This Notice describes how medical
information about you
may be used and disclosed and how you can
get access to
this Information. PLEASE REVIEW THIS NOTICE CAREFULLY.
UNDERSTANDING YOUR HEALTH RECORD
INFORMATION
Each time you visit a hospital,
physician or other healthcare provider, a record of your visit is made. Typically this record contains your
symptoms, examination and test results, diagnoses, treatment, and plan for
future care or treatment. This
information, often referred to as your health or medical record, serves as a
basis for planning your care and treatment and serves as a means of
communication among the many healthcare professionals who contribute to your
care. Understanding what is in your
medical record and how your health information is used helps you to ensure its
accuracy, better understand who, what, when, where, and why others may access your
health information, and make more informed decisions when authorizing
disclosures to others.
We, at the Office of Henry DeGroot III,
M.D. pledge to provide you with the highest quality of care and to build a
relationship based on trust. This trust
includes our commitment to respect the privacy and confidentiality of your
health information.
This Notice of Privacy
Practices is being given to you because federal law gives you the
right to be told ahead of time about:
1.
How Dr. DeGroot will handle your medical information;
2.
What our legal duties are related to your medical
information;
3.
What your rights are with regard to your medical
information;
4.
A method for filing complaints about our privacy practices
HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION
When you need health care, you give
information about yourself and your health to doctors, nurses, and other health
care workers and staff. This
information, along with the record of care you receive, is “protected health
information” (or PHI). This information
is kept an electronic form on our database.
(A)
The Office of Henry DeGroot III M.D. uses and discloses (shares)
health information for many different reasons. For some of
these uses and disclosures, we will need to obtain prior written authorization
(permission). However, we may legally
use or disclose your health information for treatment, payment, and health care
operations. We do not need to receive
prior authorization for uses and disclosures described within the following
categories:
For each category of uses or disclosures we will
explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to
use and disclose information will fall within one of the categories:
For
treatment: We may use medical information about
you to provide you with medical treatment or services. We may disclose (share) medical information
about you to other doctors and health care providers involved in your care. Example: A PCP may refer you to a
specialist, such as a radiologist or a surgeon. The specialist may tell you that you need to be admitted to the
hospital for treatment or surgery. All
of the doctors in this example will share medical information about you. This
is to coordinate care before, during, and after you go into the hospital.
For
payment: We may use and disclose (share) your health information in
order to bill and collect payment for the treatment and services provided
you. Example: A bill may be sent to you or a third party
payer. If you have health insurance,
information on or accompanying the bill may include a portion of your health
information that identifies you, as well as your diagnosis, procedures and
supplies used for treatment. The
insurance company uses the information to determine if you are eligible for
benefits or if the services you received were medically needed for payment
purposes. We may also provide your health information to our business
associates, such as a billing company, claims processing companies and others
that process our health care claims.
For health
care operations: We may disclose (share) your health information for
activities that are known as health care operations. These activities use health care information for the purpose of
evaluating our performance and finding better ways to provide care. We may use your health information 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 share
your health information with outside parties (“business associates”) who
perform services on behalf of Dr. DeGroot.
These business associates must agree to keep your health information
private. Examples of activities that
make up health care operations include; legal counsel, transcription, storage,
auditing, and consulting services.
(B)
Other uses of your health information. Dr. DeGroot
may use your health information to contact you about:
ä
scheduled appointments, registration/insurance updates,
pre-procedure assessments or test results;
ä
information about patient care issues and treatment
choices;
ä
other health-related benefits and services that may be of
interest to you.
(C)
We may disclose (share) your health information to others
without your consent in certain situations.
Example: If you need emergency treatment, or if you are unable to
communicate with us (unconscious or in severe pain). In these situations we will try to get your consent. But, if you
are unable to agree or disagree to consent and if we think you would consent if
you were able to do so, we will disclose health information without consent.
(D) Other Specific Uses and Disclosures that DO
NOT REQUIRE YOUR CONSENT.
(a)
When disclosure of health information is required by
federal, state, or local law, administrative or legal proceedings, health
oversight activities, or by law enforcement:
Examples
of some required reporting include: health information about victims of abuse,
neglect, domestic violence, or patients with gunshot and other wounds. In addition, we disclose health information
when ordered in a legal or administrative proceeding.
(b)
For public health activities: As required by law, we may disclose your health information
to public health or legal authorities charged with preventing or controlling
disease, injury, or disability. Example:
we report information about births, deaths, and various diseases to the
government officials in charge of collecting that data consistent with
applicable law to carry out their duties.
(c)
For business associates: There are some
services provided in our practice through contracts with business
associates. Examples include physical therapy, occupational therapy, home
skilled nursing care, imaging services such as MRI, CT, and X-rays, lab work. When these services are contracted, we
may disclose your health information to our business associates so that they
can perform the job we have requested them to do and, bill you or a third party
payer for services rendered.
(d)
For purpose of organ donation: Consistent with applicable law, we may disclose health
information to organ procurement organizations or other entities engaged in
procuring, banking, or transplantation of organs, eye or tissue donation and
transplants.
(e)
For research purposes: In certain circumstances this
practice may provide health information in order to conduct or participate in
medical research. Your health
information will only be used/or disclosed to researchers when their research
has been approved by an Institutional Review Board (IRB). The IRB must have reviewed the research
proposal, and established protocols to ensure the privacy of your health
information. An example of this
research would be to assess the outcomes of patients who had received specific
therapy treatments.
(f)
To avoid harm: In order to avoid a
serious threat to the health or safety of a person or the public, we may
provide health information to law enforcement personnel or persons able to
prevent or lessen such harm.
(g)
For specific government functions: We may disclose
health information of military personnel and veterans in certain
situations. And we may disclose health
information for national security purposes, such as protecting the president of
the United States or conducting intelligence operations.
(h)
For worker’s compensation purposes: We may provide health information to the extent authorized by and to
the extent necessary to comply with laws relating to worker’s compensation or
other similar programs.
(i)
Appointment reminders and health-related benefits or
services: We may use
health information to provide appointment reminders or give you information
about, treatment alternatives, or other health care services or benefits we
offer.
The Uses
and Disclosures Requiring You to Have the Opportunity to Object.
Disclosure
to family, friends or others. The Office of Dr. DeGroot, using its best
judgement, may disclose health information to a family member, friend, or other
person that you indicate, unless you object in whole or in part, health
information relevant to that person’s involvement in your care or payment
related to your care. The opportunity
to get your authorization may be obtained retroactively in emergency
situations.
(D)
All Other Uses and Disclosures Require Your Prior Written
Authorization. In any other situation not described in sections 1 (A) through (E), we will ask for your written
authorization before using or disclosing any of your health information.
OUR LEGAL DUTIES TO PROTECT YOUR HEALTH
INFORMATION
The Office of Henry DeGroot III M.D. is required by law to:
·
Make sure that medical information that identifies you is
kept private.
·
Provide you with this notice that explains our privacy
practices and how, when, and why we use and/or disclose (share) your health information.
·
Follow the terms of the Notice currently in effect. However, we reserve the right to change our
privacy policies and the terms of this notice at any time. Any changes will apply to the health
information we already have. Before any
important policy change goes into effect, we will change this Notice, the new
Notice will be posted on our web site www.drdegroot.com and in a clearly visible location within our
practice site(s) for public viewing.
·
You may request a copy of this notice at any time from our
Privacy Officer and you can view a
copy of the notice on our Web site at www.degroot.com.
YOUR HEALTH INFORMATION RIGHTS
Unless
otherwise required by law, your health record is the physical property of the
healthcare practitioner or facility that compiled it, and the information it
contains belongs to you. You have the
right to:
(A)
Request Limits on Uses and Disclosures of Your Health
Information: You have the right
to ask for restrictions on the use and disclosure (sharing) of your health
information for treatment, payment or health care operations. 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 are legally required or allowed to
make.
(B)
The Right to ask that Your Health Information Be
Communicated to You in a Confidential Manner: You have the right to ask for your health information to be sent to you
in different ways. For example you may
ask for the Practice to contact you by mail rather than telephone, or only call
at your home rather than at work. Your
request must be in writing and explain the method of contact and location where
your wish to be contacted. We will try
to honor your request so long as we can easily provide it in the format you
request.
(C)
The Right to See and Get Copies of Your Health
Information: In most cases,
you have the right to look at or get copies of your PHI that we have, but you
must make the request, in writing. We
will respond within thirty (30) days from the receipt of your request. If you
ask for a copy of your records, you will be charged a fee of $50. If your request is denied, we will inform
you, in writing, our reasons for the denial and explain your right to have the
denial reviewed. We may offer to give you a summary or explanation of the
information your requested as long as you agree in advance to this and to any
fees that this might cost. If you ask
for information we do not have, but we know where it is, we must tell you where
to direct your request.
(D)
The Right to Receive an Accounting of Disclosures (a
record of when and to whom, your health information was shared without your
authorization). You have the right to obtain a list of
the instances that we have shared your health information. You must make this request in writing. You may request as far back as six years, beginning April 14, 2003. The listing you get will include the date, name, and address (if
known) of the person or organization receiving it. It will also include a brief description of the information
given, a brief statement on why the information was shared, or a copy of the
written request for the information.
The list will
not include uses or disclosures that you have already consented to, such as
those made for the treatment, payment, or health care operations, directly to
you or your family. The list also will
not include uses or disclosures made for national security purposes, to
corrections or law enforcement personnel, or before April 14, 2003.
We have 60 days
to respond to your written request. If we are not act on your request within
the 60 days, we will notify you that we are extending the response time by 30
days. If we do that we will explain the
delay in writing and give you a new date of when to expect a response. We will
provide this list at no charge, but if you make more that one request in the
same year, we will charge you $30 for each additional request.
(E)
The Right to Correct or Update your Health Information. If you believe
that there is a mistake in your health information 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 have 60 days
to respond to your request. We may deny
your request, in writing, if the health information is: (i) correct and
complete, (ii) not created by us, (iii) not allowed to be disclosed, or (iv)
not part of our records. Our written
denial will state the reasons for the denial and explain your rights to file a
written statement of disagreement with the denial. If you do not file a written statement of disagreement, you have
the right to request that your request and our denial be attached to all future
disclosures of your health information.
HOW TO COMPLAIN ABOUT OUR PRIVACY PRACTICES
If you think
that the Office of Henry DeGroot III, M.D. may have violated your privacy
rights, or you disagree with a decision we made about access to your health
information, you may file a complaint with our Privacy Officer. You also may send a written complaint to
either:
Office for Civil Rights
U.S. Department of health and Human
Services
Government Center
J.F. Kennedy
Federal Building – Room 1875
Boston,
Massachusetts 02203
Or:
Secretary of
the Department of Health and Human Services
200 Independence
Avenue
S.W.
Washington, D.C. 20201
Or e-mail the
HHS Secretary at HHS.Mail@hhs.gov
The Office of
Henry DeGroot III, M.D. will take no retaliatory action against you if you file
a complaint about our privacy practices.
PERSON TO CONTACT FOR INFORMATION
If you have any
questions about this notice or any complaints about our privacy practices, or
would like to know how to file a complaint with the Secretary of Health and
Human Services, please contact our Privacy
Officer, Amanda Maselli via email at amaselli@drdegroot.com
or by phone at 781-237-9922.