THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU MAY GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.
Premier Medical Group is dedicated to protecting your medical information. We are required by law to maintain the privacy of protected health information (PHI) and to provide you with this notice of our legal duties and privacy practices with respect to protected health information. Premier Medical Group is required by law to abide by the terms of this notice, and we reserve the right to change the terms of this notice, making any revision applicable to all the protected health information we maintain. If we revise the terms of this notice, we will post a revised notice at the clinic, on our Web site, and will make paper copies of this Notice of Privacy Practices for Protected Health Information available upon request.
HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION.
We use and disclose health information for many different reasons. For some of these uses or disclosures, we need your prior consent or specific authorization. Below, we describe the different categories of our uses and disclosures and give you some examples of each category.
A. Uses and Disclosures Relating to Treatment, Payment, or Health Care Operations Require Your Prior Written Consent. We may use and disclose your PHI with your consent for the following reasons: 1. For treatment. We may disclose your PHI to physicians, nurses and other health care personnel who provide you with health care services or are involved in your care. For example, if you are being treated for a knee injury, we may disclose your PHI to a referring physician for continuity of care. 2. To obtain payment for treatment. We may use and disclose your PHI in order to bill and collect payment for the treatment and services provided to you. For example, we may provide portions of your PHI to our billing department and your health plan to get paid for the health care services we provided to you. We may also provide your PHI to our business associates, such as billing companies, claims processing companies and others that process our health care claims. 3. For health care operations. We may disclose your PHI in order to operate this clinic. These activities include, but are not limited to, quality assessment activities, employee review activities, training, and conducting or arranging for other business activities. For example, we may use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your physician. We may use or disclose your PHI as necessary to remind you of an appointment or a billing issue. We will share information with business associates that perform various activities (e.g. transcription services) for the practice. Whenever an arrangement between our office and a business associate involves the use or disclosure of your protected health information, we will have a written contract that contains terms that will protect the privacy of your protected health information. We may use your PHI in order to evaluate the quality of health care services that you received or to evaluate the performance of the health care professionals who provided health care services to you. We may also provide your PHI to our accountants, attorneys, consultants, and others in order to make sure we are complying with the laws that affect us. In certain circumstances, we may provide PHI to researchers when a review board has approved their research and established protocols to ensure the privacy of your protected health information.
B. Certain uses and Disclosures Do Not Require Your Consent. We may use and disclose your PHI without your consent or authorization for the following reasons: 1. When a disclosure is required by federal, state or local law, judicial or administrative proceedings, or law enforcement. For example, we make disclosures when a law requires that we report information to government agencies and law enforcement personnel about victims of abuse, neglect or domestic violence. 2. For public health activities. For example, we report information to the health department regarding communicable diseases such as tuberculosis. 3. For health oversight activities. For example, we will provide information to assist the government when it conducts an investigation or inspection of a health care provider or organization. 4. For purposes of organ donation. We may notify organ procurement organizations to assist them in organ, eye or tissue donation and transplants. 5. To avoid harm. In order to avoid a serious threat to the health or safety of a person or the public, we may provide PHI to law enforcement personnel or persons able to prevent or lessen such harm. 6. For specific government functions. We may disclose PHI of military personnel and veterans in certain circumstances. And we may disclose PHI for national security purposes. 7. For workers? compensation purposes. We may provide PHI in order to comply with workers? compensation law and other similar legally established programs. 8. Appointment reminders and health-related benefits or services. We may use PHI to provide appointment reminders or give you information about test results or treatment alternatives.
C. All Other Uses and Disclosures Require Your Prior Written Authorization. In any other situation not described in sections above, we will ask for your written authorization before using or disclosing any of your PHI. If you choose to sign an authorization to disclose your PHI, you can later revoke that authorization in writing to stop any future uses and disclosures (to the extent that we have not taken any action relying on the authorization).
WHAT RIGHTS YOU HAVE REGARDING YOUR PHI
You have the following rights with respect to your PHI:
A. The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask that we limit how we use and disclose your PHI for the purposes of treatment, payment or healthcare operations. You may also request that any part of your PHI not be disclosed to family members or others who may be involved in your care. Your request must be in writing and state the specific restriction requested and to whom you want the restriction to apply. We will consider your request but are not legally required to accept it. If we accept your request, we will put any limits in writing and abide by them except in emergency situations. You may not limit the uses and disclosures that we are legally required or allowed to make. Please make your request in writing to the Privacy Officer of Premier Medical Group.
B. The Right to Choose How We Send PHI to You. You have the right to ask that we send information to you to an alternate address (for example, sending information to your work address rather than your home address) or by alternative means. We must agree to your request so long as we can easily provide it in the format you requested. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. We will not request an explanation from you as to the basis for the request. Please make this request in writing to the Privacy Office of Premier Medical Group.
C. The Right to See and Get Copies of Your PHI. In most cases, you have the right to look at or get copies of your PHI that we have. However, under federal law you may not inspect or copy the following records: Psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding; and protected health information that is subject to law that prohibits access to PHI. You must make the request in writing. If we do not have your PHI but we know who does, we will tell you how to get it. We will respond within 30 days after receiving your written request. In certain situations, we may deny your request. If we do, we will tell you, in writing, our reasons for the denial and explain your right to have the denial reviewed.
If you request copies of your PHI, we will charge you a fee as mandated by the Mississippi State Board of Medical Licensure. This fee may be required in advance of receiving copies of your PHI. Please contact our Privacy Office if you have further questions about access to your medical record.
D. The Right to Get a List of the Disclosures We Have Made. You have the right to get a list of instances in which we have disclosed your PHI. The list will not include uses or disclosures that you have already consented to, such as those made for treatment, payment, or health care operations, directly to you, to your family, or in our facility. The list also won?t include uses and disclosures made for national security purposes or law enforcement personnel, or before April 14, 2003.
E. The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI or that a piece of important information is missing, you have the right to request that we correct the existing information or add the missing information. You must provide the request and your reason for the request in writing. We will respond within 60 days of receiving your request. We may deny your request in writing if the PHI is (a) correct and complete, (b) not created by us, (c) not allowed to be disclosed, or (d) not part of our records. Our written denial will state the reasons for the denial and explain your right to file a written statement of disagreement with the denial. If you do not file one, you have the right to request that your request and our denial be attached to all future disclosures of your PHI. If we approve your request, we will make the change to your PHI, tell you that we have done it, and tell others that need to know about the change to your PHI.
HOW TO COMPLAIN ABOUT OUR PRIVACY PRACTICES If you think that we may have violated your privacy rights, or you disagree with a decision we made about access to your PHI, you may file a complaint with:
Premier Medical Group Attn: Privacy Officer 501 Marshall Street, Suite 208 Jackson, MS 39202.
You also may send a written complaint to:
Office of Civil Rights U.S. Department of Health and Human Services 200 Independence Avenue, S.W. Washington, D.C. 20201
If you choose to file a complaint, you will not be retaliated against in any way.
If you would like further information regarding your rights or regarding the uses and disclosures of your medical information, you may contact:
Premier Medical Group 501 Marshall Street, Suite 208 Jackson, MS 39202 Telephone No. 601-352-2273 Susan Perkins,Director of Operations, or Cindy Kramer,Privacy Officer.
THIS NOTICE IS EFFECTIVE AS OF FEBRUARY 28, 2003.