This notice describes how protected health
information (PHI) about you may be used and disclosed, and how you can
get access to this information. Please review it carefully.
I. Use
and Disclosure of your PHI information
II. How Our Practice May Use & Disclose your Protected Health
Information (PHI)
III. When Specific Patient Written Authorization will be
required to disclose PHI
IV.
Changes to This Notice of Privacy Practices
V. Your Privacy Rights Regarding Your Health Information
VI.
Complaint Procedure & Contact Person
VII. Effective Date: This notice is effective April 14, 2003
To Our Patients and Colleagues,
It is the policy of the Practice to maintain the confidentiality of “Protected Health Information” (PHI). We are committed to protecting the privacy of your PHI and value the privacy of your PHI as an important part of our patient care. All staff associated with the practice are informed as to the rights of patients with this regard. We collect information from you and use it to provide you with quality care, as well as to comply with certain legal requirements. To comply with Federal HIPAA guidelines, we have enacted a Practice Privacy Notice. Under the Federal HIPAA guidelines our practice may use and disclose PHI without your prior authorization for only three purposes: 1) treatment, 2) payment, and 3) healthcare operations. All other use and disclosures require your specific, written authorization. These releases may be updated or restricted (as permissible by law) at any time, upon written request by patients or as deemed appropriate by the Practice. Additional privacy notifications will be issued in writing to patients, upon substantive changes to these practices. Due to the need for and legislation regarding patient privacy, these policies will be strictly adhered to by the Practice.
I. USE AND
DISCLOSURE OF YOUR PHI INFORMATION
Foxhall Surgical Associates, P.C. collects health
information from you and stores it in a medical record and on computer.
The medical record is the property of Foxhall Surgical Associates, P.C.
The information in the medical record belongs to you. The HIPAA laws
permit our practice to disclose PHI to other treating physicians,
insurance companies and business associates to carry out treatment,
payment or healthcare operations.
Treatment: We may use and disclose your
PHI to provide treatment, coordinate and manage your health care, and/or
for medical referrals or consultations. This includes the coordination
or management of your health care with a third party that has already
obtained your permission to have access to your PHI. For example, we may
use and disclose PHI to physicians, nurses, technicians, and other
medical personnel who are involved in your care and treatment. We may
use and disclose PHI to people outside our facility who may be assisting
in your care, such as family members, home health agencies,
nursing homes, therapists, pharmacists, clergy and others. We may
use and disclose PHI to your health plan to coordinate authorization, a
referral, consultations and health care related activities.
Payment: We may use and disclose your PHI
to obtain payment for health care services rendered. We may use and
disclose PHI when contacting your insurance company or another third
party to verify benefits, verify eligibility, and obtain authorization.
We may use and disclose PHI to your insurance company, a third party or
the facility where services were rendered, if different than our office,
that assist us to process payments, such as billing companies, claims
processing companies and collection companies. We may use and disclose
PHI to third parties who are responsible for payment such as family
members or personal billing services.
Health Care Operations: We may use and
disclose your PHI as necessary to support the legitimate business
activities of our practice. The activities include, but are not limited
to, quality care assessments and improvement activities, employee
evaluations and training, health care professionals and medical students
evaluation and training, fraud and abuse compliance, licensing, business
planning, and conducting, and/or arranging other practice activities.
For example, we may call you by name in the waiting room when your
physician is ready to see you. We may use and disclose PHI, to contact
you to remind you of an appointment, of an appointment missed, to remind
you of recommended treatment, to know about treatment alternative or
other health related services or benefits. We may use and disclose PHI
to healthcare professionals and students that have accepted clinical
rotations in our office and who may see patients at our facilities. We
may use and disclose PHI with third party "business associates" that
perform legitimate activities for the practice such as our property
management companies, transcription companies, billing companies,
accountants and legal counsel. When we involve third parties in our
business activities, we will have a written business associates
agreement obligating them to protect your PHI to the same legal
standards we must follow. We may use and disclose PHI to health agencies
during the course of audits, investigations, inspections, licensure and
other proceedings.
II. HOW OUR PRACTICE MAY USE & DISCLOSE YOUR HEALTH INFORMATION (PHI)
Notification and communication with family. We may
use and disclose PHI to notify or assist in notifying a family member,
your personal representative or another person responsible for your
care, about your location, your general condition, or in the event of
your death. If you are able and available to agree or object, we will
give you the opportunity to object prior to making this notification. If
you are unable or unavailable to agree or object, our health
professionals will use their best judgment in communication with your
family and others.
Required by law: We will use and disclose
PHI when we are required to do so by Federal, State, and other law.
There are other laws we will follow that provide additional protections,
such as laws related to mental health, alcohol, and other substance
abuse and HIV/AIDS.
Judicial and administrative proceedings:
We may use and disclose PHI in the course of any administrative or
judicial proceeding.
Public health: We may use and disclose PHI
to public health authorities for purposes related to: preventing or
controlling disease, injury or disability; reporting child abuse or
neglect; reporting domestic violence; reporting to the Food and Drug
Administration problems with products and reactions to medications; and
reporting to the Centers for Disease Control of disease or infection
exposure.
Law enforcement: We may use and disclose
PHI to a law enforcement official for purposes such as identifying or
locating a suspect, fugitive, material witness or missing person,
complying with a court order or subpoena and other law enforcement
purposes.
Deceased person information: We may use
and disclose PHI to executors, coroners, medical examiners and funeral
directors to enable them to carry out their lawful duties..
Organ donation: We may use and disclose
PHI to organizations involved in procuring, banking or transplanting
organs and tissues.
Research: We may use and disclose PHI to
researchers conducting research that has been approved by an
Institutional Review or Privacy Board of a participating hospital(s).
Public safety: We may use and disclose PHI
to appropriate persons in order to prevent or lessen a serious and
imminent threat to the health or safety of a particular person or the
general public.
Armed Forces and National Security: We may
use and disclose PHI of members of the armed forces for activities
deemed necessary by appropriate military command authorities to assure
proper execution of the military mission. We may use and disclose PHI to
certain federal officials for lawful intelligence, counterintelligence
and other national security activities.
Worker’s compensation: We may use and
disclose PHI as authorized by, and to the extent necessary, to comply
with Federal and State Worker’s compensation laws.
Change of Ownership: In the event that
Foxhall Surgical Associates, P.C. is sold or merged with another
organization, we may use and disclose PHI which will become the property
of the new owner.
III. WHEN SPECIFIC PATIENT WRITTEN AUTHORIZATION WILL BE REQUIRED TO
DISCLOSE PHI
As stated above, under the Federal HIPAA guidelines
our practice may use and disclose PHI without your prior authorization for only three purposes:
1) treatment, 2) payment, and 3) healthcare operations. All other uses
and disclosures not covered by this Notice, or the laws that govern us,
will require your specific, written authorization. Specific requests may
include health, life or disability insurance eligibility and
application; medical legal; transfer of care to another provider not
listed as a treating physician in our record, research; marketing; and
to other third parties not meeting conditions outlined in this Notice.
You may request to amend or restrict your authorization in writing at
any time. We are unable to take back any PHI that we may have already
made with your authorization, and we are required to retain the records
of care that we provided to you.
IV. CHANGES TO THIS NOTICE OF PRIVACY PRACTICES
We reserve the right to change this notice. We
reserve the right to make revised notice effective for PHI we already
have about you as well as any information we receive in the future. Upon
substantive changes to the privacy notice, additional privacy
notifications will be provided in writing to patients and posted on our
web page. Due to the need for and legislation regarding patient privacy,
these policies will be strictly adhered to by the Practice. Upon your
request, we will provide you with any revised Notice of Privacy
Practices by accessing our website, www.foxhall.com, or by calling the
office and requesting a revised copy be sent to you in the mail, or
asking for one at the time of your next appointment.
V.
YOUR PRIVACY RIGHTS REGARDING YOUR HEALTH INFORMATION
Right to Obtain a Copy of the Practice’s
Privacy Notice. We will request you to sign a written
acknowledgment of receipt of our Notice of Privacy Practices. We may
periodically amend this Notice and you may obtain an updated Notice from
our website or calling in your request.
Right to Inspect and Copy their PHI. You
have the right to inspect and obtain a copy of your PHI in a “designated
record set” (medical and billing records) as long as we maintain the PHI
in such a format. However, you do not have a right to psychotherapy
notes, information prepared for legal proceedings, and / or information
that may endanger the health or safety of yourself or others. To request
access to inspect or copy your PHI, please put your request in writing
to our Privacy Officer. We will respond to your request as soon as
possible, but no later than 30 days from the date of receipt of your
request. There will be a reasonable fee for these services.
Right to Request Amendment to their PHI.
To amend your records, please put your request in writing to our Privacy
Officer. We will respond to your request as soon as possible, but no
later than 60 days from the date of receipt of the request. If we deny
your request for amendment, you have the right to submit a written
statement of reasonable length disagreeing with the denial. We have the
right to submit a rebuttal statement. A record of any disagreement about
amendment will become part of your medical record and may be included in
subsequent disclosures of your PHI.
Right to Request List of Disclosures Made of
PHI for Non-Routine Purposes. To request a list of non-routine
disclosures of PHI, please put your request in writing to our Privacy
Officer. We will respond to your request as soon as possible, but no
later than 60 days from the date of receipt of the request. Subject to
certain limitations, you have the right to a written accounting on non-
routine disclosures by us for not more than 6 years prior to the date of
your request. We will provide you with an accounting every 12 months
free of charge. Any additional requests, there will be a reasonable fee
for these services.
Right to Request Restriction of Certain Use &
Disclosure of your PHI. You have this right unless it is a use and
disclosure required by law. Please put your request in writing to our
Privacy Officer. We are not required to agree to your restriction
request, but if we do agree to the request, we will not use or disclose
the PHI unless it is necessary for emergency treatment. In that case, we
will ask that the recipient no longer use or disclose the PHI.
Right to Choose How You Receive your PHI.
You have the right to reasonable accommodation of a request to receive
communication of PHI by alternative means or at alternative
locations. Please put your request in writing to the Privacy Officer. We
will not require an explanation or reason for the request, but we will
request you to specify the alternative address or other method of
contact. There will be a reasonable fee for these services.
VI. COMPLAINT
PROCEDURE & CONTACT PERSON
If you believe your privacy rights have been
violated, you may file a complaint in writing with the contact person
listed below. We will take no retaliatory action against you if you file
a complaint about our privacy practices. We will respond to your
complaint in writing within the legal time frames or in any case within
60 days from the date of receipt of your written complaint.
Privacy Officer Foxhall Surgical Associates, P.C.
3301 New Mexico Avenue NW, Suite 206
Washington, DC 20016
If you believe we are not complying with our legal
obligation to protect the privacy of your PHI, you may exercise your
right to file a complaint with the Secretary of the U.S. Department of
Health & Human Services. You must make your complaint to the Secretary
in writing within 180 days of the act or omission forming the basis of
your complaint.
Dept of Health & Human Services
Office of Civil Rights
Hubert H. Humphrey Building
200 Independence Avenue SW, Room 509F
Washington, DC 20201
VII. EFFECTIVE DATE: THIS NOTICE IS EFFECTIVE APRIL 14, 2003