I.
OUR COMMITMENT TO PROTECTING HEALTH INFORMATION ABOUT YOU
In this Notice, we
describe the ways that we may use and disclose health information about
our patients. The HIPAA Privacy Rule requires that we protect the privacy
of health information that identifies a patient, or where there is a
reasonable basis to believe the information can be used to identify
a patient. This information is called “protected health information”
or “PHI”. This Notice describes your rights as our patient
and our obligations regarding the use and disclosure of PHI.
We
realize that these laws are complicated, but we must provide you with
the following important information:
• How
we may use and disclose your PHI
• Your privacy rights with respect to your PHI
• Our obligations concerning the use and disclosure of your
PHI |
We reserve the right
to make changes to this Notice and to make such changes effective for
all PHI we may already have about you. 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.
II.
HOW WE MAY USE AND DISCLOSE PROTECTED HEALTH INFORMATION ABOUT YOU
The following categories describe the different ways in which we may
use and disclose your PHI:
Treatment
Our
practice may use your PHI to treat you. For example, we may ask you
to have laboratory tests, and we may use the results to help us reach
a diagnosis. We might use your PHI in order to write a prescription
for you, or we might disclose your PHI 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 PHI in order to treat you or to assist others in your treatment.
Additionally, we may disclose your PHI to others who may assist in your
care, such as your spouse, children or parents. Finally, we may also
disclose your PHI to other health care providers for purposes related
to your treatment.
Payment
Our
practice 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 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 PHI to obtain payment from third parties that may be responsible
for such costs, such as family members. Also, we may use your PHI to
bill you directly for services and items. We may disclose your PHI to
other health care providers and entities to assist in their billing
and collection efforts.
Health Care
Operations
Our practice may use and disclose your PHI to operate our business.
For example, our practice may use your PHI 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 PHI to other
health care providers and entities to assist in their health care operations.
Appointment Reminders
Our
practice may use and disclose your PHI to contact you and remind you
of an appointment.
Release
of Information to Individuals Involved in Your Care or Payment for Your
Care
We may disclose PHI about you to your family member, close
friend, or any other person identified by you if that information is
directly relevant to the person’s involvement in your care or
payment for your care. We may exercise professional judgment in determining
whether the use or disclosure of PHI is in your best interests. We also
may use professional judgment and our experience with common practice
to make reasonable decisions about your best interests in allowing a
person to act on your behalf to pick up filled prescriptions, medical
supplies, x-rays, or other things that contain PHI about you.
III.
USE AND DISCLOSURE OF YOUR PHI IN CERTAIN SPECIAL CIRCUMSTANCES
Required
By Law
We may use and disclose PHI as required by federal, state,
or local law. Any disclosure complies with the law and is limited to
the requirements of the law.
•Public
Health Risks. Our practice may disclose your PHI 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 as authorized by law to
disclose this information.
• Notifying your employer under limited circumstances related
primarily to workplace injury or illness or medical surveillance. |
Health Oversight
Activities
Our practice may disclose your PHI 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.
Lawsuits
and Other Legal Proceedings
We may use or disclose PHI when
required by a court or administrative tribunal order. We may also disclose
PHI in response to subpoenas, discovery requests, or other required
legal process when efforts have been made to advise you of the request
or to obtain an order protecting the information requested.
Law
Enforcement
Under certain conditions, we may disclose PHI to
law enforcement officials for the following purposes where the disclosure
is:
•
About a suspected crime victim if, under certain limited circumstances,
we are unable to obtain a person’s agreement because
of incapacity or emergency.
• To alert law enforcement of a death that we suspect
was the result of criminal conduct.
• Required by law.
• In response to a court order, warrant, subpoena, summons,
administrative agency request, or other authorized process.
• To identify or locate a suspect, fugitive, material
witness, or missing person.
• About a crime or suspected crime committed at our
office.
• In response to a medical emergency not occurring at
the office, if necessary to report a crime, including the
nature of the crime, the location of the crime or the victim,
and the identity of the person who committed the crime. |
|
Deceased
Patients
We may disclose PHI to a coroner or medical examiner
to identify a deceased person and determine the cause of death. In addition,
we may disclose PHI to funeral directors, as authorized by law, so that
they may carry out their jobs.
Organ and
Tissue Donation
If you are an organ donor, we may use or disclose
PHI to organizations that help procure, locate, and transplant organs
in order to facilitate an organ, eye, or tissue donation and transplantation.
To Avert
a Serious Threat to Health or Safety
We
may use or disclose PHI about you in limited circumstances when necessary
to prevent a threat to the health or safety of a person or to the public.
This disclosure can only be made to persons who are able to help prevent
the threat.
Specialized
Government Functions
Under certain circumstances we may disclose
PHI:
| •
For certain military and veteran activities, including determination
of eligibility for veterans benefits and where deemed necessary
be military command authorities.
• For national security and intelligence activities.
• To help provide protective services for the President
and others.
• For the health or safety of inmates and others at correctional
institutions or other law enforcement custodial situations. |
Worker’s
Compensation
We may release your PHI as authorized by worker’s compensation
laws or other similar programs that provide benefits for work-related
injuries or illness.
IV.
YOUR RIGHTS REGARDING PROTECTED HEALTH INFORMATION ABOUT YOU
You have the following rights regarding the PHI that we maintain about
you:
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. You must make your request in writing to the
Privacy Officer. We will accommodate all reasonable requests. Your request
must specify how or where you wish to be contacted.
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
except when otherwise required by law, in emergencies, or when the information
is necessary to treat you.
To request restrictions,
you must make your request in writing to our Privacy Officer. 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.
Right to Inspect and Copy
You have the right to request the opportunity to inspect and
receive a copy of PHI about you in certain records that we maintain.
This includes your medical and billing records but does not include
psychotherapy notes or information gathered or prepared for a civil,
criminal, or administrative proceeding. We may deny your request to
inspect and copy PHI only in limited circumstances. To inspect and copy
PHI you must submit your request in writing to our Privacy Officer.
If you request a copy of PHI about you, we may charge you a reasonable
fee for the copying, postage, labor and supplies used in meeting your
request.
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 us. To request an amendment, your request must be made in writing
and submitted to our Privacy Officer. In addition, you must provide
a reason that supports your request.
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 our practice; (c) not part of the PHI 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.
Right to an Accounting of Disclosures
Our practice tracks all disclosures of a patient’s protected
health information that occur for other than the purposes of treatment,
payment, and health care operations, that are not made to the individual
or to a person involved in the patient’s care, that are not made
as a result of a patient authorization, and that are not made for national
security or intelligence purposes or to correctional institutions or
law enforcement officials.
The practice allows
an individual to request one accounting within a 12-month period free
of charge. The practice charges a reasonable fee for more frequent accounting
requests. An individual can request an accounting of disclosures for
a period of up to six years prior to the date of the request. Requests
for shorter accounting periods will be accepted,. however, patients
may only request an accounting of disclosures made on or after April
14, 2003.
A request for an
accounting of disclosures must be made in writing and mailed or sent
to the practice. It should be marked “Attention: Privacy Officer.”
Right to
a Paper Copy of This Notice
You have the right to obtain a paper copy of our Notice of
Privacy Practices upon request. You may also obtain a copy of this notice
at our website, www.ottawamedicalcenter.com
Right to
File a Complaint
If you believe your privacy rights have been violated, you
may file a complaint with us or the Secretary of the United States Department
of Health and Human Services. To file a complaint with our office, please
contact our Privacy Officer at the address listed below. All complaints
must be submitted in writing. We will not retaliate or take adverse
action against any patient who files a complaint.
Right to
Provide an Authorization for Other Uses and Disclosures
All other uses and disclosures of PHI about you will only be
made with your written authorization. In Illinois, a specific written
authorization is required to release PHI pertaining to mental health,
alcoholism, drug abuse or HIV/Acquired Immune Deficiency Syndrome (AIDS).
V.
QUESTIONS
If
you have any questions about this Notice, please contact our Privacy
Officer at the address and telephone number listed below.
VI.
PRIVACY OFFICER CONTACT INFORMATION
You
may contact our Privacy Officer at the following address and phone number:
Attention:
Privacy Officer
Ottawa Medical Center, P.C.
1614 E. Norris Drive
Ottawa, IL 61350
(815) 433-1010 |
This
notice was published and first became effective on April 14, 2003