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for AUGUSTA
CARDIOLOGY CLINIC, P.C. |
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NOTICE OF PRIVACY PRACTICES
| THIS
NOTICE DESCRIBES HOW
PERSONAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS
TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY. |
| HOW
WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU. |
| The
following categories describe different ways that we use and disclose medical
information. For each category of uses or disclosures, we will elaborate on the
meaning and provide specific examples. Not every use or disclosure in a category
will be listed. However, all of the ways we are permitted to use and disclose
information will fall within one of the categories. |
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| For
Payment. We may use and disclose medical information about you so that the
treatment and services you receive at the practice may be billed to and payment
may be collected from you, an insurance company or a third party. For example,
it may be essential that you provide us with your health plan information regarding
care you receive at the practice so that your health plan will pay us or reimburse
you for those services. In addition, we may tell your health plan about a treatment
you are going to receive in order to obtain necessary approval or to determine
whether your plan will cover the treatment. | |
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For Treatment. We may use medical information about you to provide you with
medical treatment or services. We may disclose medical information about you to
doctors, nurses, technicians, medical students, or other practice personnel who
are involved in taking care of you at the practice. For example, a doctor treating
you for a broken leg may need to know if you have diabetes so that he/she can
arrange for an appropriate diet. Different departments of the practice also may
share medical information about you in order to coordinate the different services
you need, such as prescriptions, lab work and x-rays. We also may disclose medical
information about you to people outside the practice who may be involved in your
medical care after you leave the practice, such as family members, clergy or other
persons that are part of your care. | |
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| For
Health Care Operations. We may use and disclose medical information about
you for practice operations. These uses and disclosures are necessary to run the
practice and ensure that all of our patients receive quality care. For example,
we may combine medical information about a variety of practice patients to decide
what additional services the practice should offer, what services are not needed,
and whether certain new treatments are effective. We may also disclose information
to doctors, nurses, technicians, medical students, and other practice personnel
for review and learning purposes. We may combine the medical information we have
along with medical information from other practices to compare how we are doing
and thus, evaluate where we can make improvements in the care and services we
provide. We may remove information that identifies you from this set of medical
information so that others may use it to study health care and health care delivery,
without learning the identity of the patients. | |
| | | WHO
WILL FOLLOW THIS NOTICE. | | This
notice describes our organization's practices and that of: |
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| Any
health care professional authorized to enter information into your chart. |
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| All
departments and units of the practice. | |
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All employees, staff and other practice personnel. |
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| All
of these entities, sites and locations follow the terms of this notice. In addition,
these entities, sites and locations may share medical information with each other
for treatment, payment or practice operations purposes described in this notice. |
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| POLICY
REGARDING THE PROTECTION OF PERSONAL INFORMATION: | |
We understand that
medical information pertaining to you and your health is personal. We are committed
to protecting your medical information. We create a record of the care and services
you receive at the practice. We need this record in order to provide you with
quality care and to comply with certain legal requirements. This notice applies
to all of the records of your care generated by the practice, whether made by
practice personnel or by your personal doctor. Your personal doctor may have different
policies or notices regarding the doctor's use and disclosure of your medical
information created in the doctor's office or clinic. This
notice will inform you about the different ways in which we may use and disclose
medical information about you. We also describe your rights and certain obligations
we have regarding the use and disclosure of medical information. The
law requires us to: |
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| Make
sure that medical information that identifies you is kept private; |
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| Give
you this notice of our legal duties and privacy practices with respect to medical
information about you; and | |
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Follow the terms of the notice that is currently in effect. |
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| OTHER
CATEGORIES OF OUR INFORMATION USE INCLUDE AND DISCLOSE |
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| Appointment
Reminders. We may use and disclose medical information to contact you as a
reminder that you have an appointment for treatment or medical care at the practice. |
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| As
Required By Law. We will disclose medical information about you when required
to do so by federal, state or local law. | |
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| Health-Related
Benefits and Services. We may use and disclose medical information to tell
you about health-related benefits or services that may be of interests to you. |
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| Practice
Directory. We may include certain limited information about you in the practice
directory while you are a patient at the practice. This information may include
your name, location in the practice, your general condition (e.g. fair, stable,
etc.) and your religious affiliation. The directory information, except for your
religious affiliation, may also be released to people who ask for you by name.
Your religious affiliation may be given to a member of the clergy, such as a priest
or rabbi, even if they do not ask for you by name. This is so your family, friends
and clergy can call the practice about you and generally know how you are faring. | |
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| Individual
Involved in Your Care or Payment for Your Care. We may release medical information
about you to a friend or family member who is involved in your medical care. We
may also give information to someone who helps pay for your care. We may also
inform your family or friends about your condition. In addition, we may disclose
medical information about you to an entity assisting in a disaster relief effort
so that your family can be notified about your condition, status and location. | |
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| Research.
Under certain circumstances, we may use and disclose medical information about
you for research purposes. All research projects, however, are subject to a special
approval process. This process evaluates a proposed research project and its use
of medical information in order to balance the research needs with patients' need
for privacy of their medial information. Before we use or disclose medical information
for research, the project will have been approved through this research approval
process, but we may, however, disclose medical information about you to people
preparing to conduct a research project, for example, to help them look for patients
with specific medical needs, as long as the medical information they review does
not leave the practice. We will always ask for your specific permission if the
researcher obtains access to your name, address or other information that reveals
who you are, or will be involved in your care at the practice. | |
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| To
Avert a Serious Threat to Health or Safety. We may use and disclose medical
information about you when necessary to prevent a serious threat to your health
and safety or the health and safety of the public or another person. Any disclosure,
however, would only be to someone able to help prevent the threat. |
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| Treatment
Alternatives. We may use and disclose medical information to inform you about,
recommend possible treatment options or alternatives that may be of interest to
you.
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| | LESS
FREQUENT USES AND DISCLOSURES OF YOUR PERSONAL INFORMATION INVOLVING THOSE NOT
DIRECTLY INVOLVED IN YOUR CARE COULD INCLUDE: |
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| Coroners,
Medical Examiners and Funeral Directors. We may release medical information
to a coroner or medical examiner, in order to identify a deceased person or determine
the cause of death. We may also release medical information about patients of
the practice to funeral directors as necessary to carry out their services. |
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| Health
Oversight Activities. We may disclose medical information to a health oversight
agency for activities authorized by law. These oversight activities include, for
example, audits, investigations, inspections, and licensure. These activities
are necessary for the government to monitor the health care system, government
programs, and compliance with civil rights laws. | |
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| Inmates.
If you are an inmate of a correctional institution or under the custody of
a law enforcement official, we may release medical information about you to the
correctional institution or law enforcement official. This release would be necessary:
(1) for the institution to provide you with health care; (2) to protect your health
and safety or the health and safety of others; or (3) for the safety and security
of the correctional institution. | |
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Law Enforcement. We may release medical information if asked to do so by
a law enforcement official: | |
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| In
response to a court order, subpoena, warrant, summons or similar process; |
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| To
identify or locate a suspect, fugitive, material witness, or missing person; |
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| About
the victim of a crime if, under certain limited circumstances, we are unable to
obtain the person's agreement; | |
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| About
a death we believe may be the result of criminal conduct; |
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| About
criminal conduct at the practice; and | |
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| In
emergency circumstances to report a crime; the location of the crime or victims;
or to identify, description or location of the person who committed the crime. |
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Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we
may disclose medical information about you in response to a court or administrative
order. We may also disclose medical information about you in response to a subpoena,
discovery request, or other lawful process by someone else involved in the dispute,
but only if efforts have been made to tell you about the request or to obtain
an order protecting the information requested. |
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Military and Veterans. If you are a member of the armed forces, we may
release medical information about you as required by military command authorities.
We may also release medical information about foreign military personnel to the
appropriate foreign military authority. |
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| National
Security and Intelligence Activities. We may release medical information about
you to authorized federal officials for intelligence, counterintelligence, and
other national security activities authorized by law. |
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| Organ
and Tissue Donation. If you are an organ donor, we may release medical information
to organizations that handle organ procurement or organ, eye or tissue transplantation
or to an organ donation bank, as necessary, to facilitate organ or tissue donation
and transplantation. | |
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| Protective
Services for the President and Others. We may disclose medical information
about you to authorized federal officials so they may provide protection to the
President, other authorized persons, and foreign heads of state or conduct special
investigations. | |
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| Public
Health Risks. We may disclose medical information about you for public health
activities. These activities generally include the following, but are not limited
to: | |
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| Preventing
or controlling disease, injury or disability; | |
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| Reporting
births and deaths; | |
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| Reporting
child abuse or neglect; | |
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| Reporting
reactions to medications or problems with products; | |
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| Notifying
people of recalls of products they may be using; | |
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| Notifying
a person who may have been exposed to a disease or may be at risk for contracting
or spreading a disease or condition; | |
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| Notifying
the appropriate government authority if we believe a patient has been a victim
of abuse, neglect or domestic violence. We will only make this disclosure if you
agree or when required or authorized by law. | |
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| Worker's
Compensation. We may release medical information about you for worker's compensation
or similar programs. These programs provide benefits for work-related injuries
or illness. | |
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| NOTICE
OF INDIVIDUAL RIGHTS | | You
have the following rights regarding medical information we maintain about you: |
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| Right
to an Accounting of Disclosures. You have the right to request an "accounting
of disclosures." This is a list of the disclosures we made of medical information
about you.
To request this list or accounting of disclosures, you must
submit your request in writing to the Office Manager. Your request must state
a time period, which may not be longer than six years and may not include dates
before February 26, 2003. Your request should indicate in what form you want the
list (for example, on paper, electronically). The first list you request within
a 12-month period will be free. For additional lists, we may charge you for the
cost of providing the list. We will notify you of the cost involved and you may
choose to withdraw or modify your request at that time before any costs are incurred. |
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| Right
to Amend. If you feel that medical information we have about you is incorrect
or incomplete, you may ask us to amend the information. You have the right to
request an amendment for as long as the information is kept by or for the practice.
To request an amendment, your request must be made in writing and submitted to
the Office Manager. In addition, you must provide a reason that supports your
request. We
may deny your request for an amendment if it is not in writing or does not include
a reason to support the request. In addition, we may deny your request if you
ask us to amend information that: | |
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| Was
not created by us, unless the person or entity that created the information is
no longer available to make the amendment; | |
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Is not part of the medical information kept by or for the practice; |
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| Is
not part of information which you would be permitted to inspect and copy; or |
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Is accurate and complete. | |
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| Right
to Inspect and Copy. You have the right to insect and copy medical information
that may be used to make decisions about your care. Usually, this includes medical
and billing records, but does not include psychotherapy notes.
To
inspect and copy medical information that may be used to make decisions about
you, you must submit your request in writing to Medical Records. If you request
a copy of the information, we are entitled to charge a fee for the costs of copying,
mailing or other supplies associated with your request. We
may deny your request to inspect and copy in certain very limited circumstances.
If you are denied access to medical information, you may request that the denial
be reviewed. Another licensed health care professional chosen by the practice
will review your request and the denial. The person conducting the review will
not be the person who denied your request. We will comply with the outcome of
the review. | | |
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Right to a Paper Copy of this Notice. You have the right to a paper copy
of this notice. You may ask us to give you a copy of this notice at any time.
Even if you have agreed to receive this notice electronically, you are still entitled
to a paper copy of this notice. You may obtain a copy of this notice at our website,
www.augustacardiology.com.
To obtain a paper copy of this notice contact the Office Manager. |
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| Right
to Request Confidential Communications. You have the right to request that
we communicate with you about medical matters in a certain way or at a certain
location. For example, you can ask that we only contact you at work or by mail.
To request confidential communications, you must make your request in
writing to the
Office Manager. We will not ask you the reason for the request
and will accommodate all reasonable requests. Your request must specify how or
where you wish to be contacted. | |
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| Right
to Request Restrictions. You have the right to request a restriction or limitation
on the medical information we use or disclose about you for treatment, payment
or health care operations. You also have the right to request a limit on the medical
information we disclose about you to someone who is involved in your care or the
payment for your care, like a family member or friend. For example, you could
ask that we not use or disclose information about a surgery you had. We
are not required to agree to your request. If we do agree, we will comply
with your request unless the information is needed to provide you emergency treatment.
To
request restrictions, you must make your request in writing to the Office Manager,
Mrs. Vickie Echols. In your request, you must tell us (1) what information you
want to limit; (2) whether you want to limit our use, disclosure or both; and
(3) to whom you want the limits to apply, for example, disclosures to your spouse.
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| CHANGES
TO THIS NOTICE | | We
reserve the right to change this notice. We reserve the right to make the revised
or changed notice effective for medical information we already have about you
as well as any information we receive in the future. We will post a copy of the
current notice in the practice. The notice will contain on the first page, in
the top right-hand corner, the effective date. In addition, each time you visit
the practice for treatment or health care services, we will offer you a copy of
the current notice in effect. | |
| COMPLAINTS |
| If
you believe your privacy rights have been violated, you may file a complaint with
the practice or with the Secretary of the Department of Health and Human Services.
To file a complaint with the practice, contact [insert the name, title, and phone
number of the contact person or office responsible for handling complaints]. This
should be the same person or department listed on the first page as the contact
for more information about this notice. All complaints must be submitted in writing.
You will not be penalized for filing a complaint. | |
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| OTHER
USES OF MEDICAL INFORMATION | Other
uses and disclosures of medical information not covered by this notice or the
laws that apply to use will be made only with your written permission. If you
provide us permission to use or disclose medical information about you, you may
revoke that permission, in writing, at any time. If you revoke your permission,
we will no longer use or disclose medical information about you for the reasons
covered by your written authorization. You understand that we are unable to take
back any disclosures we have already made with your permission, and that we are
required to retain our records of the care that we provide to you.
If
you have any questions about this notice, please contact this organization's Privacy
Officer. | | | | Effective
Date: April 14, 2003 | |
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