OF PRIVACY PRACTICES
NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU
BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO
REVIEW THIS NOTICE CAREFULLY.
This Practice is committed to maintaining the privacy
of your protected health information ("PHI"),
which includes information about your health condition
and the care and treatment you receive from the Practice.
The creation of a record detailing the care and services
you receive helps this office to provide you with quality
health care. This Notice details how your PHI may be
used and disclosed to third parties. This Notice also
details your rights regarding your PHI. The privacy
of PHI in patient files will be protected when the files
are taken to and from the Practice by placing the files
in a box or brief case and kept within the custody of
a doctor or employee of the Practice authorized to remove
the files from the Practice's office. It may be necessary
to take patient files to a facility where a patient
is confined or to a patient's home where the patient
is to be examined or treated.
The Practice may use and/or disclose your PHI for the
(a) Treatment - In order to provide you with the health
care you require, the Practice will provide your PHI
to those health care professionals, whether on the Practice's
staff or not, directly involved in your care so that
they may understand your health condition and needs.
For example, a physician treating you for a condition
or disease may need to know the results of your latest
physician examination by this office.
(b) Payment - In order to get paid for services provided
to you, the Practice will provide your PHI, directly
or through a billing service, to appropriate third party
payors, pursuant to their billing and payment requirements.
For example, the Practice may need to provide the Medicare
program with information about health care services
that you received from the Practice so that the Practice
can be properly reimbursed. The Practice may also need
to tell your insurance plan about treatment you are
going to receive so that it can determine whether or
not it will cover the treatment expense.
Health Care Operations - In order for the Practice to
operate in accordance with applicable law and insurance
requirements and in order for the Practice to continue
to provide quality and efficient care, it may be necessary
for the Practice to compile, use and/or disclose your
PHI. For example, the Practice may use your PHI in order
to evaluate the performance of the Practice's personnel
in providing care to you.
The Practice may use and/or disclose your PHI, without
a written Consent from you, in the following additional
(a) De-identified Information - Information that does
not identify you and, even without your name, cannot
be used to identify you.
(b) Business Associate - To a business associate if
the Practice obtains satisfactory written assurance,
in accordance with applicable law, that the business
associate will appropriately safeguard your PHI. A business
associate is an entity that assists the Practice in
undertaking some essential function, such as a billing
company that assists the office in submitting claims
for payment to insurance companies or other payers.
Personal Representative -To a person who, under applicable
law, has the authority to represent you in making decisions
related to your health care
(d) Emergency Situations -
(i) for the purpose of obtaining or rendering emergency
treatment to you provided that the Practice attempts
to obtain your Consent as soon as possible; or
to a public or private entity authorized by law or by
its charter to assist in disaster relief efforts, for
the purpose of coordinating your care with such entities
in an emergency situation.
(e) Communication Barriers - If, due to substantial
communication barriers or inability to communicate,
the Practice has been unable to obtain your Consent
and the Practice determines, in the exercise of its
professional judgment, that your Consent to receive
treatment is clearly inferred from the circumstances.
(f) Public Health Activities - Such activities include,
for example, information collected by a public health
authority, as authorized by law, to prevent or control
disease and that does not identify you and, even without
your name, cannot be used to identify you.
(g) Abuse, Neglect or Domestic Violence - To a government
authority if the Practice is required by law to make
such disclosure; if the Practice is authorized by law
to make such a disclosure, it will do so if it believes
that the disclosure is necessary to prevent serious
(h) Health Oversight Activities - Such activities, which
must be required by law, involve government agencies
and may include, for example, criminal investigations,
disciplinary actions, or general oversight activities
relating to the community's health care system.
Judicial and Administrative Proceeding - For example,
the Practice may be required to disclose your PHI in
response to a court order or a lawfully issued subpoena.
Law Enforcement Purposes - In certain instances, your
PHI may have to be disclosed to a law enforcement official.
For example, your PHI may be the subject of a grand
jury subpoena. Or, the Practice may disclose your PHI
if the Practice believes that your death was the result
of criminal conduct.
Coroner or Medical Examiner - The Practice may disclose
your PHI to a coroner or medical examiner for the purpose
of identifying you or determining your cause of death.
(l) Organ, Eye or Tissue Donation - If you are an organ
donor, the Practice may disclose your PHI to the entity
to whom you have agreed to donate your organs.
(m) Research - If the Practice is involved in research
activities, your PHI may be used, but such use is subject
to numerous governmental requirements intended to protect
the privacy of your PHI and that does not identify you
and, even without your name, cannot be used to identify
Avert a Threat to Health or Safety - The Practice may
disclose your PHI if it believes that such disclosure
is necessary to prevent or lessen a serious and imminent
threat to the health or safety of a person or the public
and the disclosure is to an individual who is reasonably
able to prevent or lessen the threat.
(o) Workers' Compensation - If you are involved in a
Workers' Compensation claim, the Practice may be required
to disclose your PHI to an individual or entity that
is part of the Workers' Compensation system.