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Notice of Privacy Practices
Stabler Clinic, P.C.
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 Notice please
contact our Privacy Contact who is
David
Norrell
Administrator
Privacy
Contact.
This Notice of Privacy Practices describes how we
may use and disclose your Protected Health Information (PHI) to carry
out treatment, payment, or health care operations and for other purposes
that are permitted or required by law. It also describes your rights to
access and control your PHI. “PHI” is information about you, including
demographic information, that may identify you and that relates to your
past, present or future physical or mental health or condition and
related health care services.
We are required to abide by the terms of this
Notice of Privacy Practices. We may change the terms of our notice, at
any time. Upon your request we will provide you with any revised Notice
of Privacy Practices by calling the Stabler Clinic and requesting that a
revised copy be sent to you in the mail or asking for one at the time of
your next appointment.
1. Uses and Disclosures of PHI Based Upon
Your Written Consent
You will be asked by your physician to sign a
consent form. Once you have consented to use and disclosure of your PHI
for treatment, payment, and health care operations by signing the
consent form, your physician will use or disclose your PHI as described
in this Section 1. Your PHI may be used and disclosed by your
physician, our office staff, and others outside of our office that are
involved in your care and treatment for the purpose of providing health
care services to you. Your PHI may also be used and disclosed to pay
your health care bills and to support the operation of the
physician’s/Clinic’s practice.
Following are examples of the types of uses and
disclosures of your protected health care information that the
physician’s office is permitted to make once you have signed our consent
form. These examples are not meant to be exhaustive, but to describe
the types of uses and disclosures that may be made by our office once
you have provided consent.
Treatment: We will use and disclose your
PHI 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 PHI. For example, we would disclose your PHI, as
necessary, to a home health agency that provides care to you. We will
also disclose PHI to other physicians who may be treating you when we
have the necessary permission from you to disclose your PHI. For
example, your PHI may be provided to a physician to whom you have been
referred to endure that the physician has the necessary information to
diagnose or treat you.
In addition, we may disclose your PHI 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.
Payment: Your PHI 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 hospital stay may require that your relevant PHI be
disclosed to the health plan to obtain approval for the hospital
admission.
Healthcare Operations: We may use or
disclose, as needed, your PHI in order to support the business
activities of your physician’s/clinic’s practice. These activities
include, but are not limited to quality assessment activities, employee
review activities, and conducting or arranging for other business
activities. Healthcare Operations will also include the use of the
telephone to alert or maintain care for you as a patient. As necessary
we will leave messages on home answering machines and voice mailboxes.
For example, we may disclose your PHI by using a
sign-in sheet at the registration desk where you will be asked to sign
your name and indicate your physician. We may also call you by name in
the reception area (over the PA system) when your physician is ready to
see you. We may use or disclose your PHI, as necessary, to contact you
to remind you of your appointment.
We will share your protected PHI with third party
“business associates” that perform various activities (e.g.
transcription services, laboratory) for the practice. Whenever an
arrangement between our office and a business associate involves the use
or disclosure of your PHI, we will have a written contract that contains
terms that will protect the privacy of your PHI.
Uses and Disclosures of PHI Based
upon Your Written Authorization
Other uses and
disclosures of your PHI will be made only with your written
authorization, unless otherwise permitted or required by law as
described below. You may revoke this authorization, at any time, in
writing, except to the extent that your physician or the physician’s
practice has taken an action in reliance on the use or disclosure
indicated in the authorization.
Other Permitted
and Required Uses and Disclosures That May Be Made With Your Consent,
Authorization or Opportunity to Object
We may use and
disclose your PHI in the following instances. You have the opportunity
to agree or object to the use or disclosure of all or part of your PHI.
If you are not present or able to agree or object to the use or
disclosure of the PHI, then your physician may, using professional
judgment, determine whether the disclosure is in your best interest. In
this case, only the PHI 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 PHI 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
information as necessary if we determine that it is in your best
interest based on our professional judgment. We may use or disclose PHI
to notify or assist in notifying a family member, personal
representative or any other person that is responsible for your care of
your location, general condition or death. Finally, we may use or
disclose your PHI 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
PHI 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 PHI to
treat you.
Communication Barriers: We may use and
disclose your PHI if your physician or another physician in the practice
attempts to obtain consent from you but is unable to do so due to
substantial communication barriers and the physician determines, using
professional judgment, that you intend to consent to use or disclosure
under the circumstances.
Other Permitted
and Required Uses and Disclosures That May Be Made Without Your Consent,
Authorization or Opportunity to Object
We may use or
disclose your PHI in the following situations without your consent or
authorization. These situations include:
Required By Law: We may use or disclose
your PHI 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 PHI 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 also disclose your PHI, if directed by the public
health authority, to a foreign government agency that is collaborating
with the public health authority.
Communicable Diseases: We may disclose your
PHI, 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 your PHI
to a health over sight 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 PHI
to a public health authority that is authorized by law to receive
reports of child abuse or neglect. In addition, we may disclose your
PHI 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 PHI 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, as required.
Legal Proceedings: We may disclose your PHI
in the course of any judicial or administrative proceeding, in response
to an order of a court or administrative tribunal (to the extent such
disclosure is expressly authorized), in certain conditions in response
to a subpoena, discovery request or other lawful process.
Law Enforcement: We may disclose your PHI,
so long as applicable legal requirements are met, for law enforcement
purposes. The 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 (not on the Clinic’s premises) and
it is likely that a crime has occurred.
Criminal Activity: Consistent with
applicable federal and state laws, we may disclose your PHI, 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 disclose your PHI if it is necessary for law enforcement
authorities to identify or apprehend an individual.
Workers’ Compensation: Your PHI may be
disclosed by us as authorized to comply with workers’ compensation laws
and other similar legally established programs.
Inmates: We may use or disclose your PHI if
you are an inmate of a correctional facility and your physician created
or received your PHI in the course of providing care to you.
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.
2. Your Rights
Following is a statement of your rights with
respect to your PHI and a brief description of how you may exercise
these rights.
You have the right to inspect and copy your PHI.
This means you may inspect and obtain a copy of PHI about you that is
contained in a designated record set for as long as we maintain the
PHI. A “designated record set” contains medical and billing records and
any other records that your physician and the practice uses for making
decisions about you.
Under federal law, however, you may inspect or copy
the following records; psychotherapy notes; information complied in
reasonable anticipation of, or use in, a civil, criminal, or
administrative action or proceeding, and PHI that is subject to law that
prohibits access to PHI. Depending on the circumstances, a decision to
deny access may be reviewable. In some circumstances you may have a
right to have this decision reviewed. Please contact our Privacy
Contact if you have questions about access to your medical record.
You have the right to request a restriction of
your PHI. This means you may ask us to not use or disclose any part
of your PHI for the purposes of treatment, payment, or healthcare
operations. You may also request that any part of your PHI not be
disclosed to family members or friends who may be involved in your care
or for notification purposes as described in this Notice of Privacy
Practices. Your request must state the specific restriction requested
and to whom you want the restriction to apply.
Your physician is not required to agree to a
restriction that you may request. If physician believes it is in your
best interest to permit use and disclosure of your PHI, your PHI will
not be restricted. If your physician does agree to the requested
restriction, we may not use or disclose your PHI in violation of that
restriction you wish to request with your physician. You may request a
restriction by contacting our Privacy Contact Jerry W. Golden.
You have the right to request to receive
confidential communications from us by alternative means or at an
alternative location. We will accommodate reasonable request. We
may also condition this accommodation by asking you for information as
to how payment will be handled or specification of an alternative
address or other method of contact. We will not request an explanation
from you as to the basis for the request. Please make this request in
writing to our Privacy Contact.
You may have the right to have your physician
amend your PHI. This means you may request an amendment of PHI
about you in a designated record set for as long as we maintain this
information. In certain cases, we may deny your request for an
amendment. If we deny your request for amendment, you have the right to
file a statement of disagreement with us and we may prepare a rebuttal
to your statement and will provide you with a copy of any such
rebuttal. Please contact our Privacy Contact to determine if you have
questions about amending your medical record.
You have the right to receive an
accounting of certain disclosures we have made, if any, of your PHI.
This right applies to disclosures for purposes other than treatment,
payment, or healthcare operations as described in this Notice of Privacy
Practices. It excludes disclosures we have made to you, for a facility
directory, to family members or friends involved in your care, or for
notification purposes. You have the right to receive specific
information regarding these disclosures that occurred after April 14,
2003. You may request a shorter timeframe. The right to receive this
information is subject to certain exceptions, restrictions, and
limitations.
You have the right to obtain a paper copy of
this notice from us, upon request, even if you have agreed to accept
this notice electronically.
3. Complaints
You may complain
to us or to the Secretary of Health and Human Services if you believe
your privacy rights have been violated by us. You may file a complaint
with us by notifying our privacy contact of your complaint. We will not
retaliate against you for filing a complaint.
You may contact our Privacy Contact, David Norrell,
at (334) 382-2681 or
dnorrell@stablerclinic.com for further information about the
complaint process. |
