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Notice Of Privacy Practices
Effective date: Jan 31, 2006
As required by
the privacy regulations created as a result of the Health Insurance Portability
and Accountability Act of 1996 (HIPAA).
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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 (also called protected health information, or PHI). 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 PHI. 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 PHI,
• Your
privacy rights in your PHI,
• Our
obligations concerning the use and disclosure of your PHI.
The terms of
this notice apply to all records containing your PHI 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: William R. Weisberg MD
c/o Cape Urgent Care, 900 Rt. 109,
Cape May,
NJ
08204
(609)884-4357
C. We may use and disclose your PHI in the following ways:
The following
categories describe the different ways in which we may use and disclose your
PHI.
1. Treatment.
Our practice may use your PHI to treat you. For example, we may ask you to have
laboratory tests (such as blood or urine tests), and we may use the results to
help us reach a diagnosis. We might use your PHI in order to write a
prescription for you, or we might disclose your PHI 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
PHI in order to treat you or to assist others in your treatment. Additionally,
we may disclose your PHI to others who may assist in your care, such as your
spouse, children or parents. Finally, we may also disclose your PHI to other
health care providers for purposes related to your treatment.
2. Payment.
Our practice may use and disclose your PHI 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 PHI to obtain payment from third parties that
may be responsible for such costs, such as family members. Also, we may use your
PHI to bill you directly for services and items. We may disclose your PHI 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 PHI 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 PHI 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 PHI to other health care providers and
entities to assist in their health care operations.
4. Appointment
reminders.
Our practice may use and disclose your PHI to contact you and remind you of an
appointment.
5.
Treatment options.
Our practice
may use and disclose your PHI to inform you of potential treatment options or
alternatives.
6.
Health-related benefits and services.
Our practice
may use and disclose your PHI 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 PHI 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 baby sitter take their child to the
pediatrician’s office for treatment of a cold. In this example, the baby sitter
may have access to this child’s medical information.
8. Disclosures
required by law.
Our practice will use and disclose your PHI when we are required to do so by
federal, state or local law.
D. Use and disclosure of your PHI 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 PHI 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 agency(ies) and authority(ies) 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 PHI 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 PHI in response to a court or
administrative order, if you are involved in a lawsuit or similar proceeding. We
also may disclose your PHI 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 PHI 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 PHI 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 PHI 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 PHI for research purposes in certain limited
circumstances. We will obtain your written authorization to use your PHI for
research purposes.
8. Serious
threats to health or safety.
Our practice may use and disclose your PHI 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 PHI 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 PHI to federal officials for intelligence and
national security activities authorized by law. We also may disclose your PHI to
federal and national security activities authorized by law. We also may disclose
your PHI 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 PHI 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 PHI for workers’ compensation and similar
programs.
13. Sign-In
Sheets: This office
utilizes sign-in sheets that are visible to patients and staff.
E. Your rights regarding your PHI:
You have the
following rights regarding the PHI 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
Dr.
William R. Weisberg 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 PHI
for treatment, payment or health care operations. Additionally, you have the
right to request that we restrict our disclosure of your PHI 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 PHI, you must make your request in writing to
William R.
Weisberg MD c/o Cape Urgent Care, 900 Rt. 109, Cape May, NJ 08204
(609-884-4357).
Your request must describe in a clear and concise fashion:
• The
information you wish restricted,
• Whether
you are requesting to limit our practice’s use, disclosure or both,
• To whom
you want the limits to apply.
3. Inspection
and copies.
You have the right to inspect and obtain a copy of the PHI 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 Dr. William R. Weisberg in order to inspect and/or obtain a copy of
your PHI. 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
William R.
Weisberg MD c/o Cape Urgent Care,
900 Rt.
109,
Cape May, NJ 08204. 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 PHI kept by or for the practice; (c)
not part of the PHI 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 PHI for purposes not related to treatment, payment or
operations. Use of your PHI 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
Dr. William R.
Weisberg. 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, contact
Dr.
William R. Weisberg (609)884-4357.
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 Dr
William R. Weisberg. 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 PHI may
be revoked at any time in writing. After you revoke your authorization,
we will no longer use or disclose your PHI for the reasons described in the
authorization. Please note: we are required to retain records of your
care.
Again, if you
have any questions regarding this notice or our health information privacy
policies, please contact
Dr William R.
Weisberg (609)884-4357
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