your death.
Communication
with Family - Using our best judgment, we may disclose to a
family member, other relative, close personal friend, or any
other person you identify, health information relevant to that
person's involvement in your care or in payment for such care
if you do not object or in an emergency.
We
may use and disclose your protected health information to assist
in disaster relief efforts.
Opportunity
to Agree or Object Not Required
Public
Health Activities
- Controlling
Disease - As required by law, we may disclose your protected
health information to public health or legal authorities
charged with preventing or controlling disease, injury,
or disability.
- Child
Abuse & Neglect - We may disclose protected health information
to public authorities as allowed by law to report child
abuse or neglect.
- Food
and Drug Administration (FDA) - We may disclose to the
FDA your protected health information relating to adverse
events with respect to food, supplements, products and product
defects, or post-marketing surveillance information to enable
product recalls, repairs, or replacements.
Victims
Of Abuse, Neglect, or Domestic Violence
We can disclose protected health information to governmental
authorities to the extent the disclosure is authorized by statute
or regulation and in the exercise of professional judgment the
doctor believes the disclosure is necessary to prevent serious
harm to the individual or other potential victim.
Oversight
Agencies
Federal law allows us to release your protected health information
to appropriate health oversight agencies or for health oversight
activities to include audits, civil, administrative or criminal
investigations: inspections; licensure or disciplinary actions,
and for similar reasons related to the administration of healthcare.
Judicial/Administrative
Proceedings
We may disclose your protected health information in the
course of any judicial or administrative proceeding as allowed
or required by law, or as directed by a proper court order or
administrative tribunal, provided that only the protected health
information released is expressly authorized by such order,
or in certain conditions in response to a subpoena, discovery
request or other lawful process.
Law
Enforcement
We may disclose your protected health information for law
enforcement purposes as required by law, such as when required
by court order, including laws that require reporting of certain
types of wounds or other physical injury.
Coroners,
Medical Examiners And Funeral Directors
We may disclose your protected health information to funeral
directors or coroners consistent with applicable law to allow
them to carry out their duties.
Organ
Procurement Organizations
Consistent with applicable law, we may disclose your protected
health information to organ procurement organizations or other
entities engaged in the procurement, banking, or transplantation
of organs, eyes, or tissue for the purpose of donation and transplant.
Research
We may disclose 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.
Threat
To Health And Safety
To avert a serious threat to health or safety, we may disclose
your protected health information consistent with applicable
law to prevent or lessen a serious, imminent threat to the health
or safety of a person or the public.
For
Specialized Governmental Functions
We may disclose your protected health information for specialized
government functions as authorized by law such as for certain
military and veterans activities and for national security and
intelligence activities.
Correctional
Institutions
If you are an inmate of a correctional institution, we
may disclose to the institution or it’s agents the protected
health information necessary for your health and the health
and safety of other individuals.
Workers
Compensation
If you are seeking compensation through Workers Compensation,
we may disclose your protected health information as authorized
by and to the extent necessary to comply with laws relating
to Workers Compensation or other similar programs established
by law.
Other
Uses and Disclosures
- Other
uses and disclosures besides those identified in this Notice
will be made only as otherwise authorized by law or with
your written authorization which you may revoke except to
the extent information or action has already been taken
in response to your authorization.
- If
we maintain a website that provides information about our
entity, this Notice will be on the website.
