Notice Of
Privacy Practices
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 MEDICAL INFORMATION ABOUT YOU (AS A PATIENT OF THIS PRACTICE ) MAY
BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS
INFORMATION.
PLEASE REVIEW THIS NOTICE CAREFULLY.
A.
OUR COMMITMENT TO YOUR PRIVACY
Our
practice is dedicated to maintaining the privacy of your individually
identifiable health information (IIHI). 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 IIHI.
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, but we must provide you with the following
important information:
·
How we may use and disclose your IIHI
·
Your privacy rights in your IIHI
·
Our obligations concerning the use and disclosure of your IIHI
The terms of
this notice apply to all records containing your IIHI 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.
B.
IF YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT: Veronika
Tenenbaum, Office Manager at 718-616-0801.
C. WE MAY USE AND DISCLOSE
YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION (IIHI) IN THE
FOLLOWING WAYS
The following categories describe the different ways in which we may use
and disclose your IIHI.
1.
Treatment. Our
practice may use your IIHI to treat you. For
example, we may ask you to have laboratory tests (such as blood or urine tests),
and we may use the results to help us reach a diagnosis.
We might use your IIHI in order to write a prescription for you, or we
might disclose your IIHI to a pharmacy when we order a prescription for you.
Many of the people who work for our practice – including, but not
limited to, our doctors and nurses – may use or disclose your IIHI in order to
treat you or to assist others in your treatment.
Additionally, we may disclose your IIHI to others who may assist in your
care, such as your spouse, children or parents.
2.
Payment. Our
practice may use and disclose your IIHI 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 IIHI to obtain payment from third parties that
may be responsible for such costs, such as family members.
Also, we may use your IIHI to bill you directly for services and items.
3. Health Care Operations.
Our practice may use and disclose your IIHI 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 IIHI to evaluate the quality of
care you received from us, or to conduct cost-management and business planning
activities for our practice.
4.
Appointment Reminders.
Our practice may use and disclose your IIHI to contact you and remind you
of an appointment.
5. Treatment Options.
Our practice may use and disclose your IIHI to inform you of potential
treatment options or alternatives.
6.
Health-Related Benefits and Services.
Our practice may use and disclose your IIHI to inform you of
health-related benefits or services that may be of interest to you.
7. Release of Information to
Family/Friends.
Our practice may release your IIHI to a friend or family member that is
involved in your care, or who assists in taking care of you.
For example, a parent or guardian may ask that a babysitter take a child
to the pediatrician’s office for treatment of a cold.
In this example, the babysitter may have access to this child’s medical
information.
8. Disclosures Required By Law.
Our practice will use and disclose your IIHI when we are required to do
so by federal, state or local law.
D. USE AND DISCLOSURE OF
YOUR IIHI IN CERTAIN SPECIAL CIRCUMSTANCES
The following categories describe unique scenarios in which we may use or
disclose your identifiable health information:
1.
Public Health Risks.
Our practice may disclose your IIHI to public health authorities that are
authorized by law to collect information for purposes such as:
·
maintaining vital records, such as births and deaths
·
reporting child abuse or neglect
·
preventing or controlling disease, injury or disability
·
notifying a person regarding potential exposure to a communicable
disease
·
notifying a person regarding a potential risk for spreading or
contracting a disease or condition
·
reporting reactions to drugs or problems with products or devices
·
notifying individuals if a product or device they may be using has been
recalled
·
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
·
notifying your employer under limited circumstances related primarily to
workplace injury or illness or medical surveillance.
2.
Health Oversight Activities.
Our practice may disclose your IIHI to a health oversight agency for
activities authorized by law. Oversight
activities can include, for example, investigations, inspections, audits,
surveys, licensure and disciplinary actions; civil, administrative, and criminal
procedures 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.
3. Lawsuits and Similar Proceedings.
Our practice may use and disclose your IIHI in response to a court or
administrative order, if you are involved in a lawsuit or similar proceeding.
We also may disclose your IIHI 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 a court
or administrative order protecting the information the party has requested.
4.
Law Enforcement.
We may release IIHI if asked to do so by a law enforcement official:
·
Regarding a crime victim in certain situations, if we are unable to
obtain the person’s agreement
·
Concerning a death we believe has resulted from criminal conduct
·
Regarding criminal conduct at our offices
·
In response to a warrant, summons, court order, subpoena or similar
legal process
·
To identify/locate a suspect, material witness, fugitive or missing
person
·
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)
5.
Deceased Patients.
Our practice may release IIHI 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.
6.
Organ and Tissue Donation.
Our practice may release your IIHI to organizations that handle organ,
eye or tissue procurement or transplantation, including organ donation banks, as
necessary to facilitate organ or tissue donation and transplantation if you are
an organ donor.
7.
Research. Our
practice may use and disclose your IIHI for research purposes in certain limited
circumstances. We will obtain your
written authorization to use your IIHI for research purposes except when:
(a) our use or disclosure was approved by an Institutional Review Board or a
Privacy Board; (b) we obtain the oral or written agreement of a researcher that
(i) the information being sought is necessary for the research study; (ii) the
use or disclosure of your IIHI is being used only for the research and (iii) the
researcher will not remove any of your IIHI from our practice; or (c) the IIHI
sought by the researcher only relates to decedents and the researcher agrees
either orally or in writing that the use or disclosure is necessary for the
research and, if we request it, to provide us with proof of death prior to
access to the IIHI of the decedents.
8.
Serious Threats to Health or Safety.
Our practice may use and disclose your IIHI 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.
9.
Military.
Our practice may disclose your IIHI if you are a member of
U.S.
or foreign military
forces (including veterans) and if required by the appropriate authorities.
10.
National Security.
Our practice may disclose your IIHI to federal officials for intelligence
and national security activities authorized by law.
We also may disclose your IIHI to federal officials in order to protect
the President, other officials or foreign heads of state, or to conduct
investigations.
11.
Inmates. Our
practice may disclose your IIHI to correctional institutions or law enforcement
officials if you are an inmate or under the custody of a law enforcement
official. Disclosure for these
purposes would be necessary: (a) for the institution to provide health care
services to you, (b) for the safety and security of the institution, and/or (c)
to protect your health and safety or the health and safety of other individuals.
12.
Workers’ Compensation.
Our practice may release your IIHI for workers’ compensation and
similar programs.
E. YOUR RIGHTS REGARDING YOUR
IIHI
You
have the following rights regarding the IIHI that we maintain about you:
1.
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 work.
In order to request a type of confidential communication, you must make a
written request to Hemoncare, P.C.,
2558 East 18th Street
,
Brooklyn
,
NY
11235
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.
2.
Requesting Restrictions.
You have the right to request a restriction in our use or disclosure of
your IIHI for treatment, payment or health care operations.
Additionally, you have the right to request that we restrict our
disclosure of your IIHI 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 IIHI,
you must make your request in writing to Hemoncare,
P.C.,
2558 East 18th Street
,
Brooklyn
,
NY
11235
.
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.
3.
Inspection and Copies.
You have the right to inspect and obtain a copy of the IIHI that may be
used to make decisions about you, including patient medical records and billing
records, but not including psychotherapy notes.
You must submit your request in writing to Hemoncare,
P.C.,
2558 East 18th Street
,
Brooklyn
,
NY
11235
in order to inspect
and/or obtain a copy of your IIHI. 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.
4.
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 Hemoncare,
P.C.,
2558 East 18th Street
,
Brooklyn
,
NY
11235
.
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:
(a) accurate and complete; (b) not part of the IIHI kept by or for the practice;
(c) not part of the IIHI which you would be permitted to inspect and copy; or
(d) not created by our practice, unless the individual or entity that created
the information is not available to amend the information.
5.
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 IIHI for non-treatment or operations purposes.
Use of your IIHI as part of the routine patient care in our practice is
not required to be documented. For
example, the doctor sharing information with the nurse; or the billing
department using your information to file your insurance claim.
In order to obtain an accounting of disclosures, you must submit your
request in writing to Hemoncare, P.C.,
2558 East 18th Street
,
Brooklyn
,
NY
11235
.
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.
6.
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 Hemoncare,
P.C.,
2558 East 18th Street
,
Brooklyn
,
NY
11235
.
7.
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 Secretary of the Department of Health
and Human Services. To file a
complaint with our practice, contact Hemoncare, P.C.,
2558 East 18th Street
,
Brooklyn
,
NY
11235
.
All complaints must be submitted in writing. You
will not be penalized for filing a complaint.
8.
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 IIHI may be revoked at any time in writing. After you revoke your
authorization, we will no longer use or disclose your IIHI for the purposes
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 Veronika
Tenenbaum, Office Manager, Hemoncare, P.C.,
2558 East 18th Street
,
Brooklyn
,
NY
11235