Hipaa Privacy Policy Notice
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4HIPAA PRIVACY NOTICE
Effective April 14, 2003
This notice describes how medical information about you may be used and disclosed and how you can obtain access to this
information. Please review it carefully.
Introduction
We are required by law to maintain the privacy of “protected health information.” “Protected health information” includes any
identifiable information that we obtain from you or others that relates to your physical or mental health, the health care you have
received, or payment for your health care.
As required by law, this notice provides you with information about your rights and our legal duties and privacy practices with respect
to the privacy of protected health information. This notice also discusses the uses and disclosures we will make of your protected
health information. We must comply with the provisions of this notice, although we reserve the right to change the terms of this
notice from time to time and to make the revised notice effective for all protected health information we maintain. You can always
request a copy of our most current privacy notice from our office.
Permitted Uses and Disclosures
We can use or disclose your protected health information for purposes of treatment, payment and health care operations.
♦ Treatment means the provision, coordination or management of your health care, including consultations between health care
providers regarding your care and referrals for health care from one health care provider to another. For example, a doctor
treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. Therefore,
the doctor may review your medical records to assess whether you have potentially complicating conditions like diabetes.
♦ Payment means activities we undertake to obtain reimbursement for the health care provided to you, including determinations of
eligibility and coverage and other utilization review activities. For example, prior to providing health care services, we may need
to provide to your insurance carrier (or other third party payor) information about your medical condition to determine whether
the proposed course of treatment will be covered. When we subsequently bill the carrier or other third party payor for the services
rendered to you, we can provide the carrier or other third party payor with information regarding your care if necessary to obtain
payment.
♦ Health Care Operations mean the support functions of our practice related to treatment and payment, such as quality assurance
activities, case management, receiving and responding to patient complaints, physician reviews, compliance programs, audits,
business planning, development, management and administrative activities. For example, we may use your medical information
to evaluate the performance of our staff in caring for you. We may also combine medical information about many patients to
decide what services are not needed, and whether certain new treatments are effective.
Disclosures Related To Communications With You Or Your Family
We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and
services that may be of interest to you or relate specifically to your medical care through our office. For example, we may leave
appointment reminders on your answering machine or with a family member or other person who may answer the telephone at the
number that you have given us in order to contact you.
We may disclose your protected health information to your family or friends or any other individual identified by you when they are
involved in your care or the payment for your care. We will only disclose the protected health information directly relevant to their
involvement in your care or payment. We may also use or disclose your protected health information to notify, or assist in the
notification of, a family member, a personal representative, or another person responsible for your care of your location, general
condition or death. If you are available, we will give you an opportunity to object to these disclosures, and we will not make these
disclosures if you object. If you are not available, we will determine whether a disclosure to your family or friends is in your best
interest, and we will disclose only the protected health information that is directly relevant to their involvement in your care.
We will allow your family and friends to act on your behalf to pick up prescriptions, medical supplies, X-rays, and similar forms of
protected health information, when we determine, in our professional judgment, that it is in your best interest to make such
disclosures.
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