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.
If you have any questions about this Privacy Policy please contact the:
Privacy Officer or Office Manager
This Privacy Policy describes how we may use and disclose your protected
health information to carry out treatment, payment or healthcare operations
for our business. This policy also describes your rights regarding your
protected health information.
“Protected health information” is defined as, any information
that relates to the past, present or future physical or mental condition
of an individual; the provision of healthcare to the individual; or the
past present or future payment for the provision of healthcare to an
individual.
Uses and Disclosures
Your confidential healthcare information may be used or disclosed
to assist us with the treatment, payment or healthcare operations
of our office:
- Treatment---Information will be shared with healthcare
professionals,
within our office, to provide you with quality healthcare.
Information may be shared with healthcare providers outside
our office (specialists,
laboratories, radiologists) when another provider is
needed to assist your physician with diagnosis or treatment of a condition.
- Payment---Information
will be released to your insurance company to assist in the payment
for services provided. Information may also be
shared to verify eligibility, obtain authorizations, or prove medical
necessity for services provided.
- Healthcare Operations---Information may be shared with contracted
business associates that provide additional support to our office.
Examples of some business associates may include auditors, consultants,
accountants
or accreditation services.
Your confidential healthcare information may be used or
disclosed for other reasons without your authorization:
- Required Uses and Disclosures: Your protected health information
must be disclosed as required by law, when requested by you and when
required
by the Secretary of the Department of Health and Human Services to
investigate our compliance with the privacy requirements.
- Public Health Activities: As permitted by law, for the purpose
of controlling disease, injury or disability.
- Communicable Disease: As authorized by law, to notify another
person that may have been exposed to or at risk of spreading a
communicable disease.
- Health Oversight: As authorized by law, for the purpose
of audits, investigations and inspections.
- Abuse or Neglect: As authorized by law, to a health authority
that deals with child abuse or neglect. (Example: Stanly County
Child Fatality
and Prevention Team)
- Food and Drug Administration: As required, to report
adverse events, product defects or problems and to enable product recalls.
- Legal Proceedings: In response to a subpoena or
court order.
- Law Enforcement: Legal processes required by law,
Requests for information for identification/ location, Pertaining to
victims
of crime, Suspicion
of death as related to a crime, Crimes occurring on the premises
of our office.
- Coroners, Funeral Directors and Organ Donations: As
requested, for identification purposes, to assist in determining cause
of
death, or
other duties required by law or authorized by law.
- Research: When approved by an institutional review
board.
- Criminal Activity: Following state and federal
laws, to prevent or lessen a serious threat to the health or safety
of a
person or the public.
- Military Activity/ National Security: Under certain situations,
if you are Armed Forces personnel. (Examples: to determine eligibility
for
benefits, to conduct national security and intelligence activities)
- Workers Compensation: As authorized, to comply
with workers’ compensation
laws.
- Inmates: As necessary, if you are an inmate of
a correctional facility.
- Emergency Situations: As needed, when authorization
can not be provided.
- Family Members/ Others: When family member or others have
been identified by you as involved in your care. You have the right
to object to this
type of disclosure
- Marketing/Other Uses/ Disclosures: Communications
involving face-to-face discussions of treatment alternatives, appointment
reminder
cards mailed
to your home.
Your confidential healthcare information may be used or
disclosed for other reasons, only after we receive written authorization
from you.
- Example: To post a picture of your child (that
you have provided to us) on our office bulletin board or to use your
child’s
picture for maternity fair/public health fair events
> You may revoke
your authorization at any time by submitting a written
request to our office.
> Any services provided before this request will still be based
on the prior authorization. We will continue to use/ disclose information
to receive payment and perform healthcare operations
for these
services.
Patient Rights
The following is a list of your rights with respect to your protected
health information:
- You have the right to inspect and copy your protected
health information.
You may review and request copies of your protected health information
held by our office by providing a written request. This includes
medical and billing information. Your request to review your information
may
be approved or denied by the physicians, depending on the circumstances.
- You have the right to request a restriction of your protected
health information.
You may request that parts of your information not be released to
family members or others involved in you care. Your written request
must state
the specific restriction requested and to whom you want the restriction
to apply. Our office is not required to agree to all restrictions.
- You have the right to receive confidential communications from us
by alternative means or at alternative locations.
You may request to be contacted at a different phone number or
different address. You will not be required to explain your reasoning
for the
request. We will attempt to comply with your request when the alternative
means
of communication is reasonable and our resources permit the type
of communication.
- You have the right to request amendments to your
protected health information.
Requests must be provided in writing and the reason for the request
must be included. This request may be denied if your physician
maintains that
the information is accurate. Any disagreements with a denial
should be communicated to our Privacy Officer. Any information
released
to us by
another provider will not be amended.
- You have the right to receive
an accounting of certain disclosures of your protected health information.This
release record will not contain releases related to treatment,
payment, healthcare operations or releases made to you or your
family members.
You have a right to receive information on disclosures that
occur after April 14, 2003. The right to receive this information
is
subject to
certain exceptions, restrictions and limitations. (Note:
Cost-based
fees may
be added to accounting requests that occur more than once
per 12-month period)
- You have a right to obtain a paper copy of this
Privacy Notice or you may visit our website at www.albemarlepediatrics.com.
Complaints
If you believe that your privacy rights have been violated by us,
you may note your complaint to our office directly or to the Secretary
of Health and Human Services. You may notify our office, in writing,
by contacting our Privacy Officer at:
Albemarle Pediatrics
Attn: Privacy Officer
105 Yadkin Street
Suite 203
Albemarle, NC 28001
(704) 982-5437
We will not retaliate against you for filing a complaint. We want to
continue to maintain a confidential environment and notification of
any potential violations will assist us in achieving maximum privacy
standards. We will notify you, in writing, regarding our decision and/
or actions taken regarding your complaint.
We are required by law to maintain the privacy of your protected health
information. Our office will abide by the terms of this notice and
continue to maintain the confidentiality of our patient's healthcare
information. We reserve the right to make changes to this notice. You
will be informed of any substantial changes to the notice and you may
request a copy of the updated notice at any time.
This notice was published and becomes effective on April 14, 2003
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