Health Insurance Portability and Accountability Act of 1996 (HIPAA,
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND
DISCLOSED AND HOW YOU CAN GET ACCESS TO THAT INFORMATION
PLEASE 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.
NO CONSENT REQUIRED
The Practice may use and/or disclose your PHI for the purposes of:
(a) Treatment - In order to provide you with the health care you
require, the Practice will provide your PHI to those health care
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.
(c) 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.
1. The Practice may use and/or disclose your PHI, without a written
Consent from you, in the following additional instances:
(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.
(c) Personal Representative -To a person who, under applicable law, has
the authority to represent you in making decisions related to your
(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
(ii) 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 harm
(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.
(i) 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.
(j) 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
(k) 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
(n) 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