Arthritis Care
2414
Fifteenth Street
TROY,
NY 12180
NOTICE OF
PRIVACY PRACTICES
As Required by the Privacy
Regulations Created as a Result of the Health Insurance
Portability
and Accountability Act of 1996 (HIPAA)
THIS NOTICE
DESCRIBES HOW HEALTH INFORMATION ABOUT YOU (AS A PATIENT OF
THIS PRACTICE ) MAY BE USED AND DISCLOSED, AND HOW YOU CAN
GET ACCESS TO YOUR INDIVIDUALLY IDENTIFIABLE HEALTH
INFORMATION.
PLEASE REVIEW
THIS NOTICE CAREFULLY.
A. OUR
COMMITMENT TO YOUR PRIVACY
Our
practice is dedicated to maintaining the privacy of your
Individually Identifiable Health Information (IIHI). In
conducting our business, we will create records regarding
you and the treatment and services we provide to you. We
are required by law to maintain the confidentiality of
health information that identifies you. We also are
required by law to provide you with this notice of our
legal duties and the privacy practices that we maintain in
our practice concerning your IIHI. By federal and state
law, we must follow the terms of the notice of privacy
practices that we have in effect at the time. We
realize that these laws are complicated, but we must
provide you with the following important information:
• How we may use and disclose your IIHI
• Your privacy rights in your IIHI
• Our obligations concerning the use and disclosure of
your IIHI
The terms of this notice apply to all records containing
your IIHI that are created or retained by our practice. We
reserve the right to revise or amend this Notice of Privacy
Practices. Any revision or amendment to this notice will be
effective for all of your records that our practice has
created or maintained in the past, and for any of your
records that we may create or maintain in the future. Our
practice will post a copy of our current Notice in our
offices in a visible location at all times, and you may
request a copy of our most current notice at any time.
B. IF YOU
HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE
CONTACT:
Arthritis Care
2414 Fifteenth Street
Attn: Privacy Officer
Troy, NY 12180
518-271-1813
C. WE MAY USE
AND DISCLOSE YOUR INDIVIDUALLY IDENTIFIABLE HEALTH
INFORMATION (IIHI) IN THE FOLLOWING WAYS
1.
Treatment.
Our practice may use your IIHI to treat you. For
example, we may ask you to have laboratory tests (such as
blood tests), and we may use the results to help us reach a
diagnosis. We might use your IIHI in order to write a
prescription for you, or we might disclose your IIHI to a
pharmacy when we order a prescription for you. Many
of the people who work for our practice - including, but
not limited to, our doctors and nurses - may use or
disclose your IIHI in order to treat you or to assist
others in your treatment. Additionally, we may
disclose your IIHI to others who may assist in your care,
such as your spouse, children or parents.
Finally, we may also disclose your IIHI to other health
care providers for purposes related to your treatment.
2.
Payment. Our
practice may use and disclose your IIHI in order to bill
and collect payment for the services and items you may
receive from us. For example, we may contact your health
insurer to certify that you are eligible for benefits (and
for what range of benefits), and we may provide your
insurer with details regarding your treatment to determine
if your insurer will cover, or pay for, your treatment. We
also may use and disclose your IIHI to obtain payment from
third parties that may be responsible for such costs, such
as family members. Also, we may use your IIHI to bill you
directly for services and items. We may disclose your IIHI
to other health care providers and entities to assist in
their billing and collection efforts.
3. Health
Care Operations. Our practice may use and
disclose your IIHI to operate our business. As examples of
the ways in which we may use and disclose your information
for our operations, our practice may use your IIHI to
evaluate the quality of care you received from us, or to
conduct cost-management and business planning activities
for our practice. We may disclose your IIHI to other health
care providers and entities to assist in their health care
operations.
4.
Appointment Reminders. Our practice may use and
disclose your IIHI to contact you and remind you of an
appointment.
5. Treatment
Options. Our
practice may use and disclose your IIHI to inform you of
potential treatment options or alternatives.
6.
Health-Related Benefits and Services. Our practice may use and
disclose your IIHI to inform you of health-related benefits
or services that may be of interest to you.
7. Release of
Information to Family/Friends. Our practice may release your
IIHI to a friend or family member that is involved in your
care, or who assists in taking care of you. For example, a
parent or guardian may ask that a babysitter take their
child to the pediatrician's office for treatment of a cold.
In this example, the babysitter may have access to this
child's medical information.
8.
Disclosures Required By Law. Our practice will use and
disclose your IIHI when we are required to do so by
federal, state or local law.
D. USE AND
DISCLOSURE OF YOUR IIHI IN CERTAIN SPECIAL CIRCUMSTANCES
The following categories describe unique scenarios in which
we may use or disclose your identifiable health
information:
1. Public
Health Risks. Our practice may disclose your
IIHI to public health authorities that are authorized
by-law to collect information for the purpose of:
- Maintaining vital records, such as births and deaths
- Reporting child abuse or neglect
- Preventing or controlling disease, injury or disability
- Notifying a person regarding potential exposure to a
communicable disease
- Notifying a person regarding a potential risk for
spreading or contracting a disease or condition
- Reporting reactions to drugs or problems with products or
devices
- Notifying individuals if a product or device they may be
using has been recalled
- Notifying appropriate government agencies and authorities
regarding the potential abuse or neglect of an adult
patient
(including domestic violence); however, we will only
disclose this information if the patient agrees or we are
required or
authorized by law to disclose this information
- Notifying your employer under limited circumstances
related primarily to workplace injury or illness or medical
surveillance.
2. Health
Oversight Activities. Our practice may disclose your
IIHI to a health oversight agency for activities authorized
by law. Oversight activities can include, for example,
investigations, inspections, audits, surveys, licensure and
disciplinary actions; civil, administrative, and criminal
procedures or actions; or other activities necessary for
the government to monitor government programs, compliance
with civil rights laws and the health care system in
general.
3. Lawsuits
and Similar Proceedings. Our practice may use and
disclose your IIHI in response to a court or administrative
order, if you are involved in a lawsuit or similar
proceeding. We also may disclose your IIHI in response to a
discovery request, subpoena, or other lawful process by
another party involved in the dispute, but only if we have
made an effort to inform you of the request or to obtain an
order protecting the information the party has requested.
4. Law
Enforcement. We may release IIHI if asked to
do so by a law enforcement official:
- Regarding a crime victim in certain situations, if we are
unable to obtain the person's agreement
- Concerning a death we believe has resulted from criminal
conduct
- Regarding criminal conduct at our offices
- In response to a warrant, summons, court order, subpoena
or similar legal process
- To identify/locate a suspect, material witness, fugitive
or missing person
- In an emergency, to report a crime (including the
location or victim(s) of the crime, or the description,
identity or location of
the perpetrator)
5. Deceased
Patients. Our
practice may release IIHI to a medical examiner or coroner
to identify a deceased individual or to identify the cause
of death. If necessary, we also may release information in
order for funeral directors to perform their jobs.
6. Organ and
Tissue Donation. Our practice may release your
IIHI to organizations that handle organ, eye or tissue
procurement or transplantation, including organ donation
banks, as necessary to facilitate organ or tissue donation
and transplantation if you are an organ donor.
7.
Research. Our
practice may use and disclose your IIHI for research
purposes in certain limited circumstances. We will obtain
your written authorization to use your IIHI for research
purposes except when an IRB or Privacy Board has determined
that the waiver of your authorization satisfies the
following: (i) the use or disclosure involves no more than
a minimal risk to the individual's privacy based on the
following: (A) an adequate plan to protect the identifiers
from improper use and disclosure; (B) an adequate plan to
destroy the identifiers at the earliest opportunity
consistent with the research (unless there is a health or
research justification for retaining the identifiers or
such retention is otherwise required by law); and (C)
adequate written assurances that the PHI will not be
re-used or disclosed to any other person or entity (except
as required by law) for authorized oversight of the
research study, or for other research for which the use or
disclosure would otherwise be permitted; (ii) the research
could not practicably be conducted without the waiver; and
(iii) the research could not practicably be conducted
without access to and use of the PHI.
8. Serious
Threats to Health or Safety. Our practice may use and
disclose your IIHI when necessary to reduce or prevent a
serious threat to your health and safety or the health and
safety of another individual or the public. Under these
circumstances, we will only make disclosures to a person or
organization able to help prevent the threat.
9.
Military. Our
practice may disclose your IIHI if you are a member of U.S.
or foreign military forces (including veterans) and if
required by the appropriate authorities.
10. National
Security. Our
practice may disclose your IIHI to federal officials for
intelligence and national security activities authorized by
law. We also may disclose your IIHI to federal officials in
order to protect the President, other officials or foreign
heads of state, or to conduct investigations.
11.
Inmates. Our
practice may disclose your IIHI to correctional
institutions or law enforcement officials if you are an
inmate or under the custody of a law enforcement official.
Disclosure for these purposes would be necessary: (a) for
the institution to provide health care services to you, (b)
for the safety and security of the institution, and/or (c)
to protect your health and safety or the health and safety
of other individuals.
12. Workers'
Compensation. Our practice may release your
IIHI for workers' compensation and similar programs.
E. YOUR
RIGHTS REGARDING YOUR IIHI
You have the following rights regarding the IIHI that we
maintain about you:
1.
Confidential Communications. You have the right to request
that our practice communicate with you about your health
and related issues in a particular manner or at a certain
location. For instance, you may ask that we contact you at
home, rather than work. In order to request a type of
confidential communication, you must make a written request
to our Privacy Officer specifying the requested method of
contact, or the location where you wish to be contacted.
Our practice will accommodate reasonable requests. You do
not need to give a reason for your request.
2. Requesting
Restrictions. You have the right to request a
restriction in our use or disclosure of your IIHI for
treatment, payment or health care operations. Additionally,
you have the right to request that we restrict our
disclosure of your IIHI to only certain individuals
involved in your care or the payment for your care, such as
family members and friends. We are not required to agree to
your request; however, if we do agree, we are bound by our
agreement except when otherwise required by law, in
emergencies, or when the information is necessary to treat
you. In order to request a restriction in our use or
disclosure of your IIHI, you must make your request in
writing our Privacy Officer. Your request must describe in
a clear and concise fashion:
(a) the information you wish restricted;
(b) whether you are requesting to limit our practice's use,
disclosure or both; and
(c) to whom you want the limits to apply.
3. Inspection
and Copies. You have the right to inspect
and obtain a copy of the IIHI that may be used to make
decisions about you, including patient medical records and
billing records, but not including psychotherapy notes. You
must submit your request in writing to our Privacy Officer
in order to inspect and/or obtain a copy of your IIHI. Our
practice may charge a fee for the costs of copying,
mailing, labor and supplies associated with your request.
Our practice may deny your request to inspect and/or copy
in certain limited circumstances; however, you may request
a review of our denial. Another licensed health care
professional chosen by us will conduct reviews.
4.
Amendment. You may ask us to amend your
health information if you believe it is incorrect or
incomplete, and you may request an amendment for as long as
the information is kept by or for our practice. To request
an amendment, your request must be made in writing and
submitted to our Privacy Officer. You must provide us with
a reason that supports your request for amendment. Our
practice will deny your request if you fail to submit your
request (and the reason supporting your request) in
writing. Also, we may deny your request if you ask us to
amend information that is in our opinion: (a) accurate and
complete; (b) not part of the IIHI kept by or for the
practice; (c) not part of the IIHI which you would be
permitted to inspect and copy; or (d) not created by our
practice, unless the individual or entity that created the
information is not available to amend the information.
5. Accounting
of Disclosures. All of our patients have the
right to request an "accounting of disclosures." An
"accounting of disclosures" is a list of certain
non-routine disclosures our practice has made of your IIHI
for non-treatment or operations purposes. Use of your IIHI
as part of the routine patient care in our practice is not
required to be documented. For example, the doctor sharing
information with the nurse; or the billing department using
your information to file your insurance claim. In order to
obtain an accounting of disclosures, you must submit your
request in writing to our Privacy Officer. All requests for
an "accounting of disclosures" must state a time period,
which may not be longer than six (6) years from the date of
disclosure and may not include dates before April 14, 2003.
The first list you request within a 12-month period is free
of charge, but our practice may charge you for additional
lists within the same 12-month period. Our practice will
notify you of the costs involved with additional requests,
and you may withdraw your request before you incur any
costs.
6. Right to a
Paper Copy of This Notice. You are entitled to receive a
paper copy of our notice of privacy practices. You may ask
us to give you a copy of this notice at any time. To obtain
a paper copy of this notice, see a member of our staff.
7. Right to
File a Complaint. If you believe your privacy
rights have been violated, you may file a complaint with
our practice or with the Secretary of the Department of
Health and Human Services. To file a complaint with our
practice, contact our Privacy Officer. All complaints
must be submitted in writing. You will not be penalized for
filing a complaint.
8. Right to
Provide an Authorization for Other Uses and
Disclosures. Our practice will obtain your
written authorization for uses and disclosures that are not
identified by this notice or permitted by applicable law.
Any authorization you provide to us regarding the use and
disclosure of your IIHI may be revoked at any time in
writing. After you revoke your authorization, we will no
longer use or disclose your IIHI for the reasons described
in the authorization. Please note, we are required to
retain records of your care.