Office Information: Notice of Privacy Practices

Policy and Procedure Notice of Privacy Practices

Southwest Sports Medicine

Policy

The HIPAA Privacy Rule gives an individual a right to adequate notice of the uses and disclosures of protected health information (PHI) that may be made by this office, and of the individual's rights and the office's legal duties with respect to PHI.

Procedure for Content of Notice of Privacy Practices

• The Notice will be in plain language and inform the individual of the uses and disclosures of PHI that this office may make, and of the individual's rights and the office's legal duties with respect to their PHI as required by the HIPAA Privacy Rule and contained in our office Notice, which is incorporated into this procedure.
  
  
• The Notice will contain the mandatory elements required by the HIPAA Privacy Rule
  
  
• The Notice will contain the following optional elements for certain uses and disclosures:
  
  
  • The office may contact the individual to provide appointment reminders for information about treatment alternatives or other health-related benefits and services that may be of interest to the individual.
    
    
• The Notice will reserve the right to change its policy and procedures, and the office will make the Notice available on request to individuals whenever there is a material change to it.

Procedure for Providing Notice

• The Notice will be posted in a clear and prominent place in the office where individuals seeking service will be able to read it.
  
  
• This office will make available on or before the first date of service after April 14, 2003 to each patient of prospective patient its "Notice of Privacy Practices"
  
  
• The office person(s) responsible for obtaining the signed acknowledgement or documentation of good faith efforts to obtain it is; Tonya Gibbs, Compliance Officer.
  
  
• All current or new patients after April 14, 2003 will be requested to sign a written acknowledgment of Receipt of Privacy Notice, which will be maintained in their medical record.
  
  
• For patients or their representatives who either refuse or are unable to sign the acknowledgement, the appropriate staff person will prepare a documentation of good faith efforts to obtain acknowledgement of Receipt of Privacy Notice, reflecting why patient or representative did not sign, which will be maintained in their medical record.
  
  
• For those patients who cannot sign due to emergency condition, the responsible person for follow up is Tonya Gibbs, Compliance Officer.

Procedure on Documentation

• This office will keep samples of its Notice of Privacy Practices for 6 years.
  
  
• This office will maintain in the individual's medical record all acknowledgments and/or documentation of good faith efforts to obtain acknowledgement.

Procedure for Revising Notice

• This office will, as necessary and at least annually, review its Notice of Privacy Practices and related policy and procedures for possible revision.

References: HIPAA Privacy Rule, 45 C.F.R. 164.520

Notice of Privacy Practices for Protected Health Information

Southwest Sports Medicine

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

This office is required by a federal regulation, known as the HIPAA Privacy Rule, to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices. This offices will not use or disclose your health information except as described in this Notice.

The office is permitted by federal privacy laws to make uses and disclosures of your health information for purposes of treatment, payment, and health care operations. Protected health information is the information we create and obtain in providing our services to you. The health information about you is documented in a medical record and on a computer. Such information may include documenting you symptoms, medical history, examination and test results, diagnoses, treatment, and applying for future care or treatment. It also includes billing documents for those services.

Examples of uses of your health information for treatment purposes are:

• A nurse, physician assistant or medical assistant obtains treatment information about you and records it in a health record.
  
  
• During the course of your treatment, the physician determines he/she will need to consult with another specialist in the area. He/she will share information with such specialist and obtain his/her input.

Example of use of your health information for payment purposes:

• We submit requests for payment to your health insurance company. The health insurance company (or other business associate helping us obtain payment) requests health information from us regarding medical care given. We will provide information to them about you and the care given, which may include copies or excerpts of your medical record which are necessary for payment of you account. For example, a bill sent to your health insurance company may include information that identifies your diagnosis, and the procedures and supplies used.

Example of use of your health information for health care operations:

• We obtain services from our insurers or other business associates (an individual or entity under contract with us to perform or assist us in a function or activity that necessitates the use or disclosure of health information) such as quality assessment, quality improvement, outcome evaluation, protocol and clinical guidelines development, training programs, credentialing, medical transcription, medical review, legal services, and insurance. We will share health information about you with insurers and other business associates to protect the confidentiality of your health information.

Your Health Information Rights

The health and billing records we maintain are the physical property of the doctor's office. The information in it, however, belongs to you. You have a right to:

• Request a restriction of certain uses and disclosures of your health information by delivering the request in writing to our office - we are not required to grant the request but we will comply with any request granted;
  
  
• Obtain a paper copy of the Notice of Privacy Practices for Protected Health Information ("Notice") by making a request at our office;
  
  
• Request that you be allowed to inspect and copy your medical record and billing record-you may exercises this right by delivering the request in writing to our office using the form we provide to you upon request;
  
  
• Appeal an denial of access to your protected health information except in certain circumstances;
  
  
• Request that your medical record be amended to correct incomplete or incorrect information by delivering a written request, including a reason to support it, to our office using the form we provide to you upon request. (We are not required to make such amendments);
  
  
• File a statement of disagreement if your amendment is denied, and require that the request for amendment and any denial be attached in all future disclosures of your protected health information;
  
  
• Obtain an accounting of disclosures of your health information as required to be maintained by law by delivering a written request to our office using the form we provide to you upon request. An accounting will not included uses and disclosures of information for treatment, payment, or health care operations; disclosures or uses made to you or made at your request; uses or disclosures made pursuant to an authorization signed by you; or to family members or friends or uses relevant to that person's involvement in your care or in payment for such care; or sues or disclosures to notify family or others responsible for your care of your location, condition, or your death; we may charge a cost-based fee for more than one accounting in a 12-month period.
  
  
• Request that confidential communication of your health information be made by alternative means or at an alternative location by delivering the request in writing to our office using the form we provide to you upon request; and,
  
  
• Revoke authorizations that you made previously to use or disclose information except to the extent information or action has already been taken by delivering a written revocation to our office.

If you want to exercise any of the above rights, please contact Tonya Gibbs, Compliance Officer, (480) 763-5950, 1121 West Warner Rd, Suite #112, Tempe, AZ, 85284, in person or in writing, during normal business hours. Our Privacy Officer will provide you with assistance on the steps to take to exercise your rights.

You have the right to review this Notice before signing the acknowledgement authorizing use and disclosure of your protected health information for treatment, payment, and health care operations purposes.

Our Responsibilities

The Office is required to:

• Maintain the privacy of your health information as required by law;
  
  
• Provide you with a notice as to our duties and privacy practices as to the information we collect and maintain about you;
  
  
• Abide by the terms of this Notice;
  
  
• Notify you if we cannot accommodate a requested restriction or request; and
  
  
• Accommodate your reasonable requests regarding methods to communicate health information with you.

We reserve the right to amend, change, or eliminate provisions in our privacy practices and access practices and to enact new provisions regarding the protected health information we maintain. If our information practices change, we will amend our Notice. You are entitled to receive a revised copy of the Notice by calling and requesting a copy of our "Notice" or by visiting our office and picking up a copy.

To Request Information or File a Complaint

If you have questions, would like additional information, want to report a -problem regarding the handling of your information, of if you believe your privacy rights have been violated and want to file a written complaint with our office, please contact Tonya Gibbs, Compliance Officer, (480) 763-5950, 1121 West Warner Road, Suite 112, Tempe, AZ 85284. You may also file a complaint by mailing it or e-mailing it to the Secretary of Health and Human Services.

• We cannot, and will not, require you to waive your rights under the Privacy rule including the right to file a complaint with the Secretary of Health and Human Services (HHS) as a condition of receiving treatment in this office.
  
  
• We cannot, and will not, retaliate against you or filing a complaint with the Secretary of Health and Human Services.

Other Disclosures and Uses We Can Make Without Your Written Authorization

Notification of Family/Friends

• Unless you object, we may use or disclose your protected health information to notify, or assist in notifying, a family member, personal representative, or other person responsible for your care, about your location, and about your general condition, or your death.

Communication with Family/Friends

• Using our best judgment, we may disclose to a family member, other relative, close personal friend, or any other person you identity, health information relevant to that person's involvement in your care or in payment for such care if you do not object or in an emergency.

Disaster Relief

• We may use and disclose your health information to assist in disaster relief efforts.

Employers

• We may release health information about you to your employer if we provide health care services to you at the request of your employer, and the health care services are provided either to conduct and evaluation relating to medical surveillance of the workplace or to evaluate whether you have a work-related illness or injury. In such circumstances, we will give you written notice of such release of information to your employer. Any other disclosures to you employer will be made only if you execute an authorization for the release of that information to your employer.

Deceased Persons

• We may disclose your health information to funeral directors, medical examiners, or coroners consistent with applicable law to allow them to carry out their duties. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release health information about patients to funeral directors as necessary for them to carry out their duties.

Organ Procurement Organizations

• Consistent with applicable law, we may disclose your health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.

Appointment Reminders, Marketing and Treatment Alternatives

• We may contact you to provide you with appointment reminders, with information about treatment alternatives, or with information about other health-related benefits and services that may be of interest to you. We may also encourage you to purchase a product or service when we see you. We will not disclose your health information without your written authorization.

Food and Drug Administration (FDA)

• We may disclose to the FDA your health information relating to adverse events with respect of food, supplements, products and product defects, or post-marketing surveillance information to enable product recalls, repairs, or replacements.

Workers' Compensation

• If you are seeking compensation through Workers' Compensation, we may disclose your health information to the extent necessary to comply with laws relating to Workers' Compensation.

Public Health

• As required by law, we may disclose you health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability; to report reactions to medications or problems with products; to notify people of recalls; to notify a person who may have been exposed to a disease or who is at risk for contracting or spreading a disease or condition.

Abuse, Neglect, & Domestic Violence

• We may disclose your health information to public authorities as allowed by law to report abuse, neglect, or domestic violence.

Sign in Sheet

• We may use and disclose your health information by having you sign in when you arrive at our office. We may also call out your name when we are ready to see you.

Inmates

• If you are an inmate of a correctional institution or under the custody of a law enforcement officer, we may disclose to the institution or law enforcement official health information necessary for your health and the health and safety of other individuals.

Law Enforcement

• We may disclose your health information for law enforcement purposes as required by law, such as when required by a court order; for identification of a victim of a crime if certain protective requirements are met; to report a crime on our premises; to report crime in emergencies; and other appropriate situations permitted by law.

Health Oversight

• We may disclose your health information to appropriated health oversight agencies or for health oversight activities.

Judicial/Administrative Proceedings

• We may disclose your health information in the course of any judicial or administrative proceeding as allowed or required by law or as directed by a proper court order or in response to a subpoena, with your authorization, discovery request or other lawful process if certain specific requirements are met.

Serious Threat

• To avert a serious threat to health or safety, we may disclose your health information consistent with applicable law to prevent or lessen a serious, imminent threat to the health or safety of a person or the public.

For Specialized Governmental Functions

• We may disclose your health information for specialized government functions as authorized by law such as to Armed Forces personnel, for national security purposes, or to public assistance program personnel.

Other Uses

• Other uses and disclosures of your health information besides those identified in this Notice will be made only as otherwise authorized by law or with your written authorization and you may revoke the authorization as previously provided in this Notice.

Website

• If we maintain a website that provides information about our office, this Notice will be on the website.

Research

• We may disclose your 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.

Original Effective Date: April 14, 2003