4/14/2003
Dermatology Center of Western Iowa
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) requires all health care records and other individually identifiable health information (protected health information) used or disclosed to us in any form, whether electronically, on paper, or orally, be kept confidential. This federal law gives you, the patient, significant new rights to understand and control how your health information is used. HIPAA provides penalties for covered entities that misuse personal health information. As required by HIPAA, we have prepared this explanation of how we are required to maintain the privacy of your health information and how we may use and disclose your health information.
Without specific written authorization, we are permitted to use and disclose your health care records for the purposes of treatment, payment and health care operations.
•
Treatment means
providing, coordinating, or managing health care and related services
by one or more health care providers. Examples of treatment would
include dermatologic procedures, ordering lab tests and using the
results to help us reach a diagnosis, writing a prescription for you,
or disclosing your health information to a pharmacy when we order a
prescription for you.
• Payment
means such activities as obtaining reimbursement for services,
confirming coverage, billing or collection activities, and
utilization review. An example of this would be billing your dental
plan for your dental services.
• 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 would
include a periodic assessment of our documentation protocols, etc.
In addition, your confidential information may be used to remind you of an appointment (by phone or mail) or provide you with information about treatment options or other health-related services including release of information to friends and family members that are directly involved in your care or who assist in taking care of you. We will use and disclose your protected when we are required to do so by federal, state or local law. We may disclose your PROTECTED HEALTH INFORMATION to public health authorities that are authorized by law to collect information, to a health oversight agency for activities authorized by law included but not limited to: response to a court or administrative order, if you are involved in a lawsuit or similar proceeding, 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. We will release your PROTECTED HEALTH INFORMATION if requested by a law enforcement official for any circumstance required by law. We may release your PROTECTED HEALTH INFORMATION 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. We may release PROTECTED HEALTH INFORMATION to organizations that handle organ, eye or tissue procurement or transplantation, including organ donation banks, as necessary to facilitate organ or tissue donation and transplantation if you are an organ donor. We may use and disclose your PROTECTED HEALTH INFORMATION 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. We may disclose your PROTECTED HEALTH INFORMATION if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate authorities. We may disclose your PROTECTED HEALTH INFORMATION to federal officials for intelligence and national security activities authorized by law. We may disclose PROTECTED HEALTH INFORMATION to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations. We may disclose your PROTECTED HEALTH INFORMATION 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 and security of the institution, and/or (c) to protect your health and safety or the health and safety of other individuals or the public. We may release your PROTECTED HEALTH INFORMATION for workers' compensation and similar programs.
Any other uses and disclosures will be made only with your written authorization. You may revoke 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 actions relying on your authorization.
You have certain rights in regards to your PROTECTED HEALTH INFORMATION, which you can exercise by presenting a written request to our Privacy Officer at the practice address listed below:
•
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 request to receive confidential communications of
PROTECTED HEALTH INFORMATION from us by alternative means or at
alternative locations.
• The right to access, inspect and
copy your PROTECTED HEALTH INFORMATION including medical records and
billing records. You must submit your request in writing to the
Privacy Officer, Mary L. Lander at 201 Ridge Street, Suite 301,
Council Bluffs, Iowa, 51503. Phone: (712) 325-0980 in order to
inspect and/or obtain a copy of your PROTECTED HEALTH INFORMATION.
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 health care professional chosen by us will conduct
reviews.
• The right to request an amendment to your
PROTECTED HEALTH INFORMATION.
• The right to receive an
accounting of disclosures of PROTECTED HEALTH INFORMATION outside of
treatment, payment and health care operations. All requests for
“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 April 14, 2003. The first
list your request in a 12-month period is free of charge, but out
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.
• 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 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 new notice provisions effective for all PROTECTED HEALTH INFORMATION that we maintain. Revisions to our Notice of Privacy Practices will be posted on the effective date and you may request a written copy of the Revised Notice from this office.
You have the right to file a formal, written complaint with us at the address below, or with the Department of Health & Human Services, Office of Civil Rights, in the event you feel your privacy rights have been violated. We will not retaliate against you for filing a complaint.
For more information about our Privacy Practices, please contact:
Privacy
Officer
Mary L. Lander
The Dermatology Center of Western Iowa
201 Ridge Street, Suite 301
Council
Bluffs, IA 51503
(712) 325-0980
For more information about HIPAA or to file a complaint:
The U.S. Department of
Health & Human Services
Office of Civil Rights
200
Independence Avenue, S.W.
Washington, D.C. 20201
877-696-6775
(toll-free)