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 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.
PLEASE REVIEW THIS NOTICE
CAREFULLY.
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
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.
B. IF YOU HAVE QUESTIONS
ABOUT THIS NOTICE, PLEASE CONTACT:
Jason Ott, Practice
Administrator @ (405) 341-6941
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.
-
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.
-
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.
-
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.
-
Appointment Reminders.
Our practice may use and disclose your IIHI to contact you and
remind you of an appointment.
-
Treatment Options.
Our practice may use and disclose your IIHI to inform you of potential
treatment options or alternatives.
-
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.
-
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.
-
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.
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:
-
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.
-
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.
-
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.
-
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 office
-
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)
-
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.
-
Organ and Tissue Donation.
Our practice may release your IIHI to organizations that handle
organ, eye or tissue procurement or transplantation, including
organ donation banks, as necessary to facilitate organ or tissue
donation and transplantation if you are an organ donor.
-
Research. Our practice
may use and disclose your IIHI for research purposes in certain
limited circumstances. We will obtain your written authorization
to use your IIHI for research purposes except when an Institutional
Review Board or Privacy Board has determined that the waiver of
your authorization satisfies the following: (i) the use or disclosure
involves no more than a minimal risk to your privacy based on
the following: (A) an adequate plan to protect the identifiers
from improper use and disclosure; (B) an adequate plan to destroy
the identifiers at the earliest opportunity consistent with the
research (unless there is a health or research justification for
retaining the identifiers or such retention is otherwise required
by law); and (C) adequate written assurances that the PHI will
not be re-used or disclosed to any other person or entity (except
as required by law) for authorized oversight of the research study,
or for other research for which the use or disclosure would otherwise
be permitted; (ii) the research could not practicably be conducted
without the waiver; and (iii) the research could not practicably
be conducted without access to and use of the PHI.
-
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.
-
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.
-
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.
-
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: (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.
-
Workers’ Compensation.
Our practice may release your IIHI for workers’ compensation
and similar programs.
E. YOUR RIGHTS REGARDING
YOUR IIHI
You have the following
rights regarding the IIHI that we maintain about you:
-
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 Jason Ott, Practice Administrator
@ (405) 341-6941 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.
-
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 Jason Ott, Practice Administrator @ (405) 341-6941 Your request must describe
in a clear and concise fashion:
- (a) the information
you wish restricted;
- (b) whether you
are requesting to limit our practice’s use, disclosure
or both; and
- (c) to whom you
want the limits to apply.
-
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 Jason Ott, Practice Administrator @
(405) 341-6941 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.
-
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 Jason Ott, Practice Administrator @ (405) 341-6941. 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: (a) accurate and complete; (b) not part of the IIHI kept
by or for the practice; (c) not part of the IIHI which you would
be permitted to inspect and copy; or (d) 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 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 Jason Ott, Practice Administrator @
(405) 341-6941. 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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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 Jason Ott, Practice Administrator @ (405) 341-6941.
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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 Jason Ott, Practice Administrator @ (405)
341-6941. All complaints
must be submitted in writing. You will not be penalized for filing
a complaint.
-
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.
Again, if you have any
questions regarding this notice or our health information privacy
policies, please contact Jason Ott, Practice Administrator @ (405)
341-6941
Click here to view our web site privacy policy.
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