HIPAA NOTICE OF PRIVACY PRACTICES
Dermatology
Consultants, P.A.
101 5th Street East, Suite 2106
St. Paul, MN 55101-1885
Effective Date:
April 14, 2003
THIS NOTICE DESCRIBES HOW HEALTH 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 Christine T. Morgan, MHA, Privacy Officer and
Administrator at (651) 209-1627.
OUR PLEDGE REGARDING HEALTH INFORMATION:
We understand that health
information about you and your health care is personal.
We are committed to protecting health information about
you. We create a record of the care and services you
receive from us. We need this record 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 this health care practice, whether made
by your personal doctor or others working in this office.
This notice will tell you about the ways in which we
may use and disclose health information about you.
We also describe your rights to the health information
we keep about you, and describe certain obligations
we have regarding the use and disclosure of your health
information.
We are required by law
to:
- make sure that health
information that identifies you is kept private;
- give you this notice
of our legal duties and privacy practices with respect
to health information about you; and
- follow the terms
of the notice that is currently in effect.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT
YOU.
The following categories
describe different ways that we use and disclose health
information. For each category of uses or disclosures
we will explain what we mean and try to give some examples.
The examples of uses and disclosures are not exclusive.
For Treatment: We may use health information about you for a medical
emergency when the doctor is unable to obtain your consent
due to your condition or the nature of the medical emergency.
We may disclose health information about you to doctors,
nurses, technicians, health students, or other personnel
who are involved in taking care of you. They may work
at our offices, at the hospital (if you are hospitalized
under our supervision), or at another doctor’s office,
lab, pharmacy, or health care provider to whom we may
refer you for consultation, to take x-rays, to perform
lab tests, to have prescriptions filled, or for other
treatment purposes. For example, a doctor treating
you for a broken leg may need to know if you have diabetes
because diabetes may slow the healing process. In addition,
the doctor may need to tell the dietitian at the hospital
if you have diabetes so that we can arrange for appropriate
meals.
For Payment: With your consent, we may use and disclose health information
about you so that the treatment and services you receive
from us may be billed to and payment collected from
you, an insurance company, or a third party. For example,
we may need to give your health plan information about
your office visit so that your health plan will pay
us or reimburse you for the visit. We may also tell
your health plan about a treatment you are going to
received to obtain prior approval or to determine whether
your plan will cover the treatment.
For Health Care Operations:
We may use
and disclose health information about you for the operations
of our health care practice. These uses and disclosures
are necessary to run our practice and make sure that
all of our patients receive quality care. For example,
we may use health information to review our treatment
and services and to evaluate the performance of our
staff in caring for you. We may also combine health
information about many patients to decide what additional
services we should offer, what services are not needed,
whether certain new treatments are effective, or to
compare how we are doing with others and to see where
we can make improvements. We have to remove information
that identifies you from this set of health information
so others may use it to study health care delivery without
learning the identity of our specific patients.
Appointments Reminders:
We may use and disclose health information to contact
you as a reminder that you have an appointment. Please
let us know if you do not wish to have us contact you
concerning your appointment, or if you wish to have
us use a different telephone number or address to contact
you for this purpose.
Health-Related Services
and Treatment Alternatives: We
may use and disclose health information to tell you
about health-related services or recommend possible
treatment options or alternatives that may be of interest
to you. Please let us know if you do not wish us to
send you this information, or if you wish to have us
use a different address to send this information to
you.
As Required By Law:
We will disclose health information about you when required
to do so by federal, state or local law.
To Avert a Serious
Threat to Health or Safety: We
may use and disclose health information about you when
necessary to prevent or to lessen a serious or imminent
threat to the health or safety of a person or the public.
Military and Veterans:
If you are a member of the armed forces or separated/discharged
from military services, we may release health information
about you as required by military command authorities
or the Department of Veterans Affairs as may be applicable.
We may release health information about foreign military
personnel to the appropriate foreign military authorities.
Workers’ Compensation:
We may release health information about you to the extent
necessary to comply with laws relating to workers’ compensation
or similar programs. These programs provide benefits
for work-related injuries or illness.
Public Health Risks:
We may disclose health information about you for public
health activities to a public health authority or other
welfare agency. These activities generally include
the following:
- to prevent or control
disease, injury or disability;
- to report births
and deaths;
- to report child abuse
or neglect;
- to report reactions
to medications or problems with FDA-regulated products
or activities;
- to notify people
of recalls of products they may be using;
- to notify a person
who may have been exposed to a disease or may be at
risk for contracting or spreading a disease or condition
to the extent we are authorized to notify such a person.
Victims of Abuse,
Neglect or Domestic Violence:
We may disclose protected health information about an
individual whom we believe to be a victim of abuse,
neglect or domestic violence to a government authority
when we are required or authorized by law to do so or
when you agree to the disclosure.
Health Oversight
Activities: We
may disclose health information to a health oversight
agency for activities authorized by law. These activities
are included for the government to monitor the health
care system, government programs, and compliance with
civil rights laws.
Lawsuits and Disputes:
If you are involved in a lawsuit or dispute, we may disclose
health information about you in response to a court
or administrative order. We may also disclose health
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 a protective
order.
Law Enforcement:
We may release health information if asked to do so by
a law enforcement official:
- about a victim of
a crime, if the victim agrees to disclosure or under
certain limited circumstances, we are unable to obtain
the person’s agreement if certain other conditions
are met;
- about a death we
believe may be the result of criminal conduct;
- about criminal conduct
at our facility; and
- in emergency circumstances
to report a crime, the location of the crime or victims,
or the identity, description, or location of the person
who committed the crime.
Coroners, Health
Examiners and Funeral Directors: We
may release health information to a coroner or health
examiner. 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 to carry out their
duties.
National Security
and Intelligence Activities: We
may release health information about you to authorized
federal officials for intelligence, counter-intelligence,
and other national security activities authorized by
law.
Protective Services
for the President and Others: We
may disclose health information about you to authorized
federal officials so they may provide protection to
the President, other authorized persons, or foreign
heads of state, or to conduct special investigations.
Inmates: If you are an inmate of a correctional institution or
under the custody of a law enforcement official, we
may release health information about you to the correctional
institution or law enforcement official if this release
would be necessary (a) 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.
Changes in Uses or
Disclosures: Under
HIPAA, certain existing state laws may, in some facts
and circumstances, prohibit uses or disclosures identified
above.
YOUR RIGHTS REGARDING
HEALTH INFORMATION ABOUT YOU.
You have the following
rights regarding health information we maintain about
you:
Right to Inspect
and Copy: You
have the right to inspect and copy health information
that may be used to make decisions about your care.
Usually, this includes health and billing records.
You may inspect health
information that may be used to make decisions about
you by requesting this information from Christine T.
Morgan, MHA, Privacy Officer and Administrator. You
may also receive a copy of your health information by
submitting your request in writing to Christine T. Morgan,
MHA, Privacy Officer and Administrator. If you request
a copy of the information, we may charge a fee for the
costs of copying, mailing or other supplies and services
associated with your request.
We may deny your request
to inspect and/or copy in certain circumstances. If
you are denied access to health information, you may
request that the denial be reviewed. Another licensed
health care professional chosen by our 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.
Right to Receive
Confidential Communications:
You have the right to receive confidential communications
by alternative means or at alternative locations. You
must request this in writing.
Right to Amend:
If you feel that health 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 we keep the information. To request
an amendment, your request must be made in writing,
submitted to Christine T. Morgan, MHA, Privacy Officer
and Administrator, and must contain one page of paper
legibly handwritten or typed in at least 10 point font
size. In addition, you must provide a reason that supports
your request for an amendment.
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:
-
was
not created by us, unless the person or entity that
created the information is no longer available to
make the amendment;
-
is
not part of the health information kept by or for
our practice;
-
is
not otherwise available for inspection; or
-
is accurate
or complete.
Any amendment we make
to your health information will be disclosed to those
with whom we disclose information as previously specified.
Right to an Accounting
of Disclosures: You
have the right to request a list accounting for any
disclosures of your health information we have made,
except for uses and disclosures for treatment, payment,
and health care operations, as previously described.
To request this list
of disclosures, you must submit your request in writing
to Christine T. Morgan, MHA, Privacy Officer and Administrator.
Your request must state a time period which may not
be longer than six years. The first list you request
within a 12 month period will be free. For additional
lists, we may charge you for the costs 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. We will mail
you a list of disclosures in paper form within 30 days
of your request, or notify you if we are unable to supply
the list within that time period and by what date we
can supply the list; but this date will not exceed a
total of 60 days from the date you made the request.
Right to Request
Restrictions: You
have the right to request a restriction or limitation
on the health 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 health
information we disclose about you to someone who is
involved in your care or the payment for your care,
such as a family member or friend. For example, you
could ask that we restrict a specified nurse from use
of your information, or that we not disclose information
to your spouse about a surgery you had.
We are not required
to agree to your request for restrictions if it is not
feasible for us to ensure our compliance or believe
it will negatively impact the care we may provide you.
If we do agree,
we will comply with your request unless the information
is needed to provide you with emergency treatment.
To request a restriction, you must make your request
in writing to Christine T. Morgan, MHA, Privacy Officer
and Administrator. In your request, you must tell use
what information you want to limit and to whom you want
the limits to apply; for example, use of any information
by a specified nurse, or disclosure of a specified surgery
to your spouse.
Right to a Paper
Copy of This Notice: You
have a right to obtain a paper copy of this notice at
any time. To obtain a copy, please request it from
Christine T. Morgan, MHA, Privacy Officer and Administrator.
You may also obtain
a copy of this notice either from our website (www.dermatologyconsultants.com)
or by requesting a copy of this notice be sent through
electronic mail to ctmorgan@dermatologyconsultants.com.
If we know that the electronic message has failed to
be delivered, a paper copy of the notice will be provided.
Even if you have received a notice electronically, you
still retain the right to receive a paper copy upon
request.
If the first service
delivery is delivered electronically, other than by
telephone, we provide electronic notice in the same
medium, automatically and contemporaneously in response
to a first request for service.
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 health 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 our facility. The notice will contain
on the first page, in the top right-hand corner, the
effective date. In addition, each time you register
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 us or with the Secretary of the Department of Health
and Human Services. To file a complaint with us, contact
Christine T. Morgan, MHA, Privacy Officer and Administrator.
All complaints must be submitted in writing. You
will not be penalized for filing a complaint.
OTHER USES OF HEALTH
INFORMATION
Other uses and disclosures
of health information not covered by this notice or
the laws that apply to us will be made only with your
written permission. If you provide us permission to
use or disclose health 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 health 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 provided you.
Acknowledgement of
Receipt of This Notice
We will request that
you sign a separate form or notice acknowledging you
have received a copy of this notice. If you are not
able to sign, a staff member will sign their name, and
date. This acknowledgement will be filed with your
records.
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