HIPAA NOTICE OF PRIVACY PRACTICES

Effective date April 29, 2013

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THE INFORMATION. PLEASE READ IT CAREFULLY. IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT:

Office Manager

316-630-8200

Fax- 316-295-4647

This notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment or health care operations (TPO) 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 your demographic information, which may identify you and relates to your past, present, or future physical or mental health or condition and related health care services.

Each time you visit a hospital, physician, or other health care provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnosis, treatment, a plan of your future care or treatment, and billing related information. Such records are necessary for the servicing provider to provide you with the best care and comply with certain legal requirements.

Our office is committed to protecting the confidentiality of our records containing information about you. This notice applies to all records of your care created or received by Rock Ridge Family Medicine. Other healthcare providers from whom you obtain care and treatment may have different policies or notices regarding the use and disclosures of your health information created or received by that provider. Health plans that you participate may have different notices or policies concerning information they receive about you.

This notice will tell you about the ways in which we may use and disclose your health information. Also, describe your rights and certain obligations we have regarding the use and disclose of information.

We are required by law to maintain the privacy of your health information; give you this notice of our legal duties and privacy practices and make a good faith effort to obtain your acknowledgement of receipt of this notice; and follow the terms of the notice that is currently in effect.

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 the office that are involved in your care and treatment for the purpose of providing health care services to you, to pay our health care bills, to support the operation of the physician’s practice, and other use required by law.

TREATMENT: We will use and disclose our 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. For example: we would disclose your PHI, as necessary, to a home health agency that provides you care or maybe provided to another physicians in which we have referred you , to ensure that the physician has all necessary information to treat you.

PAYMENT: Your PHI will be used, as needed, to obtain payment for your health care services. For example, obtaining approval for outside imaging; which may require that your relevant PHI be disclosed to the health plan.

Healthcare Operations: We may use or disclose, as needed, your PHI in order to support the business activities of our 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:  as necessary, to conduct you to remind you of your appointment.

We may use or disclose your PHI in the following situations without your authorization, these cases include: as required by law, public health issues; communicable diseases; health oversight; abuse and neglect; Food and Drug administration requirements;  legal proceedings; law enforcement, coroners, funeral directors, and organ donation; Research; criminal activity; military and national security; Workers’ compensation; Inmates; require uses and disclosures; under the law, we must make disclosures to you and when required by the Secretary of the Department Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500.

OTHER PERMITTED AND REQUIRED USES AND DISCLOSURES WILL BE MADE ONLY WITH YOUR CONSENT UNLESS REQUIRED BY LAW.

You may revoke this authorization at any time in writing, except to the extent that the physician or the physician’s practice has taken action in reliance on the use or disclosure indicated in the authorization.

-You have the right to inspect and copy your PHI. Under Federal Law, however, you may not inspect or copy the following records: psychotherapy notes, information compiled in reasonable anticipation of m or use in a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to PHI.

– You have the right to request a restriction of your PHI. This means you may ask us not to use or disclose any part of your PHI for the purposes of treatment, payment, or healthcare operations. You may also request that any part of your PHI not to be disclosed to family members or friends who may be involved in your care or for notification purposes as described in the Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want to 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 PHI, your protected health information will not be restricted. You then have the right to use another healthcare professional.

-You have the right to request to receive confidential communications from us by alternative means or at an alternative location. 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 alternatively.

-You may have the right to have your physician amend your PHI. 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 stamen and will provide you with a copy of any such rebuttal.

– You have the right to receive an accounting of certain disclosures we have made, if any, of your PHI.

We reserve the right to change the terms of this notice and will inform you of any changes. You then have the right to objet or withdraw as provided in this notice.

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 officer. We will not retaliate against your for filling a complaint