Notice of Privacy Practices
Monday, March 28, 2011|
(As required by the privacy regulations created as a result of the Health Insurance Portability and Accountability Act of 1996)
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU MAY ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Within this document our patient is referred to as "you." Most of the individuals who are reading this are parents of our patient. As your child's personal representative, reading this notice will let you know the clinic's policies regarding your child's medical information.
A. Our Commitment to Your Privacy
Our clinic is dedicated to maintaining the privacy of your protected health information (PHI). We are required by law to maintain the confidentiality of your health information. 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 clinic concerning your PHI. 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:
The terms of this notice apply to all records containing your PHI that are created or retained by our clinic. 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 clinic has created or maintained in the past, and for any of your records that we may create or maintain in the future. Our clinic will post a copy of our current Notice in a visible location at all times.
- How we may use and disclose your PHI
- Your privacy rights of your PHI
- Our obligations concerning the use and disclosure of your PHI
B. We May Use and Disclose Your Protected Health Information (PHI) in the Following Ways
The following categories describe the different ways in which we may use and disclose your PHI.
1. Treatment. Our clinic may use your PHI to treat you. For example, we may ask you to have laboratory tests done and we may use the results to help us reach a diagnosis. We may also disclose your PHI to other health care providers for purposes related to your treatment. This includes sharing an immunization record with a school nurse, who qualifies as a provider.
2. Payment. Our clinic may use and disclose your PHI in order to bill and collect payment for the services and items you may receive from us. For example, we may use and disclose your PHI to obtain payment from third parties that may be responsible for such costs. We may disclose your PHI to other health care providers to assist in their billing and collection efforts.
3. Health Care Operations. Our clinic may use and disclose your PHI to operate our business. An example of this would be using your PHI to evaluate the quality of care you receive from us.
4. Appointment and Immunization Reminders. Our clinic may use and disclose your PHI to contact you and remind you of an appointment or immunizations.
5. Treatment Options. Our clinic may use and disclose your PHI to inform you of potential treatment options or alternatives.
6. Release of Information to Family/Friends. Our clinic may release your PHI to a friend or family member that is involved in your care. For example, if a friend, babysitter, grandparent, or other family member brings you to the clinic for care, they will receive medical information about you.
7. Disclosures Required by Law. Our clinic will use and disclose your PHI when we are required to do so by federal, state, or local law.
C. Use and Disclosure of Your PHI 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 clinic may disclose your PHI to public health authorities that are authorized by law to collect information for the purpose of:
2. Health Oversight Activities. Our clinic may disclose your PHI to a health oversight agency for activities authorized by law. Oversight activities may 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.
- maintaining vital records, such as births and deaths
- reporting child abuse or neglect
- preventing or controlling disease, injury or disability
- 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 that a product or device they may be using has been recalled
- notifying your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance.
3. Lawsuits and Similar Proceedings. Our clinic may use and disclose your PHI in response to a court order, if you are involved in a lawsuit or similar proceedings.
4. Law Enforcement. We may release PHI 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
5. Deceased Patients. Our clinic may release PHI 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 duties.
- Concerning a death we believe has resulted from criminal conduct
- Regarding criminal conduct at our offices
- In response to a warrant, summons, court order, 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)
6. Serious Threats to Health or Safety. Our clinic may use and disclose your PHI when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.
7. Military. Our clinic may disclose your PHI if you are a member of US or foreign military forces and if required by the appropriate authorities.
8. National Security. Our clinic may disclose your PHI to federal officials for intelligence and national security activities authorized by law. We also may disclose your PHI to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.
9. Inmates. Our clinic may disclose your PHI 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:
10. Workers' Compensation. Our clinic may release your PHI for workers' compensation and similar programs.
- for the institution to provide health care services to you
- for the safety and security of the institution
- to protect your health and safety or the health and safety of other individuals.
D. Your Rights Regarding Your PHI
You have the following rights regarding the PHI that we maintain about you. Requests involving your rights must be submitted in writing to the Privacy and Security Officer (PSO).
1. Confidential Communications. You have the right to request that our clinic communicate with you about your health 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. The request must specify the method of contact, or the location where you wish to be contacted. We will accommodate reasonable requests. You do not need to give a reason for your request.
2. Requesting Restrictions. You have the right to request a restriction in our use or disclosure of your PHI for treatment, payment or health care operations. Additionally, you have the right to request that we restrict our disclosure of your PHI to only certain individuals involved in your care or the payment for your care. 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. Your request must describe in a clear and concise fashion:
3. Inspection and Copies. You have the right to inspect and obtain a copy of the PHI that may be used to make decisions about you, including patient medical records and billing records. Our clinic may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial. A written request is not required for an immunization record.
- The information you wish restricted
- Whether you are requesting to limit our clinic's use, disclosure or both; and
- To whom you want the limits to apply
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 clinic. You must provide us with a reason that supports your request for amendment. 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 PHI kept by or for the clinic; or (c) not created by our clinic, 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 clinic has made of your PHI for non-treatment, non-payment, or non-operations purposes. Use of your PHI as a part of the routine patient care in our clinic is not required to be documented. All requests for an "accounting of disclosures" must state a time period, which may not be longer than six years from the date of disclosure and may not include dates before April 14, 2003.
6. Right to a Paper Copy of This Notice. You are entitled to receive a paper copy of our notice of privacy practices at any time. A written request is not required.
7. Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with our clinic's privacy and security officer, the Office of Civil Rights, or the Secretary of the Department of Health and Human Services. You will not be penalized for filing a complaint.
8. Right to Provide an Authorization for Other Uses and Disclosures. Our clinic 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 PHI may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your PHI for the reasons described in the authorization. Please note, we are required to retain records of your care.
E. If You Have Questions or Correspondence, Contact:
The Privacy and Security Officer for The Children's Clinic, Inc.
4001 Dale Street Suite 213, Anchorage AK 99508
Phone: (907) 562-2944 Fax: (907) 562-6321
Effective Date: April 14, 2003
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