As
required by the Privacy Regulations Created as a result of the
Health Insurance Portability and Accountability Act of 1996 (HIPAA),
THIS
NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU (AS A PATIENT OF
THIS PRACTICE) MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET
ACCESS TO YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION.
PLEASE
REVIEW THIS NOTICE CAREFULLY
OUR
COMMITMENT TO YOUR PRIVACY
Our
practice is dedicated to maintaining the privacy of your
individually identifiable health information as protected by law,
including the Health Information Portability and Accountability
Act (HIPAA). 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 the privacy
practices that we maintain in our practice concerning your
Protected Health Information (PHI). By federal and state law, we
must follow the terms of the notice of privacy practices that we
have in effect at the time.
We
realize that these laws are complicated. The purpose of this
notice is to provide you with information about how your protected
healthcare information will be used by our practice. This notice
will address the following areas:
üHow
we may use and disclose your PHI
üYour
privacy rights with your PHI
üOur
obligations concerning the use and disclosure of you PHI
The
terms of this notice apply to all records containing you PHI that
are created or retained by our practice. We reserve the right to
revise or amend this Notice of Privacy Practices. Any revision or
amendment to this notice will be effective for all of your records
that our practice has created or maintained in the past, and for
any of your records that we may create or maintain in the future.
Our practice will post a copy of our current Notice in our office
in a visible location at all times, and you may request a copy of
our most current Notice at any time.
IF
YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT: Privacy
Officer [Diane Hallawell, at 5500 Olympic Dr NW, Suite E-105, Gig
Harbor, WA 98335-1488/253-851-3311].
WE
MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION (PHI) IN
THE FOLLOWING WAYS.
Treatment.
Our practice may use your PHI to treat you. For example, we
may ask you to have laboratory test (such as blood or urine
tests) and/or x-rays, and we may use the results to help us
reach a diagnosis. The people who work for our practice may
use or disclose your PHI in order to treat you or assist in
your care, such as your spouse, children or parents. Finally,
we may also disclose your PHI to other health care providers
for purposes related to your treatment.
Payment.
Our practice may use and disclose your PHI 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 PHI to obtain payment from third parties that may be
responsible for such costs, such as family members. Also, we
may use your PHI to bill you directly for services and items.
We may disclose your PHI to other health care providers and
entities to assist in their billing and collection efforts.
Health
Care Operations.
Our practice may use and disclose your PHI to operate our
business. As examples of the ways in which we may use and
disclose your information for our operations, our practice may
use your PHI to evaluate the quality of care you received from
us, or to conduct cost-management and business planning
activities for our practice. We may disclose your PHI to other
health care providers and entities to assist in their health
care operations.
Appointment
Reminders/Notices.
Our practice may use and disclose your PHI to contact you and
remind you of an appointment. You have agreed that we may
leave messages for you regarding your appointment with either
a designated family member or your voice mail. You have the
right to revoke this permission at any time. We will leave
only minimal information in an effort to protect your privacy.
Harbor Healing Arts, PLLC will also be authorized to include
you in any monthly newsletter notifications that are
educational in nature.
Treatment
Options. Our
practice may use and disclose your PHI to inform you of
potential treatment options or alternatives.
Health-Related
Benefits and Services.
Our practice may use and disclose your PHI to inform you of
health-related benefits or services that may be of interest to
you.
Limited
Data Set.
Harbor Healing Arts, PLLC may use de-identified information
with some PHI to submit the de-identified information to
governing professional societies for the purpose of
documenting quality of care through a registry.
Release
of Information to Family/Friends.
Our practice may release your PHI to a friend or family member
that is involved in your care, whom you authorize, or who
assists in taking care of you. For example, an adult child may
provide assistance in your care with regards to medications or
treatment options and in that situation it would be important
that the caregiver understand the instructions and/or
indications related to your care. You have the right to revoke
previous requests to allow other individuals or family members
to receive PHI on your behalf. Harbor Healing Arts, PLLC does
require that you complete authorization for such individuals
to receive your PHI on your behalf for the purpose of
improving your healthcare.
Disclosures
Required By Law.
Our practice will use and disclose your PHI when we are
required to do so be federal, state or local law.
SPECIAL
SITUATIONS
The
following categories describe unique scenarios in which we may use
or disclose your PHI:
Public
Health Risks.
Our practice may disclose your PHI to public authorities that
are authorized by law to collect information for the purpose
of: a. maintaining
vital records, such as births and deaths
b. reporting child abuse or neglect c. preventing
or controlling disease, injury or disability d. notifying
a person regarding potential exposure to a communicable
disease e. notifying
a person regarding a potential risk for spreading or
contracting a disease or condition f. reporting
reactions to drugs or problems with products or devices
g. notifying individuals if a product or device they may be
using has been recalled h. 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 i. notifying
your employer under limited circumstances related primarily to
workplace injury or illness or medical surveillance.
Health
Oversight Activities.
Our practice may disclose your PHI to a health oversight
agency for activities authorized by law. Oversight activities
can include investigations, inspections, audits, surveys,
licensure and disciplinary actions; civil, administrative, and
criminal procedure 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.
Lawsuits
and Similar Proceedings.
Our practice may use and disclose your PHI in response to a
court or administrative order, if you are involved in a
lawsuit or similar proceeding. We also may disclose your PHI
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.
Law
Enforcement. We
may release PHI if asked to do so by law enforcement official: a. regarding
a crime victim in certain situations, if we are unable to
obtain the person’s agreement b. concerning
a death we believe has resulted from criminal conduct c. regarding
criminal conduct at our offices d. in
response to a warrant, summons court order, subpoena or
similar legal process e. to
identify/locate a suspect, material witness, fugitive or
missing person f. 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)
Deceased
Patients. Our
practice may release PHI to a medical examiner or coroner to
identify a deceased individual or to identify the cause of
death. If necessary, we also may release information in order
for funeral directors to perform their jobs.
Research.
Our practice may use and disclose your PHI for research
purposes in certain limited circumstances. We will obtain your
written authorization to use your PHI for research purposes except
when Internal or Review Board or Privacy Board has
determined that the waiver of your authorization satisfies the
following: (i) the use or disclosure involves no more than a
minimal risk to your privacy based on the following: (A) an
adequate plan to protect the identifiers from improper use and
disclosure; (B) an adequate plan to destroy the identifiers at
the earliest opportunity consistent with the research (unless
there is a health or research justification for retaining the
identifiers or such retention is otherwise required by law);
and (C) adequate written assurances that the PHI will not be
re-used or disclosed to any other person or entity (except as
required by law) for authorized oversight of the research
study, or for other research for which the use or disclosure
would otherwise be permitted; (ii) the research could not
practicably be conducted without the waiver; and (iii) the
research could not practicably be conducted without access to
and use of the PHI.
Serious
Threats to Health or Safety.
Our practice may use and disclose your PHI 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.
Military.
Our practice may disclose your PHI if you are a member of U.S.
or foreign military forces (including veterans) and if
required by the appropriate authorities.
National
Security. Our
practice may disclose your PHI to federal officials for
intelligence and national security activities authorized by
law. We also may disclose your PHI to federal officials in
order to protect the President, other officials or foreign
heads of state, or to conduct investigations.
Inmates.
Our practice may disclose your PHI to correctional
institutions or law enforcement officials if you are an inmate
or under the custody of law enforcement officials. Disclosure
for these purposes would be necessary: (i) for the institution
to provide health care services to you, (ii) for the safety
and security of the institution, and/or (iii) to protect your
health and safety or the health and safety of other
individuals.
Workers’
Compensation.
Our practice may release your PHI for Workers’ Compensation
and similar programs.
YOUR
RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION
You
have the following rights regarding the PHI that we maintain about
you:
Confidential
Communications.
You have the right to request that our practice 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 at work. In order to
request a type of confidential communication, you must make a
written request to the Privacy Officer specifying the
requested method of contact, or the location where you wish to
be contacted. Our practice will accommodate reasonable
requests. You do not need to give a reason for your request.
Requesting
Restrictions.
You have the right to request a restriction in our use or
disclosure of your PHI for treatment, payment or health care
operations. Additionally, you have the right to request that
we restrict our disclosure of your PHI to only certain
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 you. In order to request a restriction in
our use or disclosure of your PHI, you must make your request
in writing to the Privacy Officer. 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
Inspection
and Copies. You
have the right to inspect and obtain a copy of the PHI that
may be used to make decisions about you, including patient
medical records and billing records. You must submit your
request in writing to the Privacy Officer in order to inspect
and/or obtain a copy of your PHI. Our practice 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. Another licensed health care professional chosen by us
will conduct reviews.
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
practice. To request an amendment, your request must be made
in writing and submitted to the Privacy Officer. You must
provide us with a reason that supports your request for
amendment. Our practice 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 in our opinion: (i) accurate and
complete; (ii) not part of the PHI kept by or for the
practice; (iii) not part of the PHI which you would be
permitted to inspect and copy; or (iv) not created by our
practice, unless the individual or entity that created the
information is not available to amend the information.
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 non-routine disclosures our practice has made
of your PHI for non-treatment, non-payment or non-operations
purposes. Use of your PHI as part of the routine patient care
in our practice is not required to be documented. For example,
the doctor sharing information with the billing department
using your information to file your insurance claim. Also, we
are not required to document disclosures made pursuant to an
authorization signed by you. In order to obtain an accounting
of disclosures, you must submit your request in writing to the
Privacy Officer. All requests for an “accounting of
disclosures” must state a time period, which may not be
longer than six (6) years from the date of disclosure 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 practice will notify you of the costs
involved with additional requests, and you may withdraw your
request before you incur any costs.
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 the Privacy Officer. You may also obtain a copy of
this notice at our website; www.HarborHealingArts.com
Right
to File a Complaint.
If you believe your privacy rights have been violated, you may
file a complaint with our practice or with the Oregon Board of
Chiropractic Examiners. To file a complaint with our practice,
contact the Privacy Officer. We urge you to file your
complaint with us first and give us the opportunity to address
your concerns. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
Right
to Provide an Authorization for Other Uses and Disclosures.
Our practice 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 PHI may be revoked
at any time in writing. After you revoke your
authorization, we will no longer use or disclose your PHI for
the reasons described in the authorization. Please note, we
are required to retain records of your care.
Again,
if you have any questions regarding this notice or our health
information privacy policies, please contact the Privacy Officer.
CHANGE
TO THE HARBOR HEALING ARTS, PLLC PRIVACY NOTICE
Harbor
Healing Arts, PLLC reserves the right to revise this document and
its policies regarding your Protected Healthcare Information. We
will post a copy of the current notice at our office and on our
website. The effective date appears in the lower right hand
corner. Each time you are seen at the Harbor Healing Arts, PLLC
clinic you will be provided a copy of the policy upon your
request.
