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.
We care about our patients’ privacy and strive to protect the confidentiality of your medical information at this practice. New federal legislation requires that we issue this official notice of our privacy practices. You have the right to the confidentiality of your medical information, and this practice is required by law to maintain the privacy of that information. Relief Allergy & Sinus Institute is required to abide by the terms of the Notice of Privacy Practices (NPP) currently in effect, and to provide notice of its legal duties and privacy practices with respect to protected health information (PHI). If you have any questions about this Notice, please contact the Privacy Official of our practice.
Who Will Follow This Notice
Any health professional authorized to enter information into your medical record, all employees, staff and other personnel at practice who may need access to your information must abide by this Notice. All subsidiaries, business associates (e.g. a billing service), sites and locations of this practice may share medical information with each other for treatment, payment purposes or health care operations as described in this Notice. Except where treatment is involved, only the minimum necessary information needed to accomplish the task will be shared.
How We May Use and Disclose Medical Information About You
The following categories describe different ways that we may use and disclose medical information without your specific consent or authorization. Examples are provided for each category of uses or disclosures. Not all possible uses or disclosures are listed.
For Treatment. We may use medical information (PHI) about you to provide you with medical treatment or services. Example: we may use and disclose PHI when you need a prescription, lab work, an x-ray, or other health care services.
For Payment. We may use and disclose medical information (PHI) about you so that treatment and services you receive from us may be billed and payment may be collected from you, an insurance company or a third party. Example: We may need to send your PHI, such as your name, address, office visit date, copy of your chart
and codes identifying your diagnosis and treatment to your insurance company for payment.
For Health Care Operations. We may use and disclose medical information (PHI) about you for health care operations to assure that you receive quality care. Example: We may use PHI to review our treatment and services and evaluate the performance of our staff in caring for you.
Other Uses or Disclosures That Can Be Made Without Your Consent or Authorization
- As required during an investigation by law enforcement agencies
- To avert a serious threat to public health or safety
- As required by military command authorities for their medical records
- To workers’ compensation or similar programs for processing of claims
- In response to a legal proceeding
- To a coroner or medical examiner or identification of a body
- If an inmate, to the correctional institution or law enforcement official
- As required by the US Food and Drug Administration (FDA)
- Other healthcare providers’ treatment activities
- Other covered entities’ healthcare operations activities (to the extent permitted under HIPAA)
- Uses and disclosures required by law
- Uses and disclosures in domestic violence or neglect situations
- Health oversight activities
- Other public health activities
We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.
Uses and Disclosures of Protected Health Information Requiring Your Written Authorization
Other uses and disclosures of medical information not covered by this Notice or the laws that apply to us will be made only with your written authorization. If you give us authorization to use or disclose medical information about you, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will thereafter no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your authorization, and that we are required to retain our records of the care we have provided you.
Your Individual Rights Regarding Your Medical Information
Complaints. If you believe your privacy rights have been violated, you may file a complaint with the Privacy Officer at this practice ro with the Secretary of the Department of Health and Human Services. All complaints must be submitted in writing. You will not be penalized or discriminated against for filing a complaint.
Right to Request Restrictions. You have the right to request additional restrictions on the PHI that we may use or disclose for treatment, payment, and health care operations or to someone who is involved in your care or the payment for your care. We are not required to agree to your request. If we do agree, we are required to comply with our agreement except in certain cases, including where the information is needed to treat you in the case of an emergency. To request restrictions, you must submit your request in writing to the Privacy Official at this practice. In your request, you must tell us what information you want to restrict, how you want to restrict the information ( for example, restricting use to this office, only restricting disclosure to persons outside this office, or both), and to whom you want the restrictions to apply.
Right to Request Confidential Communications. You have the right to request how we should send communications to you about medical matters, and where you would like those communications sent. To request confidential communications, you must make your request in writing to the Privacy Official at this practice. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted. We reserve the right to deny a request if it imposes an unreasonable burden on the practice.
Right to Inspect and Copy. You have the right to request the opportunity to inspect and receive a copy of PHI about you that may be used to make decisions about your care. Usually this includes medical and billing records but does not include psychotherapy notes, information compiled for use in a civil, criminal, or administrative action or proceeding, and PHI to which access is prohibited by law. To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to the Privacy Official at this practice. If you request a copy of the information, we reserve the right to charge a fee for the costs of copying, mailing or other supplies associated with your request. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by this practice will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
Right to Amend. You have the right to request that we amend PHI about you as long as such information is kept by or for our office. To make this type of request, you must submit your request in writing to our Privacy Official. You must also give us a reason for your request. We may deny your request in certain cases, including if it is not in writing or if you do not give us a reason for the request. If we deny your request for amendment, you have the right to file a statement of disagreement with us. We may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Statements of disagreement and any corresponding rebuttals will be kept of file and sent out with any future authorized requests for information pertaining to the appropriate portion of your record.
Right to an Accounting on Non-Standard Disclosures. You have the right to request a list of the disclosures we made of PHI about you. To request this list, you must submit your request to the Privacy Official at our office. Your request must state the time period for which you want to receive a list of disclosures that is no longer than six years, and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (example: on paper or electronically). We reserve the right to charge you for the cost of providing the list.
Right to a Paper Copy of the Notice. You have the right to receive a paper copy of this Notice at any time. You are entitled to a paper copy of this Notice. To obtain a paper copy of this Notice, please contact our Privacy Official listed in this Notice.
Changes To This Notice
We reserve the right to change this Notice. We reserve the right to make the revised or changed Notice effective for medical information we already have about you as any information we receive in the future. If and when this Notice is changed, we will post a copy in our office in a prominent location. We will also provide you a copy of the revised Notice upon your request made to our Privacy Official.