TAFA HEALTHCARE CORPORATION
NOTICE OF PRIVACY PRACTICES
As Required by the Privacy Regulations Promulgated Pursuant to the Health
Insurance Portability and Accountability Act of 1996 (HIPAA)
THIS NOTICE
DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW
YOU CAN GET ACCESS TO YOUR IDENTIFIABLE HEALTH INFORMATION.
PLEASE REVIEW THIS NOTICE CAREFULLY.
A. OUR COMMITMENT TO YOUR PRIVACY
Our organization is dedicated to maintaining the privacy of
your identifiable health information. 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 privacy practices concerning your identifiable
health information. By law, we must follow the terms of the notice of privacy
practices that we have in effect at the time.
To summarize, this notice provides you with the following
important information:
·
How we may use and disclose your identifiable health information
·
Your privacy rights in your identifiable health information
·
Our obligations concerning the use and disclosure of your
identifiable health information.
The terms of this notice apply to all records containing
your identifiable health information that are created or retained by our
practice. We reserve the right to revise or amend our notice of privacy
practices. Any revision or amendment to this notice will be effective for all
of your records our practice has created or maintained in the past, and for any
of your records we may create or maintain in the future. Our organization will
post a copy of our current notice in our offices in a prominent location, and
you may request a copy of our most current notice during any office visit.
B. IF YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE
CONTACT:
Theodore A. Fattoross 1 800 464 4798
C. WE
MAY USE AND DISCLOSE YOUR HEALTH INFORMATION IN THE FOLLOWING WAYS
The following categories describe the different ways in
which we may use and disclose your identifiable health information.
1. Treatment. Our organization may use your
identifiable health information to treat you. For example, we may ask you to
undergo laboratory tests (such as blood or urine tests), and we may use the
results to help us reach a diagnosis. Many of the people who work for our
organization may use or disclose your identifiable health information in order
to treat you or to assist others in your treatment. Additionally, we may
disclose your identifiable health information to others who may assist in your
care, such as your physician, therapists, spouse, children or parents.
2. Payment. Our organization may use and disclose
your identifiable health information 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 identifiable health information to obtain
payment from third parties that may be responsible for such costs, such as
family members. Also, we may use your identifiable health information to bill
you directly for services and items.
3. Health Care Operations. Our organization may
use and disclose your identifiable health information to operate our business.
As examples of the ways in which we may use and disclose your information for
our operations, our organization may use your health information to evaluate the
quality of care you received from us, or to conduct cost-management and business
planning activities for our practice.
OPTIONAL:
4. Appointment Reminders. Our organization may use
and disclose your identifiable health information to contact you and remind you
of visits/deliveries.
OPTIONAL:
5. Health-Related Benefits and Services. Our
organization may use and disclose your identifiable health information to inform
you of health-related benefits or services that may be of interest to you.
OPTIONAL:
6. Release of Information to Family/Friends. Our
organization may release your identifiable health information to a friend or
family member that is helping you pay for your health care, or who assists in
taking care of you.
7. Disclosures Required By Law. Our organization
will use and disclose your identifiable health information when we are required
to do so by federal, state or local law.
D. USE AND
DISCLOSURE OF YOUR IDENTIFIABLE HEALTH INFORMATION 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 organization may
disclose your identifiable health information 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 organization
may disclose your identifiable health information 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
organization may use and disclose your identifiable health information in
response to a court or administrative order, if you are involved in a lawsuit or
similar proceeding. We also may disclose your identifiable health information
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 identifiable
health information 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 might have 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. Serious Threats to Health or Safety. Our
organization may use and disclose your identifiable health information 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.
6. Military. Our organization may disclose your
identifiable health information if you are a member of U.S. or foreign military
forces (including veterans) and if required by the appropriate military command
authorities.
7. National Security. Our organization may disclose
your identifiable health information to federal officials for intelligence and
national security activities authorized by law. We also may disclose your
identifiable health information to federal officials in order to protect the
President, other officials or foreign heads of state, or to conduct
investigations.
8. Inmates. Our organization may disclose your
identifiable health information 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.
9. Workers’ Compensation. Our organization may
release your identifiable health information for workers’ compensation and
similar programs.
E. YOUR RIGHTS REGARDING YOUR IDENTIFIABLE HEALTH
INFORMATION
You have the following rights regarding the identifiable
health information that we maintain about you:
1. Confidential Communications. You have the right
to request that our organization 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
[insert name, or title, and telephone number of a person or office to contact
for further information] specifying the requested method of contact, or the
location where you wish to be contacted. Our organization 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 identifiable health
information for treatment, payment or health care operations. Additionally, you
have the right to request that we limit our disclosure of your identifiable
health information to 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 to you. In order to
request a restriction in our use or disclosure of your identifiable health
information, you must make your request in writing to [insert name, or title,
and telephone number of a person or office to contact for further information].
Your request must describe in a clear and concise fashion: (a) the information
you wish restricted; (b) whether you are requesting to limit our practice’s use,
disclosure or both; and (c) to whom you want the limits to apply.
3. Inspection and Copies. You have the right to
inspect and obtain a copy of the identifiable health information 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 [insert name, or title, and telephone number of a person or office
to contact for further information] in order to inspect and/or obtain a copy
of your identifiable health information. Our organization 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. Reviews will be
conducted by another licensed health care professional chosen by us.
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 organization. To
request an amendment, your request must be made in writing and submitted to
[insert name, or title, and telephone number of a person or office to contact
for further information]. You must provide us with a reason that supports
your request for amendment. Our organization 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: (a) accurate and complete; (b) not part of the identifiable health
information kept by or for the organization; (c) not part of the identifiable
health information which you would be permitted to inspect and copy; or (d) not
created by our organization, 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 disclosures our organization has made of your
identifiable health information. In order to obtain an accounting of
disclosures, you must submit your request in writing to [insert name, or
title, and telephone number of a person or office to contact for further
information]. All requests for an “accounting of disclosures” must state a
time period which may not be longer than six years 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 organization 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 [insert name, or title, and telephone number of a person
or office to contact for further information].
7. Right to File a Compliant. If you believe your
privacy rights have been violated, you may file a complaint with our
organization or with the Secretary of the Department of Health and Human
Services. To file a complaint with our organization, contact [insert the
name, title, and phone number of the contact person or office responsible for
handling complaints]. 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 organization 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 identifiable health information may be revoked at any time
in writing. After you revoke your authorization, we will no longer use or
disclose your identifiable health information for the reasons described in the
authorization. Please note: We are required to retain records of your care.
