Hippa Notice of Privacy Protection
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.
A. The General Authorization for Release of Medical Records that you sign authorizes the health care practitioners who provide services to you at NIHA, or NIHA acting on their behalf (collectively referred to as “Provider”) to disclose the information in your medical records (“Protected Health Information” or “PHI”) to the extent needed for purpose of:
1. Providing treatment to you. This includes sharing information among NIHA staff involved or who may become involved in your care, or with other health care providers in the community who are treating you or consulting in your care.
2. Arranging payment for your care. This includes your insurer, employer’s health insurance program, or other third-party payer responsible for paying all or part of the cost of your care.
3. Supporting Provider’s “health care operations.” This includes internal quality assessment, contacting other health care providers regarding treatment alternatives, evaluating provider performance, training health care practitioners, business planning and management, customer service, resolutions of internal grievances, the legal and medical review of care provided and provision of legal and auditing services.
4. Assisting other health care provider’s “health care operations,” to the extent that they have a treatment relationship with you.
5. In some cases, we may conduct research without revealing your identity.
B. A Specific Authorization for Release of Medical Records that you may sign authorizes NIHA and NIHA practitioners you see to make a specific disclosure of PHI not covered under section A, above. A Specific Authorization will name the party to whom you are authorizing disclosure, and will contain any limitations you set forth regarding the disclosure of your records.
C. You may revoke any authorization given Provider by giving Provider a written notice of revocation. Provider may refuse to treat you if you revoke General Authorization, and such revocation does not apply retroactively or to disclosure that has been made in good faith prior to receipt of the revocation.
D. Provider may be required by law, in some cases, to make disclosures of your record that you have not authorized. Examples are public health reporting requirements, responding to worker’s compensation information, law enforcement or certain governmental requests involved in health care regulation including licensure agencies or the U.S. Department of Health and Human Services or national security, subpoenas in criminal or civil litigation.
E. Provider may contact you to provide appointment reminders or information about treatment alternatives or health-related benefits and services that may be of interest to you.
F. Your rights and choices with respect to your medical records/information:
1. You have the right to request restrictions on the use and disclosure of your medical records/information, however we are not required to agree to restrictions not guaranteed by law if we believe it would affect your care. You will be informed if Provider will not agree to a requested restriction.
2. If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will honor the request unless a law requires us to share that information.
3. You will have the right to receive confidential communications of your health information and to direct the place and manner of communication, such as by home or office phone or email.
4. You have the right to inspect your paper or electronic records and have a copy of your medical records. This will be done within 30 days of the request unless there is medical need for expedited copies. Provider is entitled to charge you a reasonable fee related to the cost of copying your records.
5. Requests to inspect or obtain copies of mental health records may be redacted if, in the Provider’s opinion, the information would be damaging to you. If you disagree, you may request review by an independent mental health professional to determine if release of the information is appropriate.
6. You have the right to seek to correct or amend your medical records, and if Provider does not agree with your request, we will notify you within 60 days of the reason for the denial and will note your objection in the medical record.
7. You have a right to receive an accounting (list) of disclosures of your medical records/information made by Provider, for six years prior to the request, including with whom, the date and the purpose for sharing. The accounting does not include disclosures made to you or with your specific authorization, that fall within the scope of Provider’s “health care operations, or disclosures made for the purposes of collecting payment. We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
8. If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will take reasonable steps to be sure the person has this authority and can act for you before we take any action.
9. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions:
o Share information with your family, close friends, or others involved in your care o Share information in a disaster relief situation If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
10. We will never share your information for marketing purposes or sell your information unless we have written permission. We will not share psychotherapy notes unless a legal exception applies. In the case of fund-raising we may contact you for fundraising efforts, but you can tell us not to contact you again.
11. You have the right to receive a paper copy of this notice.
G. Provider is required by law to maintain the privacy of protected health information, and to provide patients with this notice of its duties and practices, as well as changes to those practices. Patients will be provided with revised notices, as appropriate. In the event of a breach of security we will promptly advise you.
H. If a patient believes that his or her privacy rights have been violated, the patient may complain to Provider, or to the Secretary of the U.S. Department of Health and Human Services. Provider will not retaliate in any way against a patient for making a complaint. You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, by calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
I. If you as a patient or guardian believe that your privacy rights have been violated, and wish to notify our practice, please call our office and ask to speak with our designated Privacy Complaints Contact Person: Jason Makris, 202-237-7000 Ext. 102
J. Provider reserves the right to change its privacy practices and to make its new policies effective for all protected health information that provider maintains. If such changes are made, Provider will issue an updated “Notice to Patients” to all of Provider’s patients.