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Privacy Statement for the Center for SpineCare and Natural Medicine, LLC.
HIPAA NOTICE OF PRIVACY PRACTICES
(Health Information Portability and Accountability Act)
Effective Date: April 14, 2003 Version: 04142003.1
WE ARE REQUIRED BY LAW TO PROVIDE THIS NOTICE WHICH DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
We understand that health information about you and your health care is personal. We are committed to protecting health information about you. We create a record of the care and services you receive from us. We need this record to provide you with quality care and to comply with certain legal requirement. This Notice applies to all records about your care that occurs at our office, and to all medical information we keep about you, whether that information is created by us or is received from others. We also describe your rights to the health information we keep about you, and describe certain obligations we have regarding the use and disclosure of your health information.
We are required by law to:
Make sure that health information that identifies you is kept private, give you this notice of our legal duties and privacy practices with respect to health information about you and, follow the terms of the notice that is currently in effect.
FUTURE CHANGES TO OUR PRACTICES AND THIS NOTICE
We reserve the right to change our privacy practices and to make any such change applicable to your protected health information we obtained about you before the change. If a change in our practices is material, we will revise this Notice to reflect the change. You may obtain a copy of any revised Notice by contacting Center for Spine Care and Natural Medicine, LLC. at 440- 944-4300. We will also make any revised Notice available in our office.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
The law requires us to have your written authorization for some uses and disclosures. In other circumstances, the law allows us to use or disclose your protected health information without your written authorization. We will use and disclose your health information to the fullest extent authorized by law. This section gives examples of each of these circumstances.
For Treatment:
We may use health information about you to provide you with health care treatment or services. We may disclose health information about you to physicians, nurses, and other health care personnel who are involved in taking care of you. They may work at our offices, at the hospital if you are hospitalized, or at another doctor's office, lab, pharmacy or other health care provider to whom we may refer you for consultation, to take x-rays, to perform lab tests, to have prescriptions filled, or for other treatment purposes. We may disclose health information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location. We may also use and disclose your health information to contact you as a reminder that you have an appointment for treatment at our office, to tell you about or recommend possible treatment options or alternatives, or about health-related benefits or services that may interest you.
For Payment:
We may use and disclose health information about you so that the treatment services you receive from us may be billed to and payment collected from you, an insurance company or a third party. For example, we may need to give your health information about your office visit so your health plan will pay us or reimburse you for the visit. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
For Health Care Operations:
We may also use or disclose your health information for business-related activities, such as to operate our office. For example, we may use your health information to evaluate the quality of care you received from us, or to evaluate the performance of those involved with your care. We may also provide your health information to our attorneys, accountants and other consultants to make sure we are complying with the laws that affect us. We may also use and disclose your health information to contact you in connection with our fundraising efforts.
Uses and Disclosures that Require Us to Give You the Opportunity to Object:
Unless you object, we may provide relevant portions of your health information to a family member, friend or other person you indicate is involved in your health care or in helping you get payment for your health care. In an emergency or when you are not capable of agreeing or objecting to these disclosures, we will disclose health information as we determine is in your best interest.
As Required by Law:
When Required by Law. We disclose health information when we are required to do so by federal, state or local law.
To Avert Serious Threat to Health or Safety:
We may use and disclose health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. For example, we disclose health information when we report suspected child abuse, the occurrence of certain diseases, or adverse reactions to a drug or medical device.
Military and Veterans:
If you are a member of the armed forces or separated/discharged from military services, we may release health information about you as required by military command authorities or the Department of Veterans Affairs as may be applicable. We may also release health information about foreign military personnel to the appropriate foreign military authorities.
For Reports About Victims of Abuse, Neglect or Domestic Violence:
We will disclose your health information in these reports only if we are required or authorized by law to do so, or if you otherwise agree.
To Health Oversight Agencies:
We will provide health information as requested to government agencies who have authority to audit or investigate our operations.
For Lawsuits and Disputes:
If you are involved in a lawsuit or dispute, we may disclose your health information in response to a subpoena or other lawful request, but only if efforts have been made to tell you about the request or to obtain a court order that will protect the health information requested.
To Law Enforcement:
We may release protected health information if asked to do so by a law enforcement official, in the following circumstances: (a) in response to a court order, subpoena, warrant, summons or similar process; (b) to identify or locate a suspect, fugitive, material witness or missing person; (c) about the victim of a crime if, under certain limited circumstances, we are unable to obtain the person's agreement; (d) about a death we believe may be due to criminal conduct; (e) about criminal conduct at our facility; and (f) in emergency circumstances, to report a crime, its location or victims, or the identity, description or location of the person who committed the crime.
To Coroners, Medical Examiners and Funeral Directors:
We may disclose health information about you to facilitate the duties of these individuals.
For Specialized Government Functions:
For example, we may disclose your health information to authorized federal officials for intelligence and national security activities that are authorized by law, or so that they may provide protective services to the President or foreign heads of state or conduct special investigations authorized by law.
To Workers' Compensation or Similar Programs:
We may provide your health information to these programs in order for you to obtain benefits for work-related injuries or illness.
Inmates:
If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release health information about you to the correctional institution or law enforcement official This release would be necessary (1) for the institution to provide you with health care, (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
Minors:
We may disclose a minor patient's health information to a parent or guardian, but we may deny the parent's access to the minor patient's health information in some situations.
OTHER USES AND DISCLOSURES OF YOUR HEALTH INFORMATION
Other uses and disclosures of your health information that are not covered by this Notice or the laws that apply to us will be made only with your written authorization. If you give us written authorization for a use or disclosure of your health information, you may revoke that authorization, in writing, at any time. If you revoke your authorization we will no longer use or disclose your health information for the purposes specified in the written authorization, except that we are unable to take back any disclosures we have already made with your permission, and are required to retain certain records of the uses and disclosures made when the authorization was in effect.
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU
You have the following rights regarding health information we maintain about you:
The Right to Request Limits on Uses and Disclosures of Your Health Information.
You have the right to ask us to limit how we use and disclose your health information, as long as you are not asking us to limit uses and disclosures that we are required or authorized to make to the Secretary of the federal Department of Health Services, related to our facility's patient directory, or any of the disclosures described in the sections above. A Request for Restriction on Uses and Disclosures of Health Information by Center for SpineCare and Natural Medicine, LLC. form must be completed and submitted to the Privacy Officer. Forms may be requested by contacting our Medical Records department at 440-944-4300. In your request, you must tell us what information you want to limit and to whom you want the limits to apply.
We are not required to agree to your request for restrictions if it is not feasible for us to ensure our compliance or believe it will negatively impact the care we may provide you.
If we do agree, we will put it in writing and will abide by the agreement except when you require emergency treatment.
The Right to Choose How We Communicate With You.
You have the right to request that we communicate with you about health matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail to a post office box. A Request for Confidential Communications form must be completed and submitted to our Privacy Officer. Forms are available by contacting the Medical Records department at 440-944-4300. We will not ask you for the reason for your request. We will accommodate all reasonable requests as long as it is not disruptive to our operations. Your request must specify how or where you wish to be contacted.
The Right to Inspect or Request a Copy Your Health Information.
Except for limited circumstances, you may look at or request a copy of your protected health information if you ask in writing to do so. Any such request must be addressed to our Medical Records department. In certain situations we may deny your request, but if we do, we will tell you in writing of the reasons for the denial and explain your right to have the denial reviewed. If you request a copy of your health information, x-rays or similar test results, we may charge a fee for the costs of copying, mailing or other supplies and services associated with your request.
The Right to Correct or Update Your Health Information.
If you believe that the health information we have about you is incomplete or incorrect, you may ask us to amend it. A Request to Amend or Correct Health Information form must be completed and submitted to our Privacy Officer. Forms are available by contacting the Medical Records department at 440-944-4300. The request must tell us why you think the amendment is appropriate. We will not process your request if it is not submitted on the appropriate form or does not tell us why you think the amendment is appropriate. We will inform you in writing as to whether the amendment will be made or denied. If we agree to make the amendment, we will ask you who else you would like us to notify of the amendment.
We may deny your request if you ask us to amend information that:
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- was not created by us, unless the person who created the information is no longer available to make the amendment;
- is not part of the health information we keep about you;
- is not part of the health information that you would be allowed to see or copy; or
- is determined by us to be accurate and complete.
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If we deny the requested amendment, we will tell you in writing how to submit a statement of disagreement or complaint, or to request inclusion of your original amendment request in your health information.
The Right to Get a List of the Disclosures We Have Made.
You have the right to get a list of instances in which we have disclosed your health information. The list will not include, for example, disclosures we have made for our treatment, payment and health care operations purposes, or those made directly to you or your family or friends. Neither will the list include disclosures we have made with your written authorization, for national security purposes or to law enforcement personnel, disclosure of any limited data set, or disclosures made before April 14, 2003.
You may request a list of disclosures by completing and submitting a Request for an Accounting of Disclosures of Health Information form to our Medical Records department. Forms may be obtained by contacting our Medical Records department at 440-944-4300. Your request must state a time period which may not be longer than six years and may not include dates prior to April 14, 2003. The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost and you may choose to withdraw or modify your request before costs are incurred. We will mail you a list of disclosures in paper form within 30 days of your request or notify you if we are unable to supply the list within that time period and by what date we can supply the list; but this date will not exceed a total of 60 days from the date you make the request.
COMPLAINTS:
If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the federal Department of Health and Human Services. To file a complaint with us, put your complaint in writing and address it to our Privacy Officer( Alan L. Palgut, D.C.) at Center for Spine Care and Natural Medicine, LLC. 34820 Chardon Rd. Willoughby Hills, OH. 44094 We will not retaliate against you for filing a complaint. You may also contact our Privacy Officer if you have questions or comments about our privacy practices.
ACKNOWLEDGEMENT OF RECEIPT OF THIS NOTICE:
We will request that you sign a separate form or notice acknowledging you have received a copy of this notice. If you choose, or are not able to sign, a staff member will sign their name, date. This acknowledgement will be filed with your records.
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