PRICE MEDICAL NOTICE OF
THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED, AND HOW YOU CAN ACCESS YOUR INFORMATION. PLEASE REVIEW IT CAREFULLY.
Our Pledge Regarding Your Health Information
The privacy and protection of your (and your family’s) health information is as important to Price Medical Practice (the “Practice”) as it is to you. The Practice is dedicated to maintaining the privacy of your health information. In providing you with healthcare, we create records about the treatment and services we provide to you.
We are required by the Health Insurance Portability and Accountability Act (HIPAA) to protect and maintain the confidentiality of health information that is maintained by the Practice. In accordance with HIPAA, the Practice has developed written policies regarding the use and disclosure of your health information.
As a client of the Practice, you are entitled to receive notice about our privacy practices and how we may use and disclose your health information in different circumstances. This Notice explains how we may use and disclose your health information, the rights you have about how your health information is disclosed, and our obligation to protect the privacy of your health information.
Introduction. When you become a client of the Practice, you provide us with information about your health. Each time you visit, a record of your visit is created. Your health record is the information that we use to plan your care, provide treatment, and receive payment for our services. It is important for you to understand that your health record contains personal health information that is protected by federal and state laws.
Our Responsibilities. The Practice is required to maintain the privacy of your personal health information and to provide you with a notice about our legal duties and privacy practices with respect to your health information. We are also required to accommodate reasonable requests that you make to communicate personal health information by alternative means or at alternative locations. Any time we use or disclose your personal health information, we must follow the terms of this Notice.
How We Use And Disclose Your
Protected Health Information
A. Uses and Disclosures for Treatment, Payment, and Healthcare Operations.
After making a good-faith effort to provide you with this Notice, we may use your health information to provide your treatment, to obtain payment for your treatment, and for our internal health care operations. We may use and disclose your personal health information in the following situations:
1. For Treatment. We may use and disclose your personal health information to plan, provide, and coordinate your healthcare services. For example, we may send your information to a specialist to whom you are referred.
2. For Payment. We may use and disclose your personal health information to obtain payment for healthcare services we have provided to you. For example, we may send health information to your insurance carrier so that we are paid for our services.
3. For Healthcare Operations. We may use or disclose your protected health information for our healthcare operations. For example, we may use or disclose your personal health information to perform risk assessments, and other administrative tasks to monitor the quality of care that we provide.
B. Uses and Disclosures With Your Authorization
For uses and disclosures of your health information not involving treatment, payment, or health care operations, we will obtain your written authorization prior to using or disclosing such information (unless we are required or permitted by law to use or disclose your information as set forth below). You have the right to revoke any authorization previously granted. If you have any questions about written authorizations, please contact the Privacy Officer, Dr. Timothy Price, at (202) 463-0220.
The Practice will not release your personal medical information to external marketing groups without your prior written approval.
C. Uses and Disclosures Without Authorization
We may use and disclose your personal health information without obtaining your authorization in the following situations:
Business Associates. There may be some services that we provide through contracts with our business associates (for example, the Practice may outsource its billing). In such situations, we may disclose your health information to our business associates so they can perform the job we asked them to do. We require all business associates to appropriately safeguard your health information, in accordance with applicable law.
Notification of Family or Close Friends. We may use or disclose your health information to notify a family member, personal representative, or another person responsible for your care about your health condition, provided you have the opportunity to agree or object to the disclosure. If you are unable to agree or object, we may disclose this information as necessary if we determine that it is in your best interest based upon our professional judgment (for example, in the case of a medical emergency). In all cases, we will only disclose the health information that is directly relevant to that person’s involvement with your health care.
Required by Law. We may use or disclose your health information to the extent that we are required by law to do so (for example, in response to a subpoena). The use or disclosure of health information will only be made in accordance with applicable law.
Public Health Activities. We may disclose your health information for public health activities, to a public health authority authorized by law to collect or receive information for the purpose of controlling disease, injury, or disability. We may also disclose your health information to a public authority authorized to receive reports of child abuse or neglect, or to report information about products or services under the jurisdiction of the United States Food and Drug Administration. Additionally, we may disclose your health information to a person who may have been exposed to a communicable disease or otherwise be at risk of contacting or spreading a disease, and to your employer for certain work-related illness or injuries.
Health Oversight Activities. We may make disclosures of your health information to a health oversight agency charged with overseeing the health care industry. Disclosures will be made only for activities authorized by law.
Judicial and Administrative Proceedings. We may disclose your health information in the course of any judicial or administrative hearing, in response to an order of a court or administrative tribunal, or in response to a subpoena, discovery request, or other lawful process where we receive satisfactory assurance that appropriate precautions have been taken. To the extent possible, we will take reasonable steps to protect the confidentiality of your health information.
Law Enforcement. We may disclose your health information for law enforcement purposes to law enforcement officials in compliance with, and as limited by, applicable law.
Research. We may use or disclose your health information without your authorization for research purposes, but only when such research has been approved by an institutional review or privacy board that has reviewed the research and authorized the disclosure.
Victims of Abuse, Neglect, or Domestic Violence. We may disclose health information about an individual whom we reasonably believe to be a victim of abuse, neglect, or domestic violence, to a government authority, including a social service or protective service agency authorized by law to receive reports of child abuse, neglect, or domestic violence. Any such disclosures will be made in accordance with, and limited to, the requirements of the law.
Limited Government Functions. We may disclose your health information to certain government agencies charged with special government functions, as limited by applicable law. For example, we may disclose your health information to authorized federal officials for the conduct of national security activities, as required by law.
Organ Procurement. As allowed by law, we may disclose health information to organ procurement organizations for organ, eye, or tissue donation purposes.
Coroners, Medical Examiners, and Funeral Directors. We may disclose health information to a coroner or medical examiner to identify a deceased person, determine a cause of death, or for other duties as authorized by law. We may also disclose personal health information to funeral directors in accordance with applicable laws.
Health and Safety. We may disclose your health information to prevent or lessen a serious threat to a person(s) or the public health and safety. In all cases, disclosures will only be made in accordance with applicable law and standards of ethical conduct.
Workers’ Compensation. We may disclose your health information in accordance with workers’ compensation laws
Under HIPPA, you have the right to the following:
To Receive a Copy of this Notice. Upon request, you have the right to receive a paper copy of this Notice.
To Receive Further Information. You have the right to contact the Privacy Officer if you would like to receive additional information regarding about our privacy practices, your privacy rights, or disagree about a decision we made about your health information, or if you believe that your privacy rights have been violated. The Privacy Officer will provide you with the information you need to file a complaint.
To Inspect and Copy Your Health Information. Upon written request, you have the right to access and obtain a copy of your health information maintained by the Practice, with very limited exception. Please contact the Privacy Officer for information you need to access and copy your health information. The Practice has 60 days to respond to your written request.
To Amend Your Health Information. You have the right to request, in writing, that the Practice amend health information maintained in your health record. The Practice may deny your request for an amendment if it is not in writing and does not include a reason to support the request. Also we may deny your request if you ask us to amend information that:
Is not kept by the Practice;
Was not created by us, unless the person or entity that has created the information is no longer available;
Is not part of the information you are permitted to inspect and copy (such as certain physician notes); or
Is already accurate and complete.
Please contact the Privacy Officer for information you need to request an amendment of your personal health information.
To Request Additional Restrictions on Uses and Disclosures of Your Health Information. You have the right to request in writing that we place additional restrictions on how we use or disclosure your health information. While we will consider any request for additional restrictions, we are not required to agree to your request. Please contact the Privacy Officer for information you need to request additional restrictions on how we may use and disclose your personal health information.
To Request an Accounting of Disclosures. You have a right to request in writing an accounting of certain disclosures made by us of your health information. For each disclosure, the accounting will include the date the information was disclosed, to whom, the address of the person or entity that received the disclosure (if known), and a brief statement of the reason for the disclosure. Please contact the Privacy Officer for information you need to request an accounting of disclosures. Please note that no accounting is available for disclosures made for purposes of treatment, payment, or healthcare operations.
To Request Confidentiality in Certain Communications. You have the right to request to receive written health information by alternative means of communication or at alternative locations. We will attempt to accommodate any such reasonable written request. Please contact the Privacy Officer for information you need to request confidentiality in certain communications.
To File a Complaint. If you believe your privacy rights have been violated, in addition to filing a complaint with us, you have the right to file a written complaint with the Office of Civil Rights of the United States Department of Health and Human Services. Upon request, the Privacy Officer will provide you with the information needed to file your complaint. Under no circumstances will we retaliate against you for filing a complaint with us, or the Office of Civil Rights.
Changes to Notice. We reserve the right to change our privacy practices and to alter this Notice according to those changes. In the event that our Notice changes, we will mail you a copy of our revised notice to the address we have on file.
Privacy Officer. To contact the Privacy Officer, please address all requests to:
Dr. Timothy A. Price, Privacy Officer
1330 New Hampshire Avenue, N.W. Suite 121
Washington, D.C. 20036
Effective Date of this Notice. This Notice is effective as of April 14, 2003.