As Required by the Privacy Regulations Created as a Result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA)

 

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU (AS A PATIENT OF THIS PRACTICE) MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION.

 

PLEASE REVIEW THIS NOTICE CAREFULLY

 

A. OUR COMMITMENT TO YOUR PRIVACY

Little Rock Allergy & Asthma Clinic, P.A. is dedicated to maintaining the privacy of your protected health information (PHI). In conducting our business, we wil create records regarding you and the treatment and services we provide to you. We are required by law to maintain the confidentiality of health information that identifies you. We also are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your PHI. By federal and state law, we must follow the terms of the notice of privacy practices that we have in effect at the time.

We must provide you with the following important information:

1. How we may use and disclose your PHI

2. Your privacy rights in your PHI

3. Our obligations concerning the use and disclosure of your PHI

We realize that these laws are complicated, but we must provide you with the following important information:

The terms of this notice apply to al records containing your PHI that are created or retained byour practice. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all of your records that our practice has created or maintained in the past, and for any of your records that we may create or maintain in the future. Our practice wil post a copy of our current Notice in our offices in a visible location at all times, and you may request a copy of our most current Notice at any time.

 

WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION (PHI) NI THE FOLLOWING WAYS:

1. Treatment Our practice may use your PHI to treat you. For example, we may ask you to have laboratory tests (such as blood or urine tests), and we may use the results to helpu s reach a diagnosis. We might use your PHI in order to write a prescription for you, or we might disclose your PHI to a pharmacy when we order a prescription for you. Many of the people who work forour practice - including, but not limited to, our doctors and nurses - may use or disclose your PHI in order to treat you or to assist others ni your treatment. Additionally, we may disclose your PHI to others who may assist in your care, such as your spouse, children or parents. Finally, we may also disclose your PHI to other health care providers for purposes related to your treatment.

2. Payment Our practice may use and disclose your PHI in order to billand collect pavment for the services and items youmay receivefrom us. For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment. We also may use and disclose your PHI to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your PHI to bill you directly for services and items. We may disclose your PHI or other health care providers and entities to assist in their billing and collection efforts.

3. Health Care Operations Our practice may use and disclose your PHI to operate our business. As examples of the ways in which we may use and disclose your information for our operations, our practice may use your PHI to evaluate the quality of care you received from us, or to conduct cost- management and business planning activities for our practice. We may disclose your PHI to other health care providers and entities to assist in their health care operations. Limitations on the use and disclosure of protected health information(PHI) will be strengthened for marketing and fundraising purposes and the sale of PHI without an authorization will be prohibited.

4. Minors We may disclose the PHI of minor children to their parents or guardians unless such disclosure is otherwise prohibited by law.

5. Appointment Reminders Our practice may use and disclose your PHI to contact you and remind you of an appointment.

6. Treatment Options Our practice may use and disclose your PHI to inform you of potential treatment options or alternatives.

7. Business Associates We may disclose PHI to our business associates who perform functions on our behalf or provide us with services if the PHI is necessary for those functions or services. For example, we may use another company to do our billing, or to provide transcription or consulting services for us. Al of our business associates are obligated, under contract with us, to protect the privacy of your PHI.

8. Health-Related Benefits and Services Our practice may use and disclose your PHI to inform you of health-related benefits, services, and potential research projects that may be of interest to you.

9. Release of Information to Family/Friends Our practice may release your PHI to afriend or family member that is involved in your care, or who assists in taking care of you. For example, a parent or guardian may ask that a babysitter take their child to the allergist's office for treatment of asthma. In this example, the babysitter may have access to this child's medical information.

10. Disclosures Required By Law Our practice will use and disclose your PHI when we are required to do so by federal, state or local law. Business associates of covered entities will be directly liable for compliance with most HIPAA Privacy and Security Rule Requirements. It is our patients right to be notified in the event of a breach of their PHI.

 

USE AND DISCLOSURE OF YOUR PHI NI SPECIAL CIRCUMSTANCES

1. Public Health Risks Our practice may disclose your PHI to public health authorities that are authorized by law to collect information for the purpose of:

  • maintaining vital records, such as births and deaths
  • reporting child abuse or neglect
  • preventing or controlling disease, injury or disability
  • notifying a person regarding potential exposure to a communicable disease
  • notifying a personregarding apotential risk for spreading or contracting a disease or condition
  • reporting reactions to drugs or problems with products or devices
  • notifying individuals fi a product or device they may be using has been recalled
  • notifying appropriate government agencies and authorities regarding the potential abuse or neglect of an adult patient; however, we will only disclose this information if the patient agrees or we are required or authorized bylawt o disclose this information
  • notifying your employer under limited circumstances related primarily to work place injury or illness or medical surveillance

2. Health Oversight Activities Our practice may disclose your PHI to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.

3. Lawsuits and Similar Proceedings Our practice may use and disclose your PHI in response toa court or administrative order, if you are involved in a lawsuit or similar proceeding. We also may disclose your PHI in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.

4. Law Enforcement We may release PHI if askedt o do so by a law enforcement official:

  • Regarding a crime victim in certain situations, if we are unable to obtain the person's agreement concerning a death we believe has resulted from criminal conduct
  • Regarding criminal conduct at our offices
  • In response to a warrant, summons, court order, subpoenaor similar legal process
  • To identify/locate a suspect, material witness, fugitive or missing person
  • In an emergency, to report a crime (including the location or victim of the crime, or the description, identity or location of the perpetrator)

5. Deceased Patients Our practice may release PHI to a medical examiner or coroner to identify a deceased individual or to identify the cause of death. If necessary, we also may release information in order for funeral directors to perform their jobs. Authorization is will no longer be required for certain individuals to receive access to a deceased patient's records.

6. Organ and Tissue Donation Our practice may release your PHI to organizations that handle organ, eye or tissue procurement or transplantation, including organ donation banks, as necessary tofacilitate organ or tissuedonation and transplantation if you are an organ donor.

7. Research Our practice may use and disclose your PHI for research purposes in certain limited circumstances. We will obtain your written authorization to use your PHI for research purposes except when Internal or Review Board or Privacy Board has determined that the waiver of your authorization satisfies the following: (i) the use or disclosure involves no more than a minimal risk to your privacy based on the following: (A) an adequate plan to protect the identifiers from improper use and disclosure; (B) an adequate plan to destroy the identifiers at the earliest opportunity consistent with the research (unless there is a health or research justification for retaining the identifiers or such retention is otherwise required by law); and (C) adequate written assurances that the PHI will not be re-used or disclosed to any other person or entity (except as required by law) for authorized oversight of the research study, or for other research for which the use or disclosure would otherwise be permitted; (ii) the research could not practicably be conducted without the waiver; and (iii) the research could not practicably be conducted without access to and use of the PHI. Authorizations for research purposes will allow compound authorizations and the ability to include authorization for future research.

8. Serious Threats to Health or Safety Our practice may use and discloseyour PHI when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.

9. Military Our practice may disclose your PHI if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate authorities.

10. National Security Our practice may disclose your PHI to federal officials forintelligence and national security activities authorized by law. We also may disclose your PHI to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.

11. Inmates Our practice maydisclose your PHI to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. Disclosure for these purposes would be necessary: (a) for the institution to provide health care services to you, (b) for the safety andsecurity of the institution, and/or (c) to protect your health and safety or the health and safety for other individuals.

12. Workers' Compensation Our practice may release your PHI for workers' compensation and similar programs.

 

YOUR RIGHTS REGARDING YOUR PHI

1. Confidential Communications You have the right to request that our practice communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home, rather than work. In order torequest a type of confidential communication, you must make a written request to the Privacy Officer specifying the requested method of contact, or the location where you wish to be contacted. Our practice will accommodate reasonable requests. You do not need to give a reason for your request.

2. Requesting Restrictions You have the right torequest arestriction in our use or disclosure of your PHI for treatment, payment or health care operations. Additionally, you have the right to request that we restrict our disclosure of your PHI to only certain individuals involved in your care or the payment for your care, such as family members and friends. We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you. In order to request a restriction in our use or disclosure of your PHI, you must make your request in writing to the Privacy Officer. Your request must describe in a clear and concise fashion:

(a) the information youwish restricted;

(b) whether you are requesting to limit our practice's use, disclosure or both; and

(c) to whom you want the limits to apply.

3. Inspection and Copies You have the right to inspect and obtain a copy of the PHI that may be used to make decisions about you, including patient medical record and billing records, but not including psycho therapy notes. You must submit your request in writing to the Privacy Officer in order to inspect and/or obtain a copy of your PHI. Our practice may charge a fee for the costs of copying, mailing, labor and supplies associated with your request. Our practice may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial. Another licensed healthcare professional chosen by us wil conduct reviews.

4. Amendment You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our practice. To request an amendment, your request must be made in writing and submitted to the Privacy Officer. You must provide us with a reason that supports your request for amendment. Our practice will deny your request if you fail to submit your request (and the reason supporting your request) in writing. Also, we may deny your request if you ask us to amend information that is in our opinion: (a) accurate and complete; (b) not part of the PHI kept by or for the practice; (c) not part of the PHI which you would be permitted to inspect and copy; or (d) not created by our practice, unless the individual or entity that created the information is not available to amend the information.

5. Accounting of Disclosures All of our patients have the right to request an "accounting of disclosures." An "accounting of disclosures" is a list of certain non-routine disclosures our practice has made of your PHI for non-treatment, non-payment or non-operations purposes. Use of your PHI as part of the routine patient care in our practice is not required to be documented. For example, the doctor sharing information with the nurse; or the billing department using your information to file your insurance claim. Also, we are not required to document disclosures made pursuant to an authorization signed by you. In order to obtain an accounting of disclosures, you must submit your request in writing to the Privacy Officer. All requests for an "accounting of disclosures" must state a time period, which may not be longer than six (6) years from the date of disclosure and may not include dates before May 1, 2009. The first list you request within a 12-month period is free of charge, but our practice may charge you for additional lists within the same 12-month period. Our practice will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs.

6. Right to an Electronic Copy of Electronic Medical Record If your PHI is maintained in one or more designated record sets electronically (for example an electronic medical record or an electronic health record), you have the right to request that an electronic copy of your record be given to you or transmitted to another individual or entity. We may charge you a reasonable, cost-based fee for the labor associated with copying or transmitting the electronic PHI.

7. Right to a Paper Copy of This Notice You are entitled to receive a paper copy of our notice of privacy practices. You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this notice, contact the Privacy Officer.

8. Right to File a Complaint If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services. To file a complaint with our practice, contact the Privacy Officer. We urge you to file your complaint with us first and give us the opportunity to address your concerns. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

9. Right to Provide an Authorization for Other Uses and Disclosures Our practice wil obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your PHI may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your PHI for the reasons described in the authorization. Please note, we are required to retain records of your care.

10. Authorization will no longer be required to release immunization records to schools or certain individuals to receive access to a deceased patients record.

11. Right to Electronic Medical Records Patients will have the right to receive an electronic copy of their health information and to restrict disclosures to a health plan for treatment that is paid for out of pocket, in full, by the individual.

 

NOTE: A copy of this Notice of Privacy Practices is in our waiting room along with a glossary of terms.