THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED OR DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This Notice of Privacy Practices is provided to you as a requirement of the Health Insurance Portability and Accountability Act (HIPAA). It describes how we may use or disclose your protected health information, with whom that information may be shared, and the safeguards we have in place to protect it. This notice also describes your rights to access and amend your protected health information. You have the right to approve or refuse the release of specific information outside of our system except when the release is required by authorized law or regulation.
Our Duties: We are required by law to (1) make sure that your protected health information is kept private, (2) give you this notice of our legal duties and privacy practices, (3) follow the terms of the notice currently in effect, and (4) communicate any changes in the notice to you.
How We May Use Or Disclose Your Protected Health Information: The following are examples of permitted uses and disclosures of your protected health information:
Treatment: Your protected health information will be used or disclosed to provide, coordinate, or manage your health care and/or any other related service. For example, information obtained by a nurse, physician, or other member of your health care team will be recorded in your medical record and used to determine the course of treatment that should work best for you. Your protected health information may also be provided to another physician, agency, or other health care provider (example: a specialist, pharmacist, laboratory, radiology, or home health agency) to whom you have been referred. This type of use and disclosure will ensure that the physician, agency, or other health care provider has the necessary information to diagnose or treat you.
Payment: Your protected health information will be used or disclosed to obtain compensation or reimbursement for providing you with health care services. We will disclose information that identifies you as well as your diagnosis, procedures, and supplies used to your health care plan so that your health care plan may determine your eligibility for payment.
Health care Operations: Your protected health information will be used or disclosed to support the daily business activities related to your health care. These business activities include, but not limited to, quality assessment activities, investigations, oversight or staff performance reviews, training of medical students, licensing, communications about a product or service, and conducting or arranging for other health care activities.
Required By Law: Your protected health information will be used or disclosed if any law or regulation requires the use or disclosure.
Notification/Communication To Family Members: Your protected health information will be used or disclosed to notify or assist in notifying a family member, personal representative, or other person responsible for your care of your location, general condition, or death. We may also use or disclose to a family member, other relative, close personal friend, or any other person you identify health information relevant to that person?s involvement in your care.
Emergencies: Your protected health information will be used or disclosed in an emergency treatment situation if, in your physician?s professional judgment, the use or disclosure is in your best interest.
Business Associates: Your protected health information will be used or disclosed to third-party ?business associates? who perform various activities (example: collection services) for our practice. We do however, require business associates to take precautions to protect your health information.
Fundraising: Your protected health information may be used or disclosed in order to contact you for fundraising activities supported by our office.
Public Health: Your protected health information will be used or disclosed to any public health authority that is permitted by law to collect or receive information concerning the prevention or controlling of diseases, injuries, or disabilities. This includes, but not limited to, the reporting of diseases, injuries, vital events such as births or deaths, and/or the conduct of public health surveillances, public health investigations, and public health interventions.
Communicable Diseases: Your protected health information will be used or disclosed, if authorized by law, to a person who might have been exposed to a communicable disease or might otherwise be at risk of contracting or spreading the disease or condition.
Victims of Abuse, Neglect, or Domestic Violence: Your protected health information will be used or disclosed to appropriate governmental agencies, such as an adult protective or social services agencies, if we reasonably believe that you are a victim of abuse, neglect, or domestic violence.
Health Oversight: Your protected health information will be used or disclosed to any health oversight agency for activities authorized by law, such as audits, investigations, and/or inspections. These health oversight agencies might include government agencies that oversee the health care system, government benefit programs, other government regulatory programs, and/or civil rights laws.
Food And Drug Administration: Your protected health information will be used or disclosed to comply with requirements or at the direction of the Food And Drug Administration to report adverse events, product defects or problems, biologic product deviations, track products, product recalls, repairs or replacements, and/or to conduct post marketing surveillance.
Legal Proceedings: Your protected health information will be used or disclosed in response to judicial or administrative proceedings, in response to a court order or administrative tribunal (if such a disclosure is expressly authorized), and in certain conditions in response to a subpoena, discovery request, or other lawful process.
Law Enforcement: Your protected health information will be used or disclosed for law enforcement purposes to include responses to legal proceedings, information requests for identification and location, circumstances pertaining to victims of a crime, deaths suspected from criminal conduct, crimes occurring on our practice site, and medical emergencies (not on our practice site) believed to result from criminal conduct.
Threats To Public Health or Safety: Your protected health information will be used or disclosed when (consistent with ethical and legal standards) we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We will also use or disclose your information if it is necessary for law enforcement authorities to identify or apprehend an individual.
Inmates: Your protected health information will be used or disclosed to a correctional institution or law enforcement official if you are an inmate of a correctional facility or under the custody of a law enforcement official. This disclosure would be necessary (1) for the institution to provide you with health care, (2) for your health and safety or the health and safety of others, or (3) for the safety and security of the correctional institution.
Military Activity and National Security: Your protected health information will be used or disclosed for military personnel and veterans for: (1) activities deemed necessary by appropriate military command authorities, (2) for separation or discharge from military service, (3) for the purpose of determination of the Dept of Veterans Affairs of your eligibility for benefits, (4) for national security and intelligence activities, (5) for protective services for the President or others, and (6) to foreign military authorities if you are a member of that foreign military service.
Workers Compensation: Your protected health information will be used or disclosed by us as authorized to comply with workers? compensation laws and other similar legally established programs that provide benefits for work-related injuries or illnesses without regard to fault.
Coroners, Medical Examiners, and Funeral Directors: Your protected health information will be used or disclosed to a coroner, medical examiner, or funeral director for: (1) identification purposes, (2) determining cause of death, or (3) for the coroner, medical examiner, or funeral director to perform other duties authorized by law.
Organ, Eye, or Tissue Donation: Your protected health information will be used or disclosed to organ procurement organizations or other entities involved in the procurement, banking or transplantation for cadaveric organ, eye or tissue donation purposes.
Research: Your protected health information will be used or disclosed to researchers when their research has been approved by an institutional review board or privacy board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information.
Other Uses: Your protected health information will be used or disclosed for the following purposes: (1) to contact you to remind you of an appointment for treatment, (2) to describe or recommend treatment alternatives to you, (3) to furnish information about health-related benefits and services that may be of interest to you, or (4) for certain charitable fundraising purposes.
Prohibition On Other Uses Or Disclosures: Other uses or disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law. Once given, you may revoke the authorization by writing to our contact person, Sharon Roten, Clinic Administrator/Privacy Officer at Medical Outreach Ministries. Understandably, we are unable to take back any disclosure we have already made with your permission.
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Your Individual Rights: You may exercise the following rights:
Right To Request Restrictions: You may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment, or health care operations. You may also request that any part of your protected health information not be disclosed to family members, friends, or any other person who may be involved in your care or for notification purposes. We are not required to agree to a restriction that you request. If we do not agree to the requested restriction, we may not use or disclose your protected health information in violation of that restriction unless it is needed to provide emergency treatment. To request restrictions, please send a written request to the address listed below.
Right To Inspect and Copy: You may inspect and/or obtain a copy of protected health information about you that is contained in a ?designated record set? for as long as we maintain the protected health information. A ?designated record set? contains medical and billing records and any other records about you that your physician and the practice uses for making decisions about you. This right is subject to certain specific exceptions and your request to inspect or copy may be denied. If we deny your access to your protected health information, we will provide you with a reason for the basis of the denial. If you are denied access to your health information, you may request that the denial be reviewed. You must submit a request in writing to the address listed below. If you request a copy of your health information we will charge you a fee for the cost of copying, mailing, and other supplies. Fees for the copying of medical records is as follows: $5.00 Administrative Charge, $1.00 Per Page For The First 25 Pages, and $0.50 Per Page After The 25th Page.
Right To Request Confidential Communications: You may request that we communicate with you using alternative means or at an alternative location. For instance, you may request that we only contact you at work or by mail. To make such a request, you must write to us at the address listed below. In your request for confidential communications, you must tell us how or where you wish to be contacted. We will accommodate reasonable requests, when possible.
Right To Request An Amendment: If you believe that the information we have about you is incorrect or incomplete, you may request an amendment to your protected health information as long as we maintain this information. To request an amendment, you must write to us at the address listed below. In your request for amendment, you must include a reason to support your request.
While we will accept requests for an amendment, we are not required to agree to the amendment. We may also deny your request if: (1) the information was not created by us, unless the person that created the information is no longer available to make the amendment; (2) the information is not part of the health information kept by or for us; (3) the information is not part of the information you would be permitted to inspect or copy; or (4) the information is accurate and complete. If we deny your request for amendment, you have the right to file a statement of disagreement with us. Medical Outreach Ministries may also prepare a rebuttal to your statement, and will provide you with a copy of any such rebuttal.
Right To An Accounting Of Disclosures: You may request that we provide you with an accounting of the disclosures we have made of your protected health information. Not all health information is subject to this request. This right applies to disclosures made for purposes other than treatment, payment, or health care operations as described in this Notice of Privacy Practices. Your request must state a time period, no longer than 6 years and may not include dates before April 14, 2003. Your request must be in writing, and sent to the address listed below.
Right To Receive A Paper Copy Of This Notice: You have a right request a paper copy of this notice from Medical Outreach Ministries, even if you have agreed to accept this notice electronically.
Complaints: If you believe that your privacy rights have been violated, a complaint may be made to our Privacy Officer. You may also submit a complaint to the Secretary of the Department of Health and Human Services at The Office of Civil Rights, The U.S. Department of Health and Human Services, 200 Independence Avenue, S.W., Washington, D.C. 20201 (202) 619-0257 or toll free 1-877-696-6775. We will not retaliate against you for filing a complaint.
Contact Person for Medical Outreach Ministries: Our contact person for all questions, requests, or for further information related to the privacy of your health information is: Sharon Roten, Clinic Administrator/Privacy Officer, 88 W. South Boulevard, Montgomery, Alabama 36105 (334) 281-8008.
Changes To This Notice: We reserve the right to change our privacy practices and to apply the revised practices to health information about you that we already have. Any revision to our privacy practices will be described in a revised notice that will be posted prominently in our waiting room.
