NOTICE OF PRIVACY PRACTICES
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
Karen Bizzell, RN at (919)787-1374
or kbizzell@capitolent.net
This Notice of Privacy Practices describes how we may use
and disclose your protected health information 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 protected
health information. "Protected health information" 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. The new
notice will be effective for all protected health information that we maintain
at that time. Upon your request, we will provide you with any revised Notice of
Privacy Practices by accessing our web site
www.capitolent.net calling the
office 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 Protected Health
Information
Uses and Disclosures of Protected Health Information:
Your protected health information 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 protected health information may also be used and disclosed to pay your
health care bills and to support the operation of the physician’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. These examples are not meant to be exhaustive, but to
describe the types of uses and disclosures that may be made by our office.
Treatment: We will use and disclose
your protected health information 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 protected health information. For example, we would
disclose your protected health information, as necessary, to a home health
agency that provides care to you. We will also disclose protected health
information to other physicians who may be treating you when we have the
necessary permission from you to disclose your protected health information.
For example, your protected health information may be provided to a physician
to whom you have been referred to ensure that the physician has the necessary
information to diagnose or treat you.
In addition, we may disclose your protected health
information 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 protected health
information 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 a hospital stay may require that your relevant protected
health information be disclosed to the health plan to obtain approval for the
hospital admission.
Healthcare Operations: We may use or disclose,
as-needed, your protected health information in order to support the business
activities of your physician’s practice. These activities include, but are
not limited to, quality assessment activities, employee review activities,
training of medical students, licensing, and conducting or arranging for other
business activities.
For example, we may disclose your protected health
information to medical school students that see patients at our office. In
addition, we may use 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 waiting room when your physician is ready to see you. We may use or
disclose your protected health information, as necessary, to contact you to
remind you of your appointment.
We will share your protected health information with third
party "business associates" that perform various activities (e.g., answering
service, collections agency, software support company, billing, transcription
services) for the practice. Whenever an arrangement between our office and a
business associate involves the use or disclosure of your protected health
information, we will have a written contract that contains terms that will
protect the privacy of your protected health information.
We may use or disclose your protected health information, as
necessary, to provide you with information about treatment alternatives or
other health-related benefits and services that may be of interest to you. We
may also use and disclose your protected health information for other marketing
activities. For example, your name and address may be used to send you a
newsletter about our practice and the services we offer. We may also send you
information about products or services that we believe may be beneficial to
you. You may contact our Privacy Contact to request that these materials not be
sent to you.
Uses and Disclosures of Protected Health Information
Based upon Your Written Authorization
Other uses and disclosures of your protected health
information 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 protected health information in
the following instances. You have the opportunity to agree or object to the use
or disclosure of all or part of your protected health information. If you are
not present or able to agree or object to the use or disclosure of the
protected health information, then your physician may, using professional
judgement, determine whether the disclosure is in your best interest. In this
case, only the protected health information 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 protected health information 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 such
information as necessary if we determine that it is in your best interest based
on our professional judgment. We may use or disclose protected health
information 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
protected health information 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
protected health information 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 protected health information to treat you.
Communication Barriers: We may use and
disclose your protected health information 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 judgement, 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 protected health information in
the following situations without your consent or authorization. These
situations include:
Required By Law: We may use or disclose your
protected health information 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 protected
health information 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 protected health information, 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
protected health information, 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 protected
health information to a health oversight 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
protected health information to a public health authority that is authorized by
law to receive reports of child abuse or neglect. In addition, we may disclose
your protected health information 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 protected health information 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, or to conduct post marketing surveillance, as
required.
Legal Proceedings: We may disclose protected
health information 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 also disclose
protected health information, so long as applicable legal requirements are met,
for law enforcement purposes. These 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 Practice’s premises) and it is likely that a crime
has occurred.
Coroners, Funeral Directors, and Organ
Donation: We may disclose protected health information to a coroner or
medical examiner for identification purposes, determining cause of death or for
the coroner or medical examiner to perform other duties authorized by law. We
may also disclose protected health information to a funeral director, as
authorized by law, in order to permit the funeral director to carry out their
duties. We may disclose such information in reasonable anticipation of death.
Protected health information may be used and disclosed for cadaveric organ, eye
or tissue donation purposes.
Research: We may disclose your protected
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.
Criminal Activity: Consistent with applicable
federal and state laws, we may disclose your protected health information, 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 also disclose protected health information if it is necessary for law
enforcement authorities to identify or apprehend an individual.
Military Activity and National Security: When
the appropriate conditions apply, we may use or disclose protected health
information of individuals who are Armed Forces personnel (1) for activities
deemed necessary by appropriate military command authorities; (2) for the
purpose of a determination by the Department of Veterans Affairs of your
eligibility for benefits, or (3) to foreign military authority if you are a
member of that foreign military services. We may also disclose your protected
health information to authorized federal officials for conducting national
security and intelligence activities, including for the provision of protective
services to the President or others legally authorized.
Workers’ Compensation: Your protected
health information 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 protected
health information if you are an inmate of a correctional facility and your
physician created or received your protected health information 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
protected health information and a brief description of how you may exercise
these rights.
You have the right to inspect and copy your protected
health information. This means you may inspect and obtain a copy of
protected health information about you that is contained in a designated record
set for as long as we maintain the protected health information. 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 not inspect or copy the
following records; psychotherapy notes; information compiled in reasonable
anticipation of, or use in, a civil, criminal, or administrative action or
proceeding, and protected health information that is subject to law that
prohibits access to protected health information. 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
protected health information. This means you may ask us not to use or
disclose any part of your protected health information for the purposes of
treatment, payment or healthcare operations. You may also request that any part
of your protected health information 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 protected health information, your protected
health information will not be restricted. If your physician does agree to the
requested restriction, we may not use or disclose your protected health
information in violation of that restriction unless it is needed to provide
emergency treatment. With this in mind, please discuss any restriction you wish
to request with your physician. You may request a restriction by submitting a
request in writing to the attention of our privacy contact. This office is not
required to agree to a restriction.
You have the right to request to receive confidential
communications from us by alternative means or at an alternative
location. We will accommodate reasonable requests. 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 protected health information. This means you may request an
amendment of protected health information 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 protected health information.
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 may 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,
Karen Bizzell, RN at (919)787-1374
or kbizzell@capitolent.net for
further information about the complaint process.
This notice was published and becomes effective on
March 25, 2003.
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