Effective Date 8/28/2010
Notice of Privacy Practices
This notice describes how medical information about you may be used and how you can get access to this information.
Please review it carefully.
This Notice of Privacy Practices describes how Housecall Providers Services, LLC and Housecall Providers P.C. may use and disclose your protected health information (PHI) to carry out treatment, payment, or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your PHI. PHI is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health or condition and related health care services.
We are required by law to maintain the privacy of your protected health information and to give you this notice. It will tell you about the ways in which we may use and disclose health information about you and describes your rights and our obligations regarding the use and disclosure of that information.
USES AND DISCLOSURES OF PHI
We may use and disclose health information for the following purposes:
Treatment: We will use and disclose your PHI in order 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. Different personnel in our organization may share information about you and disclose information to people who do not work for Housecall Providers Services, LLC. or Housecall Providers P.C. in order to coordinate your care, such as phoning in prescriptions to your pharmacy, scheduling lab work and ordering x-rays. For example, we would disclose your PHI, as necessary, to a home health agency that provides care to you. Another example is that your PHI may be provided to a physician, to whom you have been referred, to ensure that the physician has the necessary information to diagnose or treat you.
Payment: Your PHI will be used, as needed, to obtain payment for the healthcare services you receive from Housecall Providers Services, LLC and Housecall Providers P.C.. For example, we may need to give your health plan information about a service you received here so your health plan will pay us or reimburse you for the service. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will pay for the treatment.
Healthcare Operations: We may use and disclose health information about you in order to run Housecall Providers Services, LLC. and Housecall Providers P.C. and make sure that you and our other patients receive quality care. 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, we may disclose your PHI to medical students that see patients at our practice. We may use or disclose your PHI, as necessary, to contact you to remind you of your appointment.
Fundraising We may use limited information about you, including your name, address, telephone number, email, dates of service, treating physician, and contact information for others involved in your care, to provide organizational news, updates and fundraising communications. If you do not wish to receive fundraising communications, or would like to change what communications you receive, please notify us at email@example.com or by advising us of your preference in writing at the address listed at the bottom of this Notice.
We may use or disclose your PHI in the following situations without your authorization. These situations include: To avert serious threat to health and safety, as required by Law, public health issues as required by law, communicable diseases, health oversight, abuse or neglect, Food and Drug Administration requirements, legal proceedings, law enforcement, coroners, funeral directors and organ donation, research, criminal activity, military activity and national security, worker’s compensations, inmates, required uses and disclosures. Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance of section 164.500.
We will not use or disclose your health information for any purpose other than those identified in the previous sections without your specific written Authorization. If you give us Authorization to use or disclose health information about you, you may revoke that Authorization, in writing, at any time. If you revoke your Authorization, we will no longer use or disclose information about you for the reasons covered by your written Authorization, but we cannot take back any uses or disclosures already made with your permission.
You have the following rights regarding health information we maintain about you:
You have the right to inspect and copy your protected health information. You have the right to inspect and copy your health information, such as medical and billing records, that we keep and use to make decisions about your care. You must submit a written request to our Compliance Officer in order to inspect and/or copy records of your health information. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other associated supplies. 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. A modified request may include requesting a summary of your medical record.
If you request to view a copy of your health information, we will not charge you for inspecting your health information. If you wish to inspect your health information, please submit your request in writing to our Compliance Officer. You have the right to request a copy of your health information in electronic form if we store your health information electronically.
We may deny your request to inspect and/or copy your record or parts of your record in certain limited circumstances. If you are denied copies of or access to health information that we keep about you, you may ask that our denial be reviewed. If the law gives you a right to have our denial reviewed, we will select a licensed health care professional to review your request and our denial. The person conducting the review will not be the person who denied your request, and we will comply with the outcome of the review.
Right to Amend. If you believe 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 as long as the information is kept by Housecall Providers Services, LLC or Housecall Providers P.C. To request an amendment, contact our Compliance Officer.
We may deny your request for an amendment if your request is not in writing or does not include a reason to
support the request. In addition, we may deny or partially deny your request if you ask us to amend information that:
We did not create
Is not part of the health information that we keep
Is already accurate and complete
The law restricts your access to inspect and copy
Right to an Accounting of Disclosures. You have the right to request an “accounting of disclosures”. This is a list of the disclosures we made of medical information about you for purposes other than treatment, payment, health care operations when specifically authorized by you and a limited number of special circumstances involving national security, correctional institutions and law enforcement.
To obtain this list, you must submit your request in writing to our Compliance Officer. It must state a time period that may not be longer than six years. Your request should indicate in what form you want the list (for example, on paper, electronically). 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.
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 it, 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 unless the information is needed to provide you emergency treatment or we are required by law to use or disclose the information.
- We are required to agree to your request if you pay for treatment, services, supplies and prescriptions “out of pocket” and you request the information not be communicated to your health plan for payment or health care operations purposes. There may be instances where we are required to release this information if required by law.
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.
Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive it electronically, you are still entitled to a paper copy.
CHANGES TO THIS NOTICE
We will abide by the terms of the notice of privacy practices currently in effect. We reserve the right to change this notice, and to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. You are entitled to a copy of the notice currently in effect. We will inform you of any significant changes to this Notice.
BREACH OF HEALTH INFORMATION
We will inform you if there is a breach of your unsecured health information.
If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services at:
Office for Civil Rights Region X – Seattle
U.S. Department of Health & Human Services – Regional Manager
2201 Sixth Avenue – M/S: RX-11
Seattle, WA 98121-1831
Phone 800-368-1019, Fax 206-615-2297, TDD 800-537-7697
To file a complaint with Housecall Providers Services, LLC. or Housecall Providers P.C., contact our Compliance Office at 971-202-5500 or firstname.lastname@example.org.
You will not be penalized for filing a complaint.