NEUROLOGICAL CONSULTANTS, PC
&
THE NEUROLOGICAL RESEARCH CENTER, INC
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:
Ms. Nancy Rieben, Medical
Records Department
802-447-7577
C. WE MAY USE
AND DISCLOSE YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION (IIHI) IN THE
The following categories describe the
different ways in which we may use and disclose your IIHI.
1. 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.
2. 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.
3. 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.
4. Appointment Reminders. Our practice may use and disclose your IIHI
to contact you and remind you of an appointment.
5. Treatment Options. Our practice may use and disclose your IIHI
to inform you of potential treatment options or alternatives.
6. 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.
7. Release of Information to
8. 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:
1. Public Health Risks. Our practice may disclose your IIHI to public
health authorities that are authorized by law to collect information for
purposes such as:
·
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.
2. 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.
3. 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 a court or
administrative order protecting the information the party has requested.
4. 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 offices
·
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)
5. 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.
6. 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.
7. 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 Internal 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.
8. 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.
9. Military. Our
practice may disclose your IIHI if you are a member of
10. 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.
11. 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.
12. Workers’ Compensation. Our practice may release your IIHI for
workers’ compensation and similar programs.
You have the following rights regarding the
IIHI that we maintain about you:
1. 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 Ms. Nancy Rieben, Medical Records Department, specifying the
requested method of contact, or the location where you wish to be
contacted. Our practice will accommo
2. 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 Ms. Nancy Rieben, Medical Records Department. 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.
3. 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 Ms. Nancy Rieben 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.
4. 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 Ms. Nancy Rieben.
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.
5. 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 Ms. Nancy Rieben. All requests for an “accounting of
disclosures” must state a time period, which may not be longer than six (6)
years from the
6. 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 Ms. Nancy Rieben, Medical Records Department.
7. 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 Ms. Nancy Rieben. All
complaints must be submitted in writing. You
will not be penalized for filing a complaint.
8. 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 purposes 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 Ms. Nancy Rieben,
Medical Records Department.
EFFECTIVE: