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Notice
Of Privacy Practices As
Required by the Privacy Regulations Created as a Result of the Health
Insurance Portability and Accountability Act of 1996 (HIPAA) 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. OUR COMMITMENT TO YOUR PRIVACY Our
office is dedicated to maintaining the privacy of your protected
health information (PHI). PHI
is information about you, including demographic information, that may
identify you and that relates to your past, present or future physical
or mental health or condition and related health care services.
In conducting our business, we will create records regarding
you and the treatment and services we provide to you.
Our privacy policies and procedures have long been in practice
to maintain our patients’ confidentiality.
These policies and procedures have evolved as the needs of
technology and medical practices change.
These policies and procedures as outlined in this Notice will
continue to be monitored and may change when appropriate.
The
United States Congress has passed the Health Insurance Portability and
Accountability Act. We
are required by law to provide you with this Notice of our legal
duties and the privacy practices that we maintain in our office
concerning your PHI. We are required by law to maintain the
confidentiality of health information that identifies you.
By law, we must follow the terms of the Notice that we have in
effect at the time.
We
realize that these laws are complicated, but we must provide you with
the following important information: ·
How we may use and disclose your PHI ·
Your privacy rights in regard to your PHI ·
Our obligations concerning the use and disclosure of your PHI We
may change the terms of our Notice, at any time.
The new Notice will be effective for all PHI that we maintain
at that time. You
may request a copy of our most current Notice at any time.
We will post a copy of our current Notice in our offices in a
visible location at all times and on our website at www.dermatologysurgery.com.
B. IF YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT: Privacy
Officer, (402)330-4555,
Dermatology Surgery Center, P.C., 11623 Arbor
St., Suite 102, Omaha, NE 68144 C. WE MAY USE AND DISCLOSE YOUR PHI IN THE FOLLOWING WAYS The
following are examples of the types of uses and disclosures of your
PHI that our office may make under this Notice.
These examples are not meant to be exhaustive, but to describe
the types of uses and disclosures that may be made by our office. 1. Treatment.
Our office will use and disclose your PHI to treat you.
For example, we may ask you to have laboratory tests (such as
blood or urine tests), and we may use the results to help us reach a
diagnosis. We might use
your PHI in order to write a prescription for you, or we might
disclose your PHI to a pharmacy when we order a prescription for you.
Many of the people who work for our office – including, but
not limited to, our doctors and nurses – may use or disclose your
PHI in order to treat you or to assist others such as hospitals,
specialists, home health agencies or your primary care physician in
your treatment. Additionally,
we may disclose your PHI to others who may assist in your care, such
as your spouse, children or parents. a.
Appointment Reminders/Returning Your Phone Call/Treatment
Options/Health Related Benefits. Our office will try to disclose only the minimum necessary
PHI for our patients while completing these tasks. b. Release of Information to Family/Friends.
Our office may release your PHI to your spouse, friends
and/or family members that are involved in your care unless you
request in writing, as described below, that such disclosures not be
made. 2. Payment.
Your PHI 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 PHI be disclosed to your health plan to obtain
approval for the hospital admission.
We also may use and disclose your PHI to obtain payment from
third parties that may be responsible for such costs, such as family
members. Also, we may use
your PHI to bill you directly for services and items. 3. Health Care Operations.
Our office may use and disclose your PHI to operate our
business. As examples of
the ways in which we may use and disclose your information for our
operations, our office may use your PHI to evaluate the quality of
care you received from us, or to conduct cost-management and business
planning activities for our office.
a. Disclosures
Required By Law. Our
office will use and disclose your PHI when we are b.
Mailings. Our office may use your name and address for mailings
regarding services offered c.
Business Associates.
We will share your PHI with third party “business
associates” that perform various activities (e.g., billing,
transcription services) for the office.
Whenever an arrangement between our office and a business
association involves the use or disclosure of your PHI, we will have a
written contract that contains terms that will protect the privacy of
your PHI. D. USE AND DISCLOSURE OF YOUR PHI IN CERTAIN SPECIAL
CIRCUMSTANCES The
following categories describe unique scenarios in which we may use or
disclose your identifiable health information without your consent,
authorization or opportunity to object: 1. Public Health Risks/Serious Threats to Health or Safety. Our office may disclose your PHI to public health authorities
that are authorized by law to collect such information.
We may use and disclose your PHI 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.
Examples: Centers
for Disease Control, Food and Drug Administration, Social Service
Organizations. 2. Health Oversight Activities.
Our office may disclose your PHI to health oversight agencies
for quality accreditation or other activities authorized by law. Examples: Tumor Registries, licensure, investigations,
inspections, audits, surveys, or disciplinary actions (such as 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. Legal Proceedings.
Our office may disclose your PHI 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), in certain conditions in response to a subpoena,
discovery request or other lawful process. 4.
Law Enforcement. Our office may also disclose your PHI, so long as applicable
legal requirements are met, for law enforcement purposes.
These law enforcement purposes include, but are not limited to,
(1) legal processes and other proceedings required by law, (2) limited
information requests for identification and location purposes, (3)
requests 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 our premises, and (6) medical emergency (not on our
premises) and it is likely that a crime has occurred. 5.
Abuse or Neglect.
Our
office may disclose your PHI to a public health authority that is
authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your PHI 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. 6. Deceased Patients.
Our office may release PHI to a medical examiner or coroner to
identify a deceased individual or to identify the cause of death.
We may also disclose PHI to a funeral director, as authorized
by law, in order to permit the funeral director to carry out his/her
duties. 7. Research.
Our office may use and disclose your PHI for research purposes
in certain limited circumstances.
We will obtain your written authorization to use your PHI for
research purposes except when: (a) our use or disclosure was
approved by an Institutional Review Board or a Privacy Board; (b) we
obtain the oral or written agreement of a researcher that (i) the
information being sought is necessary for the research study; (ii) the
use or disclosure of your PHI is being used only for the research and
(iii) the researcher will not remove any of your PHI from our office;
or (c) the PHI sought by the researcher only relates to decedents and
the researcher agrees either orally or in writing that the use or
disclosure is necessary for the research and, if we request it, to
provide us with proof of death prior to access to the PHI of the
decedents. 8. Military.
Our office may disclose your PHI if you are a member of U.S. or
foreign military forces (including veterans) and if required by the
appropriate authorities. 9. National Security.
Our office may disclose your PHI to federal officials for
intelligence and national security activities authorized by law.
We also may disclose your PHI to federal officials in order to
protect the President, other officials or foreign heads of state, or
to conduct investigations. 10.
Inmates.
Our office may disclose your PHI 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.
11.
Workers’ Compensation. Our office may release your PHI for workers’ compensation
and similar programs. E.
YOUR RIGHTS REGARDING YOUR PHI
You
have the following rights regarding the PHI that we maintain about
you: 1. Confidential Communications.
You have the right to request that our office 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 Privacy
Officer, (402)330-4555, Dermatology Surgery Center, P.C., 11623 Arbor
St., Suite 102, Omaha, NE 68144 specifying the requested method of
contact, or the location where you wish to be contacted.
Our office will accommodate reasonable
requests, however our office is not required
to agree to every or any restriction that you may request.
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 and/or
disclosure of your PHI for treatment, payment and/or health care
operations. Additionally, you have the right to request that we restrict
our disclosure of your PHI to only certain 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 you.
In order to request such a restriction in our use or disclosure
of your PHI, you must make your request in writing to Privacy
Officer, (402)330-4555,
Dermatology Surgery Center, P.C., 11623 Arbor
St., Suite 102, Omaha, NE 68144.
Your request must describe in a clear and concise fashion:
(a) the information you wish restricted; (b)
whether you are requesting to limit our office’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 PHI 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 Privacy
Officer, (402)330-4555, Dermatology Surgery Center, P.C., 11623 Arbor
St., Suite 102, Omaha, NE 68144 in order to inspect and/or obtain
a copy of your PHI. Our
office may charge a fee for the costs of copying, mailing, labor and
supplies associated with your request.
Our office may deny your request to inspect and/or copy in
certain limited circumstances; however, you may request a review of
our denial. 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 office.
To request an amendment, your request must be made in writing
and submitted to Privacy Officer, (402)330-4555,
Dermatology Surgery Center, P.C., 11623
Arbor St., Suite 102, Omaha, NE 68144.
You must provide us with a reason that supports your request
for amendment. Our
office 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 in our opinion: (a) accurate and complete; (b) not
part of the PHI kept by or for our office; (c) not part of the PHI
which you would be permitted to inspect and copy; or (d) not created
by our office, 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 non-routine
disclosures our office has made of your PHI for non-treatment or
operations purposes. Use
of your PHI as part of the routine patient care in our office is not
required to be documented. Examples:
the doctor sharing information with the nurse; or the billing
department using your information to file your insurance claim.
In order to obtain an accounting of disclosures, you must
submit your request in writing to Privacy
Officer, (402)330-4555,
Dermatology Surgery Center, P.C., 11623 Arbor
St., Suite 102, Omaha, NE 68144.
All requests for an “accounting of disclosures” must
state a time period, which may not be longer than six (6) years from
the date of disclosure 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 office may
charge you for additional lists within the same 12-month period.
Our office 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.
You may ask us to give you a copy of this Notice at any time.
To obtain a paper copy of this Notice, contact Privacy
Officer, (402)330-4555,
Dermatology Surgery Center, P.C., 11623 Arbor
St., Suite 102, Omaha, NE 68144.
7. Right to File a Complaint.
If you believe your privacy rights have been violated, you may
file a complaint with our office or with the Secretary of the
Department of Health and Human Services.
To file a complaint with our office, contact Privacy
Officer, (402)330-4555,
Dermatology Surgery Center, P.C., 11623 Arbor
St., Suite 102, Omaha, NE 68144.
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 office will obtain your written authorization for uses
and disclosures that are not identified by this Notice or permitted by
applicable law. In
addition, an authorization may be requested for uses and disclosures
that are identified in this Notice.
Any authorization you provide to us regarding the use and
disclosure of your PHI may be revoked at any time in writing.
After you revoke your authorization, we will no longer use or disclose
your PHI for the reasons described in the authorization.
Please note, we are required to retain records of your care. Again,
if you have any questions regarding this Notice or our health
information privacy policies, please contact Privacy
Officer, (402)330-4555,
Dermatology Surgery Center, P.C., 11623 Arbor
St., Suite 102, Omaha, NE 68144. |
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