GASTROENTEROLOGY SPECIALISTS OF FREDERICK

COURT ENDOSCOPY CENTER OF FREDERICK, INC.

 

NOTICE OF PRIVACY PRACTICES

 

 

Effective Date:  April 14, 2003

 

Effective Date of Last Revision (if any): May 15, 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.

 

Understand your health record

 

When you visit a hospital, physician, or other health care provider, a record is made of each visit. At that time, your symptoms, examination and test results, diagnoses, treatment, and a plan for future care are recorded.  This information is most often referred to as your “health or medical record.”  It serves as a means of communication between all health professionals who may contribute to your care.  Understanding what information is recorded in your record and how that information may be used will help you to ensure its accuracy, and enable you to relate to who, what, when, where, and why others may be allowed access to your health information.  This notice is being made to help you in making informed decisions before authorizing the disclosure of your medical information to others.  Use or disclosure of your health information will follow the more stringent of State or Federal laws.

 

Understanding your health information rights

 

            Your health record is the physical property of the health care practitioner or facility that compiled it but the content is about you, and therefore it belongs to you.  You have the right to request restrictions on certain uses and disclosures of your information, and to request amendments be made to your health record. We are not required to agree with your request; however, if we do, we will attempt to honor it.  Your rights include being able to review your information or obtain a paper copy of your health information, and to receive an accounting of the disclosures we have made of your PHI for most purposes other than treatment, payment or health care operations.  Excluded are direct disclosures to yourself, family or friends involved in your care.  You also have the right to request a paper copy of a notice originally sent or received electronically. You may revoke in writing any further authorization to use or disclose your health information other than activity that already has occurred.  You may also request communications of your health information be made to different locations or by alternative means.  Other uses and disclosures will be made only with your written authorization.  You may revoke such authorization as by CFR 164.508 (b) (5). If you request or authorize copying of your records, we may charge for such as permitted by State law.

 

Our responsibilities

 

            This office is required to maintain the privacy of your health information, called “protected health information” or “PHI”, and to provide you with notice of our legal commitment and privacy practices with respect to the information we collect and maintain about you.  This office is required to abide by the terms of this notice and to notify you if we are unable to grant your requested restrictions or reasonable desires to communicate your health information by alternative means or to alternative locations.

 

            This office reserves the right to make changes to this notice and to make such changes effective for all PHI we may already have about you.  In the event that changes are made, we will post a copy in our office in a prominent location.  We will also provide you with a copy of the revised notice upon your request made to our Privacy Official.  If applicable, this office will post changes on our web site that provides information about our customer service and/or benefits. We are not required to notify you of any changes to this notice.

 

            We may use and disclose PHI about you in some circumstances where you have the opportunity to agree or object to certain uses and disclosures of PHI about you.  If you do not object, then we may make these types of uses and disclosures of PHI.

 

            Other than for reasons described in this notice, this office agrees not to use or disclose your health information without your authorization.

 

To receive additional information or report a problem

 

            For further explanation of this notice, you may contact our privacy official,

 Ginny Wolf at (301) 663-9440  ext. 204.

 

            If you believe your privacy rights have been violated, you have the right to file a complaint with this office by contacting the individual above, or by contacting the Secretary of Health and Human Services, with no fear of retaliation by this office. We do, however, request that you notify us FIRST to allow us an opportunity to address your concern.

 

Your health information will be used for treatment, payment, and health care operations.

 

            Treatment- Information obtained by your health practitioner in this office will be recorded in your medical record and used to determine the course of treatment that should work best for you.  This consists of your physician recording his/her own expectations and those of others involved in providing you care.  We may use and disclose PHI about you to provide, coordinate, or manage your health care and related services.  We may consult with other health care providers regarding your treatment to coordinate and manage your health care.  For example, we may use and disclose PHI when you need a prescription, lab work, an x-ray, or other health care services.  We may also use and disclose PHI about you when referring you to another health care provider.  For example, if you are referred to another physician, we may disclose PHI to your new physician regarding whether you are allergic to any medications.

 

We may also disclose PHI about you to coordinate treatment with another health care provider.  For example,  we may send a report about your care from our physician to a physician that we refer you to so that the other physician may treat you.

 

Payment- Your health care information will be used in order to receive payment for services rendered by this office.  A bill may be sent to either you or a third-party payer with documentation that identifies you, your diagnosis, exams and procedures performed and supplies used. For example, we may ask for payment approval from your health plan before we schedule a procedure or an x-ray.

 

Health Care Operations- The medical staff in this office will use your health information to assess the care you received and the outcome of your case compared to others like it. Your information may be reviewed for risk management or quality improvement purposes in our efforts to continually improve the quality and effectiveness of the care and services we provide.  For example, we may use PHI to identify groups of people with similar health problems to give them information regarding treatment alternatives, or educational classes.

 

Understanding our office policy for specific disclosures

 

• Business Associates   Some or all of your health information may be subject to disclosure through contracts for services to help this office in providing health care.  For example, it may be necessary to obtain specialized assistance to process certain laboratory tests. We require these Business Associates to follow the same standards held by this office through a written agreement to protect your health information.
• Notification-Your health record may be used to notify or assist family members, personal representatives, or other persons responsible for your care to better your well being or where you may be.  We may contact you with appointment reminders, replies to your inquiries, messages regarding test results or treatment, or information about treatment alternatives, via answering machine or voicemail messages, letters, or e-mail.
• Communications with Family- You authorize communication of your medical care, treatment, billing issues, etc. with your immediate family (spouse, adult children, siblings, parents) or a close personal friend so identified by you, when felt to be in your best interest.  However, we are not compelled to discuss any issues with your family or authorized friend if we have concerns regarding imparting such information.
• Funeral Directors- Your health information may be disclosed consistent with laws governing mortician services.
• Organ Procurement Organizations- Your health information may be disclosed consistent with laws governing entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation or transplant.
• Marketing- This office reserves the right to contact you with appointment reminders such as voicemail messages, letters, or e-mail, or information about treatment alternatives and other health-related benefits that may be appropriate to you.
• Fund Raising- This office reserves the right to contact you as part of fund-raising efforts.
• Food and Drug Administration (FDA)- This office is required by law to disclose health information to the FDA related to any adverse effects of food, supplements, products, and product defects for surveillance to enable product recalls, repairs, or replacements.
• Worker’s Compensation – This office will release information to the extent authorized by law in matters of worker’s compensation.
• Public Health- This office is required by law to disclose health information to public health and/or legal authorities charges with tracking reports of birth and morbidity.  This office is further required by law to report communicable disease, injury, or disability.
• Correctional Facilities- This office will release medical information on incarcerated individuals to correctional agents or institutions for the necessary welfare of the individual or for the health and safety of other individuals.  The rights outlined in this Notice of Privacy Practices will not be extended to incarcerated individuals.
• Law Enforcement- (1) Your health information will be disclosed for law enforcement purposes as required under state law or in response to a valid subpoena.  (2) Provisions of federal law permit the disclosure of your health information to appropriate health oversight agencies, public health authorities, or attorneys in the event that a staff member or business associate of this office believes in good faith that there has been unlawful conduct or violations of professional or clinical standards that may endanger one or more patients, workers, or the general public.
• Specialized Government Functions:

Under certain circumstances, we may disclose PHI for the following activities:

(1) certain military and veteran activities, (2) national security and intelligence activities,(3) to help provide protective services for the president and others, (4) for the health and safety of inmates and others at correctional institutions.

 

Notice of Privacy Practices Availability:  The terms described in this notice will be posted where registration occurs.  All individuals receiving care will be given a hard copy.

 

 

Revision 051503