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Hospital
Pathology Associates, PA Effective April 14, 2003 Notice
of Privacy Practices
This Notice of Privacy Practices
describes how we may use and disclose your protected health information to
carry out treatment, payment or health care operations and for other
purposes that are permitted or required by law. It also describes your
rights to access and control your protected health information.
“Protected health information” is information about you, including
demographic information, that may identify you and that relates to your
past, present or future physical or mental health or condition and related
health care services. We are required to abide by the terms
of this Notice of Privacy Practices. We may change the terms of our
notice, at any time. The new notice will be effective for all protected
health information that we maintain at that time. Upon your request, we
will provide you with any revised Notice of Privacy Practices by accessing
our website or calling the office to request a revised copy be sent to you
in the mail. 1. Uses and Disclosures of
Protected Health Information
Uses and Disclosures of Protected
Health Information Based Upon Your Written Consent You will be asked by your physician or
health care organization to sign an authorization form. Once you have
consented to use and disclosure of your protected health information for
treatment, payment and health care operations by signing the consent form,
your physician will use or disclose your protected health information as
described in this Section 1. Your protected health information may be used
and disclosed by your physician, our office staff and others outside of
our office that are involved in your care and treatment for the purpose of
providing health care services to you. Your protected health information
may also be used and disclosed to pay your health care bills and to
support the operation of the physician’s practice. Following are examples of the types of
uses and disclosures of your protected health care information that HPA is
permitted to make once you have signed the consent form. These examples
are not meant to be exhaustive, but to describe the types of uses and
disclosures that may be made by our office once you have provided consent. Treatment: We will use and disclose your protected
health information to provide and coordinate your health care and any
related services. 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 protected health information. We will also disclose
protected health information to other physicians who may be treating you
when we have the necessary permission from you to disclose your protected
health information. For example, your protected health information may be
provided to a physician to whom you have been referred to ensure that the
physician has the necessary information to diagnose or treat you. In addition, we may disclose your
protected health information from time-to-time to another physician or
health care provider (e.g., a specialist or laboratory) who, at the
request of your physician, becomes involved in your care by providing
assistance with your health care diagnosis or treatment to your physician. Payment: Your protected health information will
be used, as needed, to obtain payment for your health care services. This
may include certain activities that your health insurance plan may
undertake before it approves or pays for the health care services we
recommend for you such as; making a determination of eligibility or
coverage for insurance benefits, reviewing services provided to you for
medical necessity, and undertaking utilization review activities. Healthcare Operations: We may use or disclose,
as-needed, your protected health information in order to support our
business activities. These activities include, but are not limited to,
quality assessment activities, employee review activities, and conducting
or arranging for other business activities. We will share your protected health
information with third party “business associates” that perform
various activities (e.g., billing) 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. Uses and Disclosures of Protected
Health Information Based upon Your Written Authorization Other uses and disclosures of your
protected health information will be made only with your written
authorization, unless otherwise permitted or required by law as described
below. You may revoke this authorization, at any time, in writing, except
to the extent that your physician or the physician’s practice has taken
an action in reliance on the use or disclosure indicated in the
authorization. Other Permitted and Required Uses and
Disclosures That May Be Made With Your Consent, Authorization or
Opportunity to Object
We may use and disclose your protected
health information in the following instances. You have the opportunity to
agree or object to the use or disclosure of all or part of your protected
health information. If you are not present or able to agree or object to
the use or disclosure of the protected health information, then your
physician may, using professional judgment, determine whether the
disclosure is in your best interest. In this case, only the protected
health information that is relevant to your health care will be disclosed.
Others Involved in Your
Healthcare:
Unless you object, we may disclose to a member of your family, a relative,
a close friend or any other person you identify, your protected health
information that directly relates to that person’s involvement in your
health care. If you are unable to agree or object to such a disclosure, we
may disclose such information as necessary if we determine that it is in
your best interest based on our professional judgment. We may use or
disclose protected health information to notify or assist in notifying a
family member, personal representative or any other person that is
responsible for your care of your location, general condition or death. Communication Barriers:
We may use and disclose your protected health information if your
physician or another physician in the practice attempts to obtain consent
from you but is unable to do so due to substantial communication barriers
and the physician determines, using professional judgment, that you intend
to consent to use or disclosure under the circumstances. Other Permitted and Required Uses and
Disclosures That May Be Made Without Your Consent, Authorization or
Opportunity to Object We may use or disclose your protected
health information in the following situations without your consent or
authorization. These situations include: Required By Law: We may use or disclose your protected
health information to the extent that the use or disclosure is required by
law. The use or disclosure will be made in compliance with the law and
will be limited to the relevant requirements of the law. You will be
notified, as required by law, of any such uses or disclosures. Health Oversight: We may disclose protected health
information to a health oversight agency for activities authorized by law,
such as audits, investigations, and inspections. Oversight agencies
seeking this information include government agencies that oversee the
health care system, government benefit programs, other government
regulatory programs and civil rights laws. Legal Proceedings: We may disclose protected health
information in the course of any judicial or administrative proceeding, in
response to an order of a court or administrative tribunal (to the extent
such disclosure is expressly authorized), in certain conditions in
response to a subpoena, discovery request or other lawful process. Law Enforcement: We may also disclose protected health
information, so long as applicable legal requirements are met, for law
enforcement purposes. These law enforcement purposes include (1) legal
processes and otherwise required by law, (2) limited information requests
for identification and location purposes, (3) pertaining to victims of a
crime, (4) suspicion that death has occurred as a result of criminal
conduct, (5) in the event that a crime occurs on the premises of the
practice, and (6) medical emergency (not on the Practice’s premises) and
it is likely that a crime has occurred. Coroners, Funeral Directors, and
Organ Donation:
We may disclose protected health information to a coroner or medical
examiner for identification purposes, determining cause of death or for
the coroner or medical examiner to perform other duties authorized by law.
We may also disclose protected health information to a funeral director,
as authorized by law, in order to permit the funeral director to carry out
their duties. We may disclose such information in reasonable anticipation
of death. Protected health information may be used and disclosed for
cadaveric organ, eye or tissue donation purposes. Criminal Activity: Consistent with applicable
federal and state laws, we may disclose your protected health information,
if we believe that the use or disclosure is necessary to prevent or lessen
a serious and imminent threat to the health or safety of a person or the
public. We may also disclose protected health information if it is
necessary for law enforcement authorities to identify or apprehend an
individual Required Uses and Disclosures:
Under the law, we must make disclosures to you and when required by the
Secretary of the Department of Health and Human Services to investigate or
determine our compliance with the requirements of Section 164.500 et. seq.
2. Your Rights Following is a statement of your
rights with respect to your protected health information and a brief
description of how you may exercise these rights. You have the right to inspect
and copy your protected health information. This means you may inspect and obtain a copy of protected
health information about you that is contained in a designated record set
for as long as we maintain the protected health information. A
“designated record set” contains medical and billing records and any
other records that your physician and the practice uses for making
decisions about you. We may deny your request to inspect
and copy in certain very limited circumstances (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 protected health information).
If you are denied access to health information, you may request that the
denial be reviewed. Another licensed health care professional chosen by
our practice will review your request and the denial. The person
conducting the review will not be the person who denied your request. We
will comply with the outcome of the review. Please contact our Privacy Official if
you have questions about access to your protected health information.
You may request a copy of the information by making the request in
writing and sending it to the Privacy Official at Hospital Pathology
Associates. If you request a
copy of the information, we may charge a fee for the costs of copying,
mailing or other supplies and services associated with your request. You have the right to request a
restriction of your protected health information. This means you may ask us not to use or
disclose any part of your protected health information for the purposes of
treatment, payment or healthcare operations. You may also request that any
part of your protected health information not be disclosed to family
members or friends who may be involved in your care or for notification
purposes as described in this Notice of Privacy Practices. Your request
must state the specific restriction requested and to whom you want the
restriction to apply. Your physician is not required to
agree to a restriction that you may request. If physician believes it is
in your best interest to permit use and disclosure of your protected
health information, your protected health information will not be
restricted. If your physician does agree to the requested restriction, we
may not use or disclose your protected health information in violation of
that restriction unless it is needed to provide emergency treatment. With
this in mind, please discuss any restriction you wish to request with your
physician. You may request a restriction by making the request in writing
and sending it to the Privacy Official at Hospital Pathology Associates.
In the request, specify the information you want to limit and to
whom the limits apply; for example, use of any information by specified
Hospital Pathology Associates staff.
You have the right to request to
receive confidential communications from us by alternative means or at an
alternative location.
We will accommodate reasonable requests. 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 our Privacy Official.
Your request must specify how or where you wish to be contacted.
You may have the right to have
your physician amend your protected health information. This means you may request an amendment
of protected health information about you in a designated record set for
as long as we maintain this information. In certain cases, we may deny
your request for an amendment. To request an amendment, your request
must be made in writing, submitted to the HPA Privacy Official, and must
be contained on one page of paper legibly handwritten or typed in at least
10 point font size. In addition, you must provide a reason that supports
your request for an amendment. We may deny your request for an
amendment if it is not in writing or does not include a reason to support
the request. In addition, we may deny your request if you ask us to amend
information that:
If we deny your request for amendment,
you have the right to file a statement of disagreement with us and we may
prepare a rebuttal to your statement and will provide you with a copy of
any such rebuttal Any amendment we make to your health
information will be disclosed to those with whom we disclose information
as previously specified. You have the right to receive an
accounting of certain disclosures we have made, if any, of your protected
health information.
This right applies to disclosures for purposes other than treatment,
payment or healthcare operations as described in this Notice of Privacy
Practices. It excludes disclosures we may have made to you, to family
members or friends involved in your care, or for notification purposes. To request this list of disclosures,
you must submit your request in writing to the HPA Privacy Official. Your
request must state a time period which may not be longer than six years
and may not include dates before April 14, 2003. The first list you
request within a 12 month period will be free. For additional lists, we
may charge you for the costs of providing the list. We will notify you of
the cost involved and you may choose to withdraw or modify your request at
that time before any costs are incurred.
The right to receive this information is subject to certain
exceptions, restrictions and limitations. You have the right to obtain a
paper copy of this notice from us, upon request, even if you have agreed to accept this notice
electronically. 3. Complaints You may complain to us or to the
Secretary of Health and Human Services if you believe your privacy rights
have been violated by us. You may file a complaint with us by notifying
our privacy contact of your complaint. We will not retaliate against you
for filing a complaint. You may contact our Privacy Official
at (651) 483-2033. This notice becomes effective on April 14, 2003. |
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| This page was last modified November 22, 2004 Copyright © 2003-2010 Hospital Pathology Associates, P.A. |