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789-1149
Billing
Fax: (316)
789-1102
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| NOTICE OF PRIVACY PRACTICES |
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Family
MedCenters, PA
Effective Date: April 14, 2003
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
AND HOW YOU CAN GET ACCESS TO THIS INORMATION.
PLEASE REVIEW IT CAREFULLY.
OUR PLEDGE REGARDING YOUR HEALTH INFORMATION.
Each time you visit a hospital, physician, or other healthcare provider, a record
of your visit is made. Typically, this record contains your symptoms, examination
and test results, diagnoses, treatment, a plan for your future care or treatment,
and billing-related information. Such records are necessary for the healthcare
provider to provide you with quality care and to comply with certain legal requirements.
We are committed to protecting the confidentiality of our records containing
information about you. This notice applies to protected health information about
you. Other healthcare providers from whom you obtain care and treatment may have
different policies or notices regarding the use and disclosure of your health
information created or received by the provider. Also, health plans in which
you participate may have different policies or notices concerning information
they receive about you.
This notice will tell you about they ways in which we may use and disclose health
information about you. We also describe your rights and certain obligations we
have regarding the use and disclosure of health information.
We are required by law to maintain the privacy of your health information; give
you this notice of our legal duties and privacy practices and make a good faith
effort to obtain your acknowledgment of receipt of this notice; and follow the
terms of the notice that is currently in effect.
HOW WE MAY USE
AND DISCLOSE HEALTH INFORMATION ABOUT
YOU WITHOUT YOUR SPECIFIC AUTHORIZATION.
The following categories describe different way that we are permitted to use
and disclose health information without a specific authorization from you.
For Treatment: We may use information about you to provide you with medical treatment
or services. We may disclose health information about you to doctors, nurses,
technicians, medical students, or other personnel who are involved in taking
care of you at the Family MedCenters, PA. 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. In addition, the doctor may need to tell the dietitian
if you have diabetes so that we can arrange for appropriate meals. Different
departments of the Family MedCenters, PA may also share information about you
in order to coordinate the different things you need, such as prescriptions,
lab work, and x-rays. We may also disclose health information about you to other
health care providers who request such information for purposes of providing
medical treatment to you.
For Payment: We
may use and disclose health information
about you so that the treatment and
services you receive at our offices
may be billed to and payment may
be collected from you, an insurance
company, or other third party. For
example, we may need to give your
health plan information about surgery
you received so your health plan
will pay us or reimburse you for
the surgery. 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.
We also may provide information about
you to other health care providers,
health plans, or health care clearinghouses
to assist them in obtaining payment
for treatment and service they provided
to you.
For Health
Care Operations: We may use
and disclose health information about
you for our internal operations.
These uses and disclosures are necessary
to run our office and to make sure
that all of our patients receive
quality care. For example, we may
use health information to review
our treatment and services and to
evaluate the performance of our staff
in caring for you. We may also combine
health information about many patients
to decide what additional services
we should offer, what services are
not needed, and whether certain new
treatments are effective. We may
also disclose information to doctors,
nurses, technicians, medical students,
and other personnel for review and
learning purposes. In addition, we
may disclose health information about
you to another health care provider,
health plan, or health care clearinghouse
with which you also have had a relationship
for certain internal operations of
that entity.
Appointment
Reminders: We may use and
disclose health information to contact
you as a reminder that you have an
appointment for treatment or medical
care at Family MedCenters, PA. Unless
you direct us to do otherwise, we
may leave messages on your telephone
answering machine identifying our
office and asking for you to return
our call and may send you appointment
reminders through the mail using
a postcard.
Treatment
Alternatives/Other Benefits and Services:
In addition, we may use your information to provide you with information about
treatment alternatives or other health-related benefits and services that may
be of interest to you.
Fundraising
Activities: We may use health
information about you to contact
you in an effort to raise money for
Family MedCenters, PA and its operations.
We may disclose health information
to a foundation related to Family
MedCenters, PA so that the foundation
may contact you in raising money
for Family MedCenters, PA. We only
would release contact information,
such as your name, address, phone
number and dates you received treatment
or services at our offices. If you
do not want us to use or disclose
your health information for fundraising
efforts, you must notify us in writing
at the address set forth at the end
of this notice.
Business
Associates: There are some
services provided in our organization
through contracts or arrangements
with business associates. For example,
we may contract with a copy service
to make copies of your health record.
When these services are contracted,
we may disclose your health information
to our business associate so they
can perform the job we’ve asked
them to do. To protect your health
information, however, we require
our business associates to appropriately
safeguard your information.
Individuals
Involved In Your Care of Payment
For Your Care: We have policies
and procedures that provide for the
release of information about your
care or payment for such care to
a member of your family, a relative,
a close friend, or any other person
when your are not present or able
to give authorization for the release
of information. If you are present
for such a disclosure (whether in
person or on a telephone call), we
will either seek your verbal agreement
to the disclosure or provide you
an opportunity to object to it.
Research: We
may use and disclose health information
for research purposes, provided we
have taken established measures to
protect your privacy. For instance,
we must obtain your authorization
to use or disclose health information
for research purposes unless such
authorization requirement is altered
or waived by an Institutional Review
Board or other authorized privacy
board or unless we enter into a data
use agreement with the recipient
of the information and only use or
disclose information in a “limited
data set” in accordance with
such agreement.
As Required
By Law: We may use or disclose
your health information to the extent
we are required to do so by federal,
state, or local law. For example,
we may disclose health information
about you for the following purposes:
 For
judicial and administrative proceedings
pursuant to legal authority;
To
report information related to victims
of abuse, neglect or domestic violence;
and
To
assist law enforcement officials
in their law enforcement duties.
To Avert a Serious Threat to Health or Safety: We may use and disclose health
information about you if we believe in good faith that such use or disclosure
is necessary to prevent or lessen a serious and imminent threat to your health
and safety or that of the public or another person. Any disclosure, however,
would only be to someone reasonably able to help prevent or lessen the threat.Organ
and Tissue Donation: If you are an organ donor, we may use or disclose health
information to organizations that handle organ procurement or organ, eye or tissue
transplantation or to an organ donation bank, as necessary to facilitate organ
or tissue donation and transplantation.
Military and Veterans: If you are a member of the armed forces, we may release
health information about you as required by military command authorities. We
may also release health information about foreign military personnel to the appropriate
foreign military authority.
Employers: We
may release health information about
you to your employer if we provide
health care services to you at the
request of your employer, and the
health care services are provided
either to conduct an evaluation relating
to medical surveillance of the workplace
or to evaluate whether you have a
work-related illness or injury. In
such circumstances, we will give
you written notice of such release
of information to your employer.
Any other disclosures to your employer
will be made only if you execute
a specific authorization for the
release of the information to your
employer.
Worker’s
Compensation: We may release
health information about you for
workers’ compensation or similar
programs. These programs provide
benefits for work-related injuries
or illness.
Public
Health Risk: We may disclose
health information about you for
public health activities such as
assisting public health authorities
or other legal authorities to prevent
or control disease, injury, or disability
or for other health oversight activities
authorized by law, such as reporting
reactions to medications or problems
with product and notifying people
of recalls of product they may be
using.
Health Oversight Activities: We may disclose health information to health
oversight agency for that agency to carry out activities authorized by law. These
oversight activities include, for example, audits, investigations, inspections,
and licensure, which are necessary for the government to monitor the health care
system, government programs involving health care, and compliance with certain
civil rights laws.
Lawsuits
and Disputes: We may disclose
health information about you in response
to a court or administrative order.
We may also disclose health information
about you in response to a subpoena,
discovery request, or other lawful
process by someone else involved
in the dispute, but only if efforts
have been made to tell you about
the request or to obtain an order
protecting the information requested.
Law Enforcement: We
may release certain health information
if asked to do so by a law enforcement
official to assist such official
in carrying out his or her duties,
including such things as identifying
or location a suspect, fugitive,
material witness, or missing person
or reporting a crime, the location
of the crime or victims, or the identity,
description or location of the person
who committed the crime.
Coroners,
Medical Examiners and Funeral Directors: We
may release health information to
a coroner or medical examiner. This
may be necessary, for example, to
identify a deceased person or determine
the cause of death. We may also release
health information about patients
of Family MedCenters, PA to funeral
directors as necessary for them to
carry out their duties.
Government Functions: We may release health information about you to authorized
federal officials for government functions such as special investigations, intelligence,
counterintelligence, and other national security activities authorized by law,
including disclosures necessary for the protection of the President and other
authorized individuals.
Inmates/Persons
In Custody: 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 as necessary
to allow them to carry out certain
specified activities, including,
but not limited to providing you
with health care, protecting the
health and safety of you and others,
and protecting the security of the
correctional institution. |
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