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Privacy Notice |
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By Michael Hueneke, M.D. |
Notice of Privacy Practices for Protected Health Information
April 14, 2003
THIS NOTICE DESCRIBES HOW MEDICAL
INFORMATION ABOUT YOU MAY BE USED
AND DISCLOSED AND HOW YOU CAN GET
ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY!
Our office is permitted by federal privacy laws to make uses and
disclosures of your health information for purposes of treatment,
payment, and health care operations. Protected health information is
the information we create and obtain in providing our services to
you. Such information may include documenting your symptoms,
examination and test results, diagnoses, treatment, and applying for
future care or treatment. It also includes billing documents for
those services.
Examples of uses of your health information for treatment purposes
are:
* A nurse obtains treatment information about you and records it in
a health record.
* During the course of your treatment, the physician determines
he/she will need to consult with another specialist in the area.
He/she will share the information with such specialist and obtain
his/her input.
Example of use of your health information for payment purposes:
* We submit requests for payment to your health insurance company.
The health insurance company or business associate helping us obtain
payment requests information from us regarding your medical care
given. We will provide information to them about you and the care
given.
Your Health Information Rights
The health and billing records we maintain are the physical property
of the doctor's office. You have the following rights with respect
to your Protected Health Information
1. Request a restriction on certain uses and disclosures of your
health information by delivering the request in writing to our
office-we are not required to grant the request but we will comply
with any request granted;
2. Obtain a paper copy of the Notice of Privacy Practices for
Protected Health Information ("Notice") by making a request at our
office;
3. Right to inspect and copy your health record and billing
record-you may exercise this right by delivering the request in
writing to our office using the form we provide to you upon request;
appeal a denial of access to your protected health information
except in certain circumstances;
4. Right to request that your health care record be amended to
correct incomplete or incorrect information by delivering a written
request to our office using the form we provide to you upon request.
(The physician or other health care provider is not required to make
such amendments); you may file a statement of disagreement if your
amendment is denied, and require that the request for amendment and
any denial be attached in all future disclosures of your protected
health information;
5. Right to receive an accounting of disclosures of your health
information as required to be maintained by law by delivering a
written request to our office using the form we provide to you upon
request. An accounting will not include internal uses of information
for treatment, payment, or operations, disclosures made to you or
made at your request, or disclosures made to family members or
friends in the course of providing care;
6. Right to confidential communication by requesting that
communication of your health information be made by alternative
means or at an alternative location by delivering the request in
writing to our office using the form we give you upon request; and,
If you want to exercise any of the above rights, please contact Dr.
Hueneke in person or in writing, during normal hours. He will
provide you with assistance on the steps to take to exercise your
rights.
Our Responsibilities
The office is required to:
* Maintain the privacy of your health information as required by
law;
* Provide you with a notice as to our duties and privacy practices
as to the information we collect and maintain about you;
* Abide by the terms of this Notice;
* Notify you if we cannot accommodate a requested restriction or
request; and
* Accommodate your reasonable requests regarding methods to
communicate health information with you.
* Accommodate your request for an accounting of disclosures.
We reserve the right to amend, change, or eliminate provisions in
our privacy practices and access practices and to enact new
provisions regarding the protected health information we maintain.
If our information practices change, we will amend our Notice. You
are entitled to receive a revised copy of the Notice by calling and
requesting a copy of our "Notice" or by visiting our office and
picking up a copy.
To Request Information or File a Complaint
If you have questions, would like additional information, or want to
report a problem regarding the handling of your information, you may
contact Dr. Hueneke. Additionally, if you believe your privacy
rights have been violated, you may file a written complaint at our
office by delivering the written complaint to Dr. Hueneke. You may
also file a complaint by mailing it or e-mailing it to the Secretary
of Health and Human Services.
* We cannot, and will not, require you to waive the right to file a
complaint with the Secretary of Health and Human Services (HHS) as a
condition of receiving treatment from the office.
* We cannot, and will not, retaliate against you for filing a
complaint with the Secretary of Health and Human Services.
Following is a List of Other Uses and Disclosures Allowed by the
Privacy Rule
Patient Contact
We may contact you to provide you with appointment reminders, with
information about treatment alternatives, or with information about
other health-related benefits and services that may be of interest
to you. We may contact you as part of a fund raising effort.
Notification - Opportunity to Agree or Object
Unless you object we may use or disclose your protected health
information to notify, or assist in notifying, a family member,
personal representative, or other person responsible for your care,
about your location, and about your general condition, or your
death.
Communication with Family - Using our best judgment, we may 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 or in payment for such care if you
do not object or in an emergency.
Opportunity to Agree or Object Not Required
PUBLIC HEALTH ACTIVITIES
Controlling Disease - As required by law, we may disclose your
protected health information to public health or legal authorities
charged with preventing or controlling disease, injury, or
disability.
Child Abuse & Neglect - We may disclose protected health information
to public authorities as allowed by law to report child abuse or
neglect.
Food and Drug Administration (FDA) - We may disclose to the FDA your
protected health information relating to adverse events with respect
to food, supplements, products and product defects, or
post-marketing surveillance information to enable product recalls,
repairs, or replacements.
VICTIMS OF ABUSE , NEGLECT, OR DOMESTIC VIOLENCE
We can disclose protected health information to governmental
authorities to the extent the disclosure is authorized by statute or
regulation and in the exercise of professional judgment the doctor
believes the disclosure is necessary to prevent serious harm to the
individual or other potential victim.
OVERSIGHT AGENCIES
Federal law allows us to release your protected health information
to appropriate health oversight agencies or for health oversight
activities to include audits, civil, administrative or criminal
investigations: inspections; licensures or disciplinary actions, and
for similar reasons related to the administration of healthcare.
JUDICIAL/ADMINISTRATIVE PROCEEDINGS
We may disclose your protected health information in the course of
any judicial or administrative proceeding as allowed or required by
law, or as directed by a proper court order or administrative
tribunal, provided that only the protected health information
released is expressly authorized by such order, or in response to a
subpoena, discovery request or other lawful process.
LAW ENFORCEMENT
We may disclose your protected health information for law
enforcement purposes as required by law, such as when required by
court order, including laws that require reporting of certain types
of wounds or other physical injury.
CORONERS, MEDICAL EXAMINERS AND FUNERAL DIRECTORS
We may disclose your protected health information to funeral
directors or coroners consistent with applicable law to allow them
to carry out their duties.
ORGAN PROCUREMENT ORGANIZATIONS
Consistent with applicable law, we may disclose your protected
health information to organ procurement organizations or other
entities engaged in the procurement, banking, or transplantation of
organs, eyes, or tissue for the purpose of donation and transplant.
RESEARCH
We may disclose information to researchers when their research has
been approved by an institutional review board that has reviewed the
research proposal and established protocols to ensure the privacy of
your protected health information.
THREAT TO HEALTH AND SAFETY
To avert a serious threat to health or safety, we may disclose your
protected health information consistent with applicable law to
prevent or lessen a serious, imminent threat to the health or safety
of a person or the public.
FOR SPECIALIZED GOVERNMENTAL FUNCTIONS
We may disclose your protected health information for specialized
government functions as authorized by law such as to Armed Forces
personnel, for national security purposes, or to public assistance
program personnel.
CORRECTIONAL INSTITUTIONS
If you are an inmate of a correctional institution, we may disclose
to the institution or it's agents the protected health information
necessary for your health and the health and safety of other
individuals.
WORKERS COMPENSATION
If you are seeking compensation through Workers Compensation, we may
disclose your protected health information to the extent necessary
to comply with laws relating to Workers Compensation.
Other Uses and Disclosures
* Other uses and disclosures besides those identified in this Notice
will be made only as otherwise authorized by law or with your
written authorization which you may revoke except to the extent
information or action has already been taken.
Privacy Notice Page 1 of 4
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