HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)
Dear Patient,
As of April 14, 2003 a new law was implemented called the Health Insurance Portability and Accountability Act (HIPAA). This was established to ensure the privacy of your health records. Our practice has always strived to ensure your privacy and thus things will continue as normal in our office. However, law mandates us to provide you with a copy of our notice of Privacy Practices that explains how we will use and disclose your health information and obtain your consent for providing the mutual sharing of needed information with entities as referring physicians, other specialists, hospital and insurance companies for billing as necessary. The consent will also allow us to send recall/reminder notices as needed. Please sign the consent form at the time of your visit.
Please do not hesitate to discuss any of your concerns or objections to this request. Please rest assured we respect the privacy of your health information. It is important to us.
HEALTH INFORMATION DISCLOSURE
Family and Friends
We may not disclose your health information to family or friends without your authorization.
Persons Involved in Care
We may not use or disclose health information to notify a family member or another person responsible for your care, of your location, your general condition or death. If you are present, then prior to use or disclosure we will provide you with an opportunity to object to such uses or disclosure. In the event of your incapacity or emergency circumstances, we will disclose health information based on a determination using our professional judgement disclosing only health information that is directly relevant to the person’s involvement in your healthcare.
Required by Law
We may use or disclose your health information when we are required to do so by law.
Abuse or Neglect
We may disclose your health information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect or domestic violence, or the possible victim of other crime. We may disclose your health information to the extent necessary to avert a serious threat to your health and safety.
Appointment Reminders
We may use or disclose your health information to provide you with appointment reminders by the use of voicemail, text messages, My Hill Chart, postcards or letters.
Patient Rights
You have the following rights with respect to your protected health information:
- Access: You have the right to inspect and receive a copy of your health information. You have the right to reasonable requests to receive confidential communications of protected health information from us by alternative means or at alternative locations.
- Amend: You have the right to request that we amend your protected health information. Your requests must be in writing and it must explain why the information should be amended. We may deny your request under certain circumstances.
- Accounting: You have the right to receive an accounting of disclosures of your protected health information.
- Restrictions: You have the right to request restrictions that we place additional restrictions on our use or disclosure of your protected health information. We are, however, not required to agree to requested restriction. If we do not agree to the restriction, we must abide by it unless you agree in writing to remove it.
We are required by law to maintain the privacy of your protected health information and to provide you with notice of our legal duties and privacy practices with respect to health information.
NOTICE OF PRIVACY PRACTICES
The privacy of your health information is important to us.
This notice describes how health information about you may be used and disclosed, and how you can get access to this information. Please review it carefully.
The health information Portability & Accountability Act of 1996 (HIPAA) is a federal program that requires all medical records and other individually identifiable health information used or disclosed by us in any form, whether electronically, paper or orally, are kept confidential. This act gives you, the patient, significant new rights to understand and control how your health information is used. HIPAA provides penalties for covered entities that misuse personal health information.
Our Legal Duty
We are required by applicable federal and state law to maintain the privacy of health information. We are also required to post and give you this notice about our privacy practices and your rights concerning your health information.
Uses and Disclosures of Health Information
We may use and disclose your medical records only for each of the following purposes:
- Treatment means providing, coordinating or managing health care and related service by one or more health care provider. Example: Consultation and/or testing
- Payment means billing to obtain reimbursement for services, confirming coverage and utilization review. Example: Bill your insurance for consultation services
- Healthcare operations means quality assessment and improvement activities, reviewing competence of healthcare professionals, evaluating provider’s performance and conducting training programs, accreditation or credentialing activities. Example: Technologist internal performance evaluation.
Your Authorization
In addition to our use of your health care information for treatment, payment or healthcare operations, you may give us written authorization to use your health information or to disclose it to anyone for any purpose. You may revoke authorization, in writing, at any time. Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect. Unless you give us written authorization, we cannot use or disclose your health information for any reason except those described in this notice.
Notice
This notice is effective as of April 14, 2003, and we are required to abide by the terms of the Notice of Privacy Practices currently in effect. We reserve the right to change the terms of our Notice or Privacy Practices and to make the new notice provisions effective for all protected health information that we maintain. We will post and you may obtain a copy of revised Notice of Privacy Practices from this office.
Recourse
You have recourse if you feel that your privacy protections have been violated. You have the right to file written complaint with our office, or with the U.S. Department of Health and Human Services (Office of Civil Rights) about violations of the provisions of this notice or the policies and procedures of our office. We will not retaliate against you for filing a complaint.
Our compliance officer can be reached at:
(209) 944-5750 Ext 221, (209) 464-2684 Fax
415 E. Harding Way, Suite D
Stockton, California 95204
For more information about HIPAA or to file a complaint, visit the U.S. Department of Health and Human Services, U.S. Office of Civil Rights HIPAA website.
Or contact:
Office of Civil Rights
200 Independence Avenue SW
Washington, DC 20201
(202) 619-0257 or Toll Free (877) 696-6775