Notice of Privacy
Practices
THIS NOTICE DESCRIBES
HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN
GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Introduction
At
Consultants in Gastroenterology, we are committed to treating and
using protected health information about you responsibly. This Notice
of Health Information Practices describes the personal information we
collect, and how and when we use or disclose that information. It
also describes your rights as they relate to your protected health
information. This Notice is effective 4/14/03, and applies to all
protected health information as defined by federal regulations.
Understanding Your Health Record/Information
Each time you visit Consultants in Gastroenterology, a record of your
visit is made. Typically, this record contains your symptoms,
examination and test results, diagnoses, treatment, and a plan for
future care or treatment. This information, often referred to as your
health or medical record, serves as a:
• Basis for planning your care and treatment,
• Means of communication among the many health professionals who
contribute to your care,
• Legal document describing the care you received,
• Means by which you or a third-party payer can verify that
services billed were actually provided,
a tool in educating health professionals,
• Source of data for medical research,
• Source of information for public health officials charged with
improving the health of this state and the nation,
• Source of data for our planning and marketing,
• Tool with which we can assess and continually work to improve
the care we render and the outcomes we achieve,
Understanding what is
in your record and how your health information is used helps you to:
ensure its accuracy, better understand who, what, when, where, and why
others may access your health information, and make more informed
decisions when authorizing disclosure to others.
Your
Health Information Rights
Although your health record is the physical property of Consultants in
Gastroenterology, the information belongs to you. You have the right
to:
• Obtain a paper copy of this notice of information practices upon
request,
• Inspect and copy your health record as provided for in 45 CFR
164.524,
• Amend your health record as provided in 45 CFR 164.528,
• Obtain an accounting of disclosures of your health information
as provided in 45 CFR 164.528,
• Request communications of your health information by alternative
means or at alternative locations,
• Request a
restriction on certain uses and disclosures of your information as
provided by 45 CFR 164.522, and
• Revoke your
authorization to use or disclose health information except to the
extent that action has already been taken.
Our
Responsibilities
Consultants in Gastroenterology is required to:
• Maintain the privacy of your health information,
• Provide you with this notice as to our legal duties and privacy
practices with respect to information we collect and maintain about
you,
• Abide by the terms of this notice,
• Notify you if we are unable to agree to a requested restriction,
and
• Accommodate reasonable requests you may have to communicate
health information by alternative means or at alternative locations.
We
reserve the right to change our practices and to make the new
provisions effective for all protected health information we
maintain. Should our information practices change, you will be
notified at your next appointment.
We will not use or
disclose your health information without your authorization, except as
described in this notice. We will also discontinue to use or disclose
your health information after we have received a written revocation of
the authorization according to the procedures included in the
authorization.
For More
Information or to Report a Problem
If
have questions and would like additional information, you may contact
the practice’s Privacy Officer at 402-441-5600.
If
you believe your privacy rights have been violated, you can file a
complaint with the practice’s Privacy Officer, or with the Office for
Civil Rights, U.S. Department of Health and Human Services. There will
be no retaliation for filing a complaint with either the Privacy
Officer or the Office for Civil Rights. The address for the OCR is
listed below:
Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F, HHH Building
Washington, D.C. 20201
Examples
of Disclosures for Treatment, Payment and Health Operations
Following are examples of the types of uses and disclosures of your
protected health information that the physician’s office is permitted
to make. These examples are not meant to be exhaustive, but to
describe the types of uses and disclosures that may be made by our
office.
Treatment:
We will use and disclose your protected health information to provide,
coordinate, or manage your health care and any related services. This
includes the coordination or management of your health care with a
third party that has already obtained your permission to have access
to your protected health information (e.g. home health care agency).
We will also disclose protected health information to other physicians
who may be treating you. For example, your protected health
information may be provided to a physician to whom you have been
referred to ensure that the physician has the necessary information to
diagnose or treat you.
In
addition, we may disclose your protected health information from
time-to-time to another physician or health care provider (e.g., a
specialist or laboratory) who, at the request of your physician,
becomes involved in your care by providing assistance with your health
care diagnosis or treatment to your physician. Photographs, digital,
x-rays, or other images may be recorded to document part of our
healthcare management and treatment. This includes ultrasound and
certain diagnostic procedures. The images are the property of
Consultants in Gastroenterology or the entity that produced them.
Payment:
Your protected health information 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 protected health information be disclosed to the health plan
to obtain approval for the hospital admission.
Unless you have advised us in writing otherwise, we may release
information to your spouse, other family member, or responsible party
(after verification of relationship), as to balance due information on
your account to facilitate payment.
Healthcare Operations:
We may use or disclose, as needed, your protected health information
in order to support the business activities of our physician’s
practice. These activities include, but are not limited to,
communications with you, quality assessment activities, employee
review activities, training of medical students, licensing, marketing
and fundraising activities, and conducting or arranging for other
business activities.
For example, we may disclose your protected health information to
qualified students that are training/learning at our office. We may
also call you by name in the waiting room. We may use or disclose
your protected health information, as necessary, to contact you to
remind you of your appointment or to notify you about your
healthcare. We may leave a message on voice mail or answering
machine, or with the person answering the phone, unless you have
advised us in writing and we have agreed to alternate means of
communication.. We may communicate with you via e-mail if we have
your e-mail address.
We
will share your protected health information with third party
“business associates” that perform various activities (e.g., billing,
transcription services) for the practice. Whenever an arrangement
between our office and a business associate involves the use or
disclosure of your protected health information, we will have a
written contract that contains terms that will protect the privacy of
your protected health information.
We
may use or disclose your protected health information, as necessary,
to provide you with information about treatment alternatives or other
health-related benefits and services that may be of interest to you.
We may also use and disclose your protected health information for
other marketing activities. For example, your name and address may be
used to send you a newsletter about our practice and the services we
offer. We may also send you information about products or services
that we believe may be beneficial to you. You may contact our Privacy
Officer to request that these materials not be sent to you.
Uses and
Disclosures of Protected Health Information Based upon Your Written
Authorization
Other uses and
disclosures of your protected health information will be made only
with your written authorization, unless otherwise permitted or
required by law as described below. You may revoke that
authorization, at any time, in writing, except to the extent that your
physician or the physician’s practice has already acted on the use or
disclosure indicated in the authorization.
Other Permitted and
Required Uses and Disclosures That May Be Made With Your
Authorization or Opportunity to Object
We may use and
disclose your protected health information in the following
instances. You have the opportunity to agree or object to the use or
disclosure of all or part of your protected health information. If
you are not present or able to agree or object to the use or
disclosure of the protected health information, then your physician
may, using professional judgment, determine whether the disclosure is
in your best interest. In this case, only the protected health
information that is relevant to your health care will be disclosed.
Others Involved in
Your Healthcare: Unless you object, we may disclose to a member of your
family, a relative, a close friend or any other person you identify,
your protected health information that directly relates to that
person’s involvement in your health care. If you are unable to agree
or object to such a disclosure, we may disclose such information as
necessary if we determine that it is in your best interest based on
our professional judgment. We may use or disclose protected health
information to notify or assist in notifying a family member, personal
representative or any other person that is responsible for your care
of your location and general condition. Finally, we may use or
disclose your protected health information to an authorized public or
private entity to assist in disaster relief efforts and to coordinate
uses and disclosures to family or other individuals involved in your
health care.
Emergencies:
We may use or disclose your protected health information in an
emergency treatment situation. If this happens, your physician shall
try to obtain your consent as soon as reasonably practicable after the
delivery of treatment. If your physician or another physician in the
practice is required by law to treat you and the physician has
attempted to obtain your consent but is unable to obtain your consent,
he or she may still use or disclose your protected health information
to treat you.
Other Permitted and
Required Uses and Disclosures That May Be Made Without Your
Authorization or Opportunity to Object
We may use or
disclose your protected health information in the following situations
without your authorization. These situations include:
Required by Law:
We may use or disclose your protected health information to the extent
that the use or disclosure is required by law. The use or disclosure
will be made in compliance with the law and will be limited to the
relevant requirements of the law. You will be notified, as required
by law, of any such uses or disclosures.
Public Health:
We may disclose your protected health information for public health
activities and purposes to a public health authority that is permitted
by law to collect or receive the information. The disclosure will be
made for the purpose of controlling disease, injury or disability. We
may disclose your protected health information, if authorized by law,
to a person who may have been exposed to a communicable disease or may
otherwise be at risk of contracting or spreading the disease or
condition.
Health Oversight:
We may disclose protected health information to a health oversight
agency for activities authorized by law, such as audits,
investigations, and inspections. Oversight agencies seeking this
information include government agencies that oversee the health care
system, government benefit programs, other government regulatory
programs and civil rights laws.
Abuse or Neglect:
We may disclose your protected health information to a public health
authority that is authorized by law to receive reports of child abuse
or neglect. In addition, we may disclose your protected health
information 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.
Food and Drug
Administration: We may disclose your protected health information to a
person or company required by the Food and Drug Administration to
report adverse events, product defects or problems, biologic product
deviations, track products; to enable product recalls; to make repairs
or replacements, or to conduct post marketing surveillance, as
required.
Legal Proceedings:
We may disclose protected health information in the course of any
judicial or administrative proceeding, in response to an order of a
court or administrative tribunal (to the extent authorized), in
certain conditions in response to a subpoena, discovery request or
other lawful process.
Law Enforcement:
We may also disclose protected health information, so long as
applicable legal requirements are met, for law enforcement purposes.
These law enforcement purposes include (1) legal processes and
otherwise required by law, (2) limited information requests for
identification and location purposes, (3) 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 the premises of the
practice, and (6) medical emergency and it is likely that a crime has
occurred.
Coroners, Funeral
Directors, and Organ Donation: We may disclose protected health information to
coroners, organ procurement organizations and funeral directors
consistent with applicable law to carry out their duties.
Research:
We may disclose your protected health 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.
Criminal Activity:
Consistent with applicable federal and state laws, we may disclose
your protected health information, if we believe that the use or
disclosure is necessary to prevent or lessen a serious and imminent
threat to the health or safety of a person or the public. We may also
disclose protected health information if it is necessary for law
enforcement authorities to identify or apprehend an individual.
Inmates:
We may disclose your protected health information if you are an inmate
of a correctional facility and your physician created or received your
protected health information in the course of providing care for you.
Workers’
Compensation:
Your protected health information may be disclosed by us as to comply
with workers’ compensation laws and other similar legally-established
programs.
Required Uses and
Disclosures: Under the law, we must make disclosures to you and when required by the
Secretary of the Department of Health and Human Services to
investigate or determine our compliance with the requirements of
Section 164.500 et. seq.
Notice of Privacy
Policies Revision #1. 8/02
