| 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) |
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THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT
YOU (AS A PATIENT OF THIS PRACTICE ) MAY BE USED
AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO YOUR
INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION.
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| PLEASE REVIEW
THIS NOTICE CAREFULLY. |
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| A. OUR
COMMITMENT TO YOUR PRIVACY |
Our
practice is dedicated to maintaining the privacy
of your individually identifiable health information
(IIHI). In conducting our business, we will create
records regarding you and the treatment and services
we provide to you. We are required by law to maintain
the confidentiality of health information that identifies
you. We also are required by law to provide you
with this notice of our legal duties and the privacy
practices that we maintain in our practice concerning
your IIHI. By federal and state law, we must follow
the terms of the notice of privacy practices 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 IIHI
- Your privacy rights in your IIHI
- Our obligations concerning the use and disclosure
of your IIHI
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| The terms
of this notice apply to all records containing your
IIHI that are created or retained by our practice.
We reserve the right to revise or amend this Notice
of Privacy Practices. Any revision or amendment
to 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 in our offices
in a visible location at all times, and you may
request a copy of our most current Notice at any
time. |
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B. IF YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE
CONTACT: |
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Amanda Beddingfield
110 College Street,
Suite B Athens,
AL 35611 256-233-2393 |
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C. WE MAY
USE AND DISCLOSE YOUR INDIVIDUALLY IDENTIFIABLE
HEALTH INFORMATION (IIHI) IN THE FOLLOWING WAYS
The following categories describe the different
ways in which we may use and disclose your IIHI.
1. Treatment.
Our practice may use your IIHI 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 IIHI in order to write a prescription for you,
or we might disclose your IIHI to a pharmacy when
we order a prescription for you. Many of the people
who work for our practice – including, but
not limited to, our doctors and nurses – may
use or disclose your IIHI in order to treat you
or to assist others in your treatment. Additionally,
we may disclose your IIHI to others who may assist
in your care, such as your spouse, children or parents.
Finally, we may also disclose your IIHI to other
health care providers for purposes related to your
treatment.
2. Payment.
Our practice may use and disclose your IIHI in order
to bill and collect payment for the services and
items you may receive from us. For example, we may
contact your health insurer to certify that you
are eligible for benefits (and for what range of
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 also may use and disclose your IIHI to obtain
payment from third parties that may be responsible
for such costs, such as family members. Also, we
may use your IIHI to bill you directly for services
and items. We may disclose your IIHI to other health
care providers and entities to assist in their billing
and collection efforts.
3.
Health Care Operations. Our practice may
use and disclose your IIHI to operate our business.
As examples of the ways in which we may use and
disclose your information for our operations, our
practice may use your IIHI to evaluate the quality
of care you received from us, or to conduct cost-management
and business planning activities for our practice.
We may disclose your IIHI to other health care providers
and entities to assist in their health care operations.
4. Appointment Reminders.
Our practice may use and disclose your IIHI to contact
you and remind you of an appointment.
5.
Treatment Options. Our practice may use and
disclose your IIHI to inform you of potential treatment
options or alternatives.
6.
Health-Related Benefits and Services. Our
practice may use and disclose your IIHI to inform
you of health-related benefits or services that
may be of interest to you.
7.
Release of Information to Family/Friends.
Our practice may release your IIHI to a friend or
family member that is involved in your care, or
who assists in taking care of you. For example,
a parent or guardian may ask that a babysitter take
their child to the pediatrician’s office for
treatment of a cold. In this example, the babysitter
may have access to this child’s medical information.
8. Disclosures Required
By Law. Our practice will use and disclose
your IIHI when we are required to do so by federal,
state or local law.
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D. USE AND DISCLOSURE OF
YOUR IIHI IN CERTAIN SPECIAL CIRCUMSTANCES |
The following categories describe unique scenarios
in which we may use or disclose your identifiable
health information:
1. Public Health Risks.
Our practice may disclose your IIHI to public
health authorities that are authorized by law
to collect information for the purpose of:
- maintaining vital records, such as births
and deaths
- reporting child abuse or neglect
- preventing or controlling disease, injury
or disability
- notifying a person regarding potential exposure
to a communicable disease
- notifying a person regarding a potential risk
for spreading or contracting a disease or condition
- reporting reactions to drugs or problems with
products or devices
- notifying individuals if a product or device
they may be using has been recalled
- 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 or
authorized by law to disclose this information
- notifying your employer under limited circumstances
related primarily to workplace injury or illness
or medical surveillance.
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| 2.
Health Oversight Activities. Our practice
may disclose your IIHI to a health oversight agency
for activities authorized by law. Oversight activities
can include, 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. |
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| 3.
Lawsuits and Similar Proceedings. Our practice
may use and disclose your IIHI in response to a
court or administrative order, if you are involved
in a lawsuit or similar proceeding. We also may
disclose your IIHI in response to a discovery request,
subpoena, or other lawful process by another party
involved in the dispute, but only if we have made
an effort to inform you of the request or to obtain
an order protecting the information the party has
requested. |
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4.
Law Enforcement. We may release IIHI if asked
to do so by a law enforcement official:
- Regarding a crime victim in certain situations,
if we are unable to obtain the person’s
agreement
- Concerning a death we believe has resulted
from criminal conduct
- Regarding criminal conduct at our offices
- In response to a warrant, summons, court
order, subpoena or similar legal process
- To identify/locate a suspect, material witness,
fugitive or missing person
- In an emergency, to report a crime (including
the location or victim(s) of the crime, or the
description, identity or location of the perpetrator)
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| 5. Deceased
Patients. Our practice may release IIHI to
a medical examiner or coroner to identify a deceased
individual or to identify the cause of death. If
necessary, we also may release information in order
for funeral directors to perform their jobs. |
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| 8. Serious
Threats to Health or Safety. Our practice
may use and disclose your IIHI 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 |
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| 9.
Military. Our practice may disclose your
IIHI if you are a member of U.S. or foreign military
forces (including veterans) and if required by the
appropriate authorities. |
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| 10.
National Security. Our practice may disclose
your IIHI to federal officials for intelligence
and national security activities authorized by law.
We also may disclose your IIHI to federal officials
in order to protect the President, other officials
or foreign heads of state, or to conduct investigations.
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11. Inmates.
Our practice may disclose your IIHI 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:
- for the institution to provide health care
services to you,
- for the safety and security of the institution,
and/or
- to protect your health and safety or the health
and safety of other individuals
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| 12. Workers
Compensation. Our practice may release your
IIHI for workers’ compensation and similar
programs. |
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| E. YOUR
RIGHTS REGARDING YOUR IIHI |
| You have the following rights
regarding the IIHI that we maintain about you: |
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| 1. Confidential
Communications. 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.
In order to request a type of confidential communication,
you must make a written request to Amanda
Beddingfield 256-233-2393 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. |
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2. Requesting
Restrictions. You have the right to request
a restriction in our use or disclosure of your IIHI
for treatment, payment or health care operations.
Additionally, you have the right to request that
we restrict our disclosure of your IIHI 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 a restriction in our use or disclosure
of your IIHI, you must make your request in writing
to Amanda Beddingfield 256-233-2393.
Your request must describe in a clear and concise
fashion:
- the information you wish restricted;
- whether you are requesting to limit our practice’s
use, disclosure or both; and
- to whom you want the limits to apply.
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| 3. Inspection
and Copies. You have the right to inspect
and obtain a copy of the IIHI 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
Amanda Beddingfield 256-233-2393
in order to inspect and/or obtain a copy
of your IIHI. 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. |
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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 practice. To request
an amendment, your request must be made in writing
and submitted to Amanda Beddingfield
256-233-2393. 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 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:
- accurate and complete
- not part of the IIHI kept by or for the practice;
- not part of the IIHI 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.
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| 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 practice
has made of your IIHI for non-treatment, non-payment
or non-operations purposes. Use of your IIHI as
part of the routine patient care in our practice
is not required to be documented. For example, 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 Amanda Beddingfield
256-233-2393. 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 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. |
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| 6. Right
to a Paper Copy of This Notice. You are entitled
to receive a paper copy of our notice of privacy
practices. You may ask us to give you a copy of
this notice at any time. To obtain a paper copy
of this notice, contact Amanda
Beddingfield 256-233-2393. |
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7. Right
to File a Complaint. If you believe your
privacy rights have been violated, you may file
a complaint with our practice or with the Secretary
of the Department of Health and Human Services.
To file a complaint with our practice, contact Amanda
Beddingfield 256-233-2393. All complaints
must be submitted in writing. You will not be penalized
for filing a complaint.
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| 8. Right
to Provide an Authorization for Other Uses and Disclosures.
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 us regarding the use
and disclosure of your IIHI may be revoked at any
time in writing. After you revoke your authorization,
we will no longer use or disclose your IIHI for
the reasons described in the authorization. Please
note, we are required to retain records of your
care. |
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Again, if you have any questions
regarding this notice or our health information
privacy policies, please contact Amanda
Beddingfield 256-233-2393.
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Hippa policy | | |
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