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Notice of Privacy
Practices for Protected Health Information
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!
Our office is permitted by federal
privacy laws to make uses and disclosures of your health information for
purposes of treatment, payment, and health care operations. Protected
health information is the information we create and obtain in providing our
services to you. Such information may include documenting your symptoms,
examination and test results, diagnoses, treatment, and applying for future
care or treatment. It also includes billing documents for those services.
Examples of uses of your
health information for treatment purposes are:
- A nurse obtains treatment
information about you and records it in a health record.
- During the course of your
treatment, the physician determines he/she will need to consult with
another specialist in the area. He/she will share the information with
such specialist and obtain his/her input.
Example of use of your
health information for payment purposes:
- We submit requests for payment
to your health insurance company. The health insurance company or
business associate helping us obtain payment requests information from us
regarding your medical care given. We will provide information to them
about you and the care given.
Example of use of your
information for Health Care Operations:
- We may obtain services from
business associates such as quality assessment, quality improvement,
outcome evaluation, protocol and clinical guidelines development, training
programs, credentialing, medical review, legal services, and insurance.
We will share information about you with such business associates as
necessary to obtain these services.
Your Health Information Rights
The health and billing records we maintain are the
physical property of West Tennessee Bone & Joint Clinic. You have the
following rights with respect to your Protected Health Information:
1.
Request a restriction on certain uses and disclosures of your health
information by delivering the request in writing to our office-we are not
required to grant the request but we will comply with any request granted;
2.
Obtain a paper copy of the Notice of Privacy Practices for Protected
Health Information (“Notice”) by making a request at our office;
3.
Right to inspect and copy your health record and billing record-you
may exercise this right by delivering this request in writing to our office
using the form we provide to you upon request; appeal a denial of access to
your protected health information except in certain circumstances. (There is
a minimal charge for obtaining copies of your health and/or billing record);
4.
Right to request that your health care record be amended to correct
or incomplete or incorrect information by delivering a written request to
our office using the form we provide to you upon request. (The physician or
other health care provider is not required to make such amendments); you may
file a statement of disagreement if your amendment is denied, and require
that the request for amendment and any denial be attached in all future
disclosures of your protected health information;
5.
Right to receive an accounting of disclosures of your health
information as required to be maintained by law by delivering a written
request to our office using the form we provide to you upon request. An
accounting will not include internal uses of information for treatment,
payment, or operations, disclosures made to you or made at your request, or
disclosures made to family members or friends in the course of providing
care;
6.
Right to confidential communication by requesting that communication
of your health information be made by alternative means or at an alternative
location by delivering the request in writing to our office using the form
we give you upon request; and,
If
you want to exercise any of the above rights, please contact Custodian of
Medical Records, 24 Physicians Drive Jackson TN 38305, (731) 661-9825.
Our Responsibilities
The office is required to:
- Maintain the privacy of your
health information as required by law;
- Provide you with a notice as to
our duties and privacy practices as to the information we collect and
maintain about you;
- Abide by the terms of this
Notice;
- Notify you if we cannot
accommodate a requested restriction or request; and
- Accommodate your reasonable
requests regarding methods to communicate health information with you.
- Accommodate your request for an
accounting of disclosures.
We
reserve the right to amend, change, or eliminate provisions in our privacy
practices and access practices and to enact new provisions regarding the
protected health information we maintain. If our information practices
change, we will amend our Notice. You are entitled to receive a revised
copy of the Notice by calling and requesting a copy of our “Notice” or by
visiting our office and picking up a copy.
To Request Information of File a Complaint
If you have questions, would like additional
information, or want to report a problem regarding the handling of your
information, you may contact: Practice Administrator, West Tennessee Bone &
Joint Clinic, 24 Physicians Drive Jackson, TN 38305 or call: (731)
661-9825.
Additionally, if you believe your privacy rights have been violated, you may
file a written complaint at our office by delivering the written complaint
to Practice Administrator, West Tennessee Bone & Joint Clinic, 24 Physicians
Drive Jackson, TN 38305.
Following is a List of Other Uses and Disclosures Allowed by the Privacy
Rule
Patient Contact
We may contact you to provide you with
appointment reminders, with information about treatment alternatives, or
with information about other health-related benefits and services that may
be of interest to you.
We may use or disclose your protected health
information to notify, or assist in notifying, a family member, personal
representative, or other person responsible for you care, about your
location, and about your general condition, or your death.
Communication with Family-Using our best
judgment, we may disclose to a family member, other relative, close personal
friend, or any other person you identify, health information relevant to
that person’s involvement in your care or in payment for such care if you do
not object or in an emergency.
We may use and disclose your protected health
information to assist in disaster relief efforts.
PUBLIC HEALTH ACTIVITIES
Controlling Disease- As required by law,
we may disclose your protected health information to public health or legal
authorities charged with preventing or controlling disease, injury, or
disability.
Child Abuse & Neglect- We may disclose
protected health information to public authorities as allowed by law to
report child abuse or neglect.
Food and Drug Administration (FDA)- We
may disclose to the FDA your protected health information relating to
adverse events with respect to food, supplements, products and product
defects, or post-marketing surveillance information to enable product
recalls, repairs, or replacements.
VICTIMS OF ABUSE, NEGLECT, OR DOMESTIC
VIOLENCE
We can disclose protected health information to
governmental authorities to the extent the disclosure is authorized by
statute or regulation and in the exercise of professional judgment the
doctor believes the disclosure is necessary to prevent serious harm to the
individual or other potential victim.
OVERSIGHT AGENCIES
Federal law allows us to release your protected
health information to appropriate health oversight agencies or for health
oversight activities to include audits, civil, administrative or criminal
investigations: inspections; licensures or disciplinary actions, and for
similar reasons related to the administration of healthcare.
JUDICIAL/ADMINISTRATIVE PROCEEDINGS
We may disclose your protected health
information in the course of any judicial or administrative tribunal,
provided that only the protected health information released is expressly
authorized by such order, or in response to a subpoena, discovery request or
other lawful process.
LAW ENFORCEMENT
We may disclose your protected health
information for law enforcement purposes as required by law, such as when
required by court order, including laws that require reporting of certain
types of wounds or other physical injury.
CORONERS, MEDICAL EXAMINERS AND FUNERAL
DIRECTORS
We may disclose your protected health
information to funeral directors or coroners consistent with applicable law
to allow them to carry out their duties.
ORGAN PROCUREMENT ORGANIZATIONS
Consistent with applicable law, we may disclose
your protected health information to organ procurement organizations or
other entities engaged in the procurement, banking, or transplantation of
organs, eyes, or tissue for the purpose of donation and transplant.
RESEARCH
We may disclose information to researchers when
their research has been approved by an institutional review board that has
reviewed the research proposal and established protocols to ensure the
privacy of your protected health information.
THREAT TO HEALTH AND SAFETY
To avert a serious threat to health or safety,
we may disclose your protected health information consistent with applicable
law to prevent or lessen a serious, imminent threat to the health or safety
of a person or the public.
FOR SPECIALIZED GOVERNMENTAL FUNCTIONS
We may disclose your protected health
information for specialized government functions as authorized by law such
as to Armed Forces personnel, for national security purposes, or to public
assistance program personnel.
CORRECTIONAL INSTITUTIONS
If you are an inmate of a correctional
institution, we may disclose to the institution or it’s agents the protected
health information necessary for your health and the health and safety of
other individuals.
WORKERS COMPENSATION
If you are seeking compensation through Workers
Compensation, we may disclose your protected health information to the
extent necessary to comply with laws relating to Workers Compensation.
Other Uses and Disclosures
·
Other uses and disclosures besides those identified in this
Notice will be made only as otherwise authorized by law or with your written
authorization which you may revoke except to the extent information or
action has already been taken.
Website
·
This Privacy Notice will be posted on the website. For more
information about our Notice, Clinic, or website, please call (731)
661-9825. |
