Notice of Privacy Practices
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GATEWAY DERMATOLOGY – NOTICE OF PRIVACY PRACTICES – PLEASE REVIEW CAREFULLY – EFFECTIVE SEPTEMBER 23, 2013
*HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION
OUR COMMITMENT TO YOUR PRIVACY
Our practice is dedicated to maintaining the privacy of your personal health information (PHI). The Health Insurance Portability & Accountability Act of 1996 (HIPAA) is a Federal program that requests that all medical records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper, or orally are kept properly confidential. This act gives you, the patient, the right to understand and control how your personal health information (PHI) is used. HIPAA provides penalties for covered entities that misuse PHI. As required by HIPAA, we prepared this explanation of how we are to maintain the privacy of your PHI and how we may disclose your PHI. In conducting our business, we will create records regarding you and the treatment and services we provide to you. By federal and state law, we must follow the terms of the notice of privacy practices that we have in effect at the time. The terms of this notice apply to all records containing your PHI that are created or retained by our practice. We will notify you of any breaches of your PHI. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment of this notice will be effective for all of your records that our practice has created or maintained in the past and for any of your records that we may create or maintain in the future. Our practice will post a copy of our current Notice of Privacy Practices in our office in a visible location at all times, and you may request a copy of our most current Notice of Privacy Practices at any time.
WE MAY USE AND DISCLOSE YOUR PERSONAL HEALTH INFORMATION (PHI) IN THE FOLLOWING WAYS:
Treatment means providing, coordinating, or managing health care and related services by one or more healthcare providers. For example, we may ask you to have laboratory tests and we may use the results to help us make a diagnosis. We may use your PHI to write prescriptions. We may also disclose your PHI to other health care providers for purposes related to your treatment.
Payment means such activities as obtaining reimbursement for services, confirming coverage, billing or collections activities, and utilization review. For example, we may contact your health insurer to certify that you are eligible for 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 may use your PHI to bill you directly for services and items. We may disclose your PHI to other health care providers and entities to assist in their billing and collections efforts.
HEALTH CARE OPERATIONS:
Health Care Operations include business aspects of running our practice, such as conducting quality assessments and improving activities, auditing functions, cost management analysis, and customer service. For example, we may evaluate the quality of care you received from us through a patient survey card, or to conduct cost-management and business planning activities for our practice. We may disclose your PHI to other health care providers and entities in their health care operations.
LAW ENFORCEMENT, LAWSUITS, AND SIMILAR PROCEEDINGS:
Our practice may disclose your PHI for law enforcement and other legitimate reasons when we are required to do so by federal, state, or local law in response to a warrant, summons, court or administrative order, subpoena, or other lawful process by another party involved in a dispute. We will make an effort to inform you of the request or to obtain an order protecting the information the party has requested.
Our practice may use and disclose your PHI to contact you, by phone or in writing, to provide appointment reminders or information about treatment alternatives or other health-related benefits and services, in addition to other fundraising communications, that may be of interest to you. You do have the right to “opt out” with respect to receiving fundraising communications from us.
RELEASE OF INFORMATION TO FAMILY/FRIENDS:
Our practice may release your health information to a friend or family member that is involved in your care, or who assists in taking care of you. For example, we may give treatment information to a babysitter that has been asked by a parent/guardian to bring their child to our practice for treatment.
USE AND DISCLOSURE OF YOUR HEALTH INFORMATION IN CERTAIN SPECIAL CIRCUMSTANCES:
Our practice may use and disclose your PHI to identify/locate a suspect, material witness, fugitive or missing person. In an emergency: to report a crime including the location or victim of the crime, or the description, identity, or location of the perpetrator.
SERIOUS THREATS TO HEALTH OR SAFETY:
Our practice 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.
PUBLIC HEALTH RISKS:
Our practice may disclose your PHI to health authorities that are authorized by law to collect information for the purpose of maintaining vital records (birth and death), reporting child abuse or neglect, preventing or controlling disease, injury, or disability, notifying a person regarding potential exposure to a communicable disease and a potential risk for spreading or contracting a disease or condition, reporting reactions to drugs or problems with products or devices, 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 by law to do so, notifying your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance.
MILITARY AND VETERANS:
Our practice may use and disclose your PHI if you are a member of U.S. or foreign military forces and if required by the appropriate authorities.
Our practice may use and disclose your PHI for workers’ compensation and similar programs.
DE-IDENTIFIED HEATLH INFORMATION:
Our practice may also create and distribute de-identified PHI by removing all reference to individually identifiable information.
The following use and disclosures of PHI will only be made pursuant to us receiving a written authorization from you regarding most psychotherapy notes, marketing purposes, including subsidized treatment and health care operations, sale of PHI under HIPAA, and those not described in this notice. You may revoke such authorization in writing and we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization.
YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI REQUESTING RESTRICTIONS:
You have the right to request a restriction in our use or disclosure of your PHI for treatment, payment, or health care operations. 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. You must make your request in writing to Gateway Dermatology PC to request a restriction in our use or disclosure of your PHI. You must tell us what information you want limited and to whom you want the limits to apply.
You have the right to request that our practice 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. You must make a written request to us to request a type of confidential communication specifying the requested method of contact, or the location where you wish to be contacted. Our practice will accommodate reasonable requests. You do not need to give a reason for your request. If you have paid for services “out of pocket”, in full, and you request that we not disclose PHI related solely to those services to a health plan, we will accommodate your request, except where we are required by law to make a disclosure.
INSPECTIONS AND COPIES:
You have the right to inspect and obtain a copy of your PHI that may be used to make decisions about you, including patient medical and billing records. You must submit your request to us in writing in order to inspect and/or obtain a copy of your PHI. Our practice 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. Another licensed health care professional chosen by us will conduct reviews.
You may ask us to amend your PHI if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by/for our practice. Your amendment request must be submitted to us in writing. You must provide us with a reason that supports your request for amendment. Our practice will deny your request if you fail to submit your request and supporting reason in writing. Also, we may deny your request if you ask us to amend information that is in our opinion accurate and complete, not part of the PHI kept by/for the practice, not part of the PHI which you would be permitted to inspect and copy, or not created by our practice, unless the individual or entity that created the information is not available to amend the information.
ACCOUNTING OF DISCLOSURES:
All of our patients have the right to request a list accounting for any disclosures of your PHI we have made, except for uses and disclosures for treatment, payment, and health care operation. You must submit to us your written request. All requests for a list of disclosures must state a time period, which may not be longer than 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 practice may charge you for additional lists within the same 12 month period. Our practice will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs.
RIGHTS TO A PAPER COPY OF THIS NOTICE:
You are entitled to receive a paper copy of the Notice of Privacy Practices from us upon request.
HEALTH OVERSIGHT ACTIVITIES:
Our practice may use and disclose your PHI to a health oversight agency for activities authorized by law. For example, investigations, 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.
RIGHT TO FILE A COMPLAINT:
If you believe your privacy rights have been violated, you may file a written complaint with our practice or the Department of Health and Human Services. We will not retaliate against you for filing a complaint.
OTHER USES AND DISCLOSURES OF HEALTH INFORMATION:
Our practice 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 use 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 reasons described in the authorization. We are unable to take back any disclosure already made and we are required to retain records of the care that we provided to you. You will be asked to sign a form acknowledging that you have received this notice. If you choose or are unable to sign, a staff member will sign their name and date and it will be filed with your records.
If you have any question regarding this notice of our health information privacy policies, please contact Gateway Dermatology PC, 600 N. Cotner Blvd, Ste #311, Lincoln, NE 68505 (402) 467-4361.