Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you can get access to this information.

Please Review It Carefully

The Health Insurance 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, on paper, or orally, are kept properly confidential. These requirements are to be followed unless state laws offer greater protection. This act gives you, the patient, significant new rights to understand and control how your health information is used. “HIPPA” provides penalties for covered entities that misuse personal health information (PHI).

As required by “HIPPA”, we have prepared this explanation of how we are required to maintain the privacy of your personal health information (PHI) and how we may use and disclose your health information. We may use and disclose your PHI only for each of the following purposes: treatment, payment, and health care operations.

• Treatment means providing, coordinating, or managing health care and related services by one or more health care providers. An example of this would be referring you to another provider.
  
• Payment means such activities as obtaining reimbursement for services, confirming coverage, billing or collection activities and utilization review. An example of this would be sending a bill for your visit to your insurance company for payment.
  
• Health care operations include the business aspects of running our practice, such as conducting quality assessment and improvement activities, auditing functions, cost-management analysis, and customer service. An example of this would be an internal quality assessment review.
  

We may also create and distribute de-identified health information by removing all references to individually identifiable information. We will also only release the “minimum necessary” information to accomplish the intended purpose. The “minimum necessary” does not apply to disclosures to: health care providers for treatment, disclosures made to the patient, disclosures made pursuant to an authorization, disclosures made to Department of Health and Human Services, disclosures required by law and disclosures required for compliance with HIPAA.

We may call or mail a card to your home address to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

We may share your PHI with third party “business associates” that perform various activities for us: however, we will require protection of your PHI in our written agreements with our business associates. An example of a business associate would be a clearing house where electronic claims are sent.

Any other uses and disclosures will be made only with your written authorization. You may evoke such authorization in writing and we are required to honor and abide by that written request, except to the extent that we have already taken relying on your authorization.

You have the following rights with the respect to your protected health information, which you can exercise by presenting a written request to the Privacy Officer:

• The right to request restrictions on certain uses and disclosures of protected health information, including those related to disclosures to family members, other relatives, close personal friends, or any other person identified by you. We are however, not required to agree to a requested restriction. If we do agree to a restriction, we must abide by it unless you agree in writing to remove it.
  
• The right to reasonable request to receive confidential communication or protected health information from us by alternative means or at alternative locations.
  
• The right to inpsect and copy your protected health information. We are required to respond to your request within 30 days of receipt of your request if the information is maintained on-site and 60 days if the information is maintained off-site. We may have to extend this response time by an additional 30 days with written notice to you of the reasons for the delay. We may charge you a fee to copy your PHI records. You may request an appointment to inspect your PHI by completing an Access Request form and submitting it to our Privacy Officer (Michelle Lycans). We will schedule a mutually convenient time. We may deny your request to inspect and copy your records in certain very limited circumstances. If you are denied access to medical information, you may request the denial be reviewed. One of our medical staff 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.
  
• The right to amend your protected health information, with certain restrictions, such as when the provider did not create the information to be amended, or the provider believes the information is accurate and complete. You must fill out a “request to amend records” form. You can get this form from our Privacy Officer (Michelle Lycans).
  
• The right to receive an accounting of disclosures of protected health information. The accounting does not have to include disclosures related to treatment, payment or operations, disclosures for which an authorization is required, for national security or intelligence purposes, to correctional institutions or law enforcements officials, any other use or disclosure that is permitted or required by law so long as the provider only releases the minimum amount of information required for the purpose, or disclosures made prior to April 14, 2003.
  
• The right to obtain a paper copy of this notice from us upon request.
  

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 protected health information.We may disclose your PHI to a public health authority who is permitted by law to collect or receive the information. We may disclose your PHI for law enforcement purposes, in response to a court order or subpoena, or other lawful process.

This notice is effective as of 4-14-03 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 of Privacy Practices and to make the provisions effective for all protected health information that we maintain. We will post and you may request a written copy of a revised Notice of Privacy Practices from this office. The notice will also be posted here on our website.

You have recourse if you feel that your privacy protections have been violated. You have the right to file a written complaint with our office, or with the 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. To contact our Privacy Officer, Michelle Lycans, call 304-522-6388. We will not retaliate against you for filing a complaint.

To file a complaint with the Department of Health & Human Services contact:

The US Department of Health & Human Services
Office of Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
(202) 619-0257
Toll free: 1-877-696-6775