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NOTICE OF PRIVACY PRACTICES
Also available in MS Word
2000 and as PDF.
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 effective
date of this Privacy Notice is April
14, 2003.
Revision Date(s) ________________________________
This Notice of Privacy
Practices is being provided to you as a requirement of the privacy
regulations issued under the Health Insurance Portability and
Accountability Act of 1996 (HIPAA).
This notice describes how Bayview
Physician Services, PC (BAYVIEW) and NowCare Physicians, PC (NOWCARE) may
use and disclose medical information about you 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 protected health
information about you. Your personal health information (i.e., "protected
health information" or "PHI" for any purposes of HIPAA)
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. We
are required by law to maintain the privacy of your PHI, and we must
abide by the terms of this notice.
We will use or disclose your PHI in ways consistent
with what is stated in our Privacy Notice.
We reserve the right to
change the terms of this Privacy Notice and to make a new Privacy Notice
effective for all PHI we maintain.
In the event of a change to our Privacy Notice, we will provide
you with the new Privacy Notice upon request.
We have designated a
Privacy Officer whom you may consult to ask questions and bring up
concerns you might have about your PHI and how it is handled.
Information on contacting the Privacy Officer for this facility
is located on the last page of this document.
In this notice we provide descriptions of the
different ways we may use and disclose your personal health information.
In some cases, an example is provided to describe the types of
uses and disclosures of your PHI that may be made by our organization;
however, these examples are not intended to be inclusive of all the ways
we may use your PHI.
ACKNOWLEDGMENT OF RECEIPT OF THIS PRIVACY NOTICE
You are receiving our
current Privacy Notice and are asked to sign an acknowledgment that you
have received it. You may
provide the signed acknowledgment by:
- signing the attached “Acknowledgment of Receipt”
for the Privacy Notice and returning it to the reception desk or a
nurse, physician or other staff member, or
- by mailing it to the address found on the last page of
this document.
- If, after April 14, 2003, your initial contact with
our office is through electronic mail, you will be asked to
acknowledge receipt of this Privacy Notice by replying to our
electronic message that contains the Privacy Notice and typing the
following in your reply message:
"I acknowledge receipt of the Privacy Notice", and
including the date and your name.
HOW WE
MAY USE AND DISCLOSE PHI ABOUT YOU
The following categories
describe different ways that we use and disclose PHI.
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 and disclose your PHI as reasonably necessary to provide for
your treatment. We do not
need to obtain your permission, written or otherwise, for us to do this.
We may disclose PHI about you to doctors, nurses, technicians or
other healthcare personnel who are involved in taking care of you.
For example, a specialist who is providing care to you may need
your medical history to better evaluate your medical condition.
For Payment. We
may use and disclose PHI about you so that the treatment and services
you receive may be billed to and payment may be collected from you, an
insurance company or a third party.
For example, we may need to give your health plan information
about a procedure performed in our office so your health plan will pay
us or reimburse you for the procedure.
We may also tell your health plan about a treatment you are going
to receive to obtain prior approval or to determine whether your plan
will cover the treatment.
For Health Care Operations.
We may use and disclose PHI about you for healthcare
operations. These uses and
disclosures are necessary to run our office and make sure that all
individuals receive quality care. Some
examples of how we may use your PHI performing day to day tasks include
utilizing a sign-in sheet at the front desk or calling you by name from
the waiting room. We also
may use PHI to review our treatment and services and to evaluate the
performance of our staff in caring for you.
As another part of
health care operations, we may use and disclose PHI about you to our
business associates. Our
business associates, such as transcription services, collection agencies
and answering services perform services on behalf of our practice.
Our business associates who have access to PHI agree to protect
the privacy of your personal health information.
Appointment Reminders, Test Results. As a part of our
health care operations, we may use and disclose PHI to contact
you as a reminder that you have an appointment for treatment or medical
care at our office. We may
leave a message on an answering machine or voicemail system including
your name, the name of the physician in which you have an appointment,
the practice name and a reminder to bring your co-payment, insurance
referral and/or medical records or x-rays to your appointment.
BAYVIEW/NOWCARE may also send appointment reminder cards
or recall notices to the address you provided to us during registration
with your name, the name of the physician in which you have an
appointment, the practice name and a reminder to bring your co-payment,
insurance referral and/or medical records or x-rays to your appointment.
We may contact you to
discuss treatment and/or test results.
If you are not available, we may leave a message using your name,
the name of your physician and the practice name so you may return our
call.
Individuals Involved in Your Care or Payment for Your Care.
We may release PHI about you to a friend or family member who
is involved in your medical care, and/or has transported you to or from
our office. We may also
give information to someone who helps pay for your care.
We may also tell your family or friends your condition and that
you are in a hospital.
Research. Under
certain circumstances, we may use and disclose PHI about you for
research purposes. For
example, a research project may involve comparing the health and
recovery of all patients who received one medication to those who
received another, for the same condition.
All research projects, however, are subject to a special approval
process. We will almost
always ask for your specific permission if the researcher will have
access to your name, address or other information that reveals who you
are, or will be involved in your care.
As
Required By Law. We
will disclose PHI about you when required to do so by federal, state or
local law.
To Avert a Serious Threat to Health or Safety.
We may use and disclose PHI about you when necessary to
prevent a serious threat to your health and safety or the health and
safety of the public or another person. Any disclosure, however, would only be to someone able to
help prevent the threat.
Organ and Tissue Donation. If
you are an organ donor, we may release PHI to organizations that handle
organ procurement or eye or tissue transplantation or to an organ
donation bank, as necessary to facilitate organ or tissue donation and
transplantation.
Military and Veterans. If
you are a member of the armed forces, we may release PHI about you as
required by military command authorities.
We may also release PHI about foreign military personnel to the
appropriate foreign military authority.
Workers' Compensation. We
may release PHI about you for workers' compensation or similar programs.
These programs provide benefits for work‑related injuries
or illness.
Public
Health Risks. We
may disclose PHI about you for public health activities.
These activities generally include the following:
·
to prevent or control disease, injury or disability;
·
to report births and deaths;
·
to report child abuse or neglect;
·
to report reactions to medications or problems with
products;
·
to notify people of recalls of products they may be using;
·
to notify a person who may have been exposed to a disease
or may be at risk for contracting or spreading a disease or condition;
·
to notify the appropriate government authority if we
believe a patient has been the victim of abuse, neglect or domestic
violence.
Health Oversight Activities.
We may disclose PHI to a health oversight agency for
activities authorized by law. These
oversight activities include, for example, audits, investigations,
inspections, and licensure. These
activities are necessary for the government to monitor the health care
system, government programs, and compliance with civil rights laws.
Lawsuits and Disputes. If
you are involved in a lawsuit or a dispute, we may disclose PHI about
you in response to a court or administrative order.
We may also disclose PHI about you in response to a subpoena,
discovery request, or other lawful process by someone else involved in
the dispute, but only if efforts have been made to tell you about the
request or to obtain an order protecting the information requested.
Law
Enforcement. We may
release PHI if asked to do so by a law enforcement official:
·
In response to a court order, subpoena, warrant, summons
or similar process;
·
To identify or locate a suspect, fugitive, material
witness, or missing person;
·
About the victim of a crime if, under certain limited
circumstances, we are unable to obtain the person's agreement;
·
About a death we believe may be the result of criminal
conduct;
·
About criminal conduct at our office; and
·
In emergency circumstances to report a crime; the location
of the crime or victims; or the identity, description or location of the
person who committed the crime.
Coroners, Medical Examiners and Funeral Directors.
We may release PHI to a coroner or medical examiner.
This may be necessary, for example, to identify a deceased person
or determine the cause of death. We
may also release PHI about an individual to funeral directors as
necessary to carry out their duties.
National Security and Intelligence Activities.
We may release PHI about you to authorized federal officials
for intelligence, counterintelligence, and other national security
activities authorized by law.
Protective Services for the President and Others.
We may disclose PHI about you to authorized federal officials
so they may provide protection to the President, other authorized
persons or foreign heads of state or conduct special investigations.
Inmates. If you
are an inmate of a correctional institution or under the custody of a
law enforcement official, we may release PHI about you to the
correctional institution or law enforcement official.
This release would be necessary (1) for the institution to
provide you with health care; (2) to protect your health and safety or
the health and safety of others; or (3) for the safety and security of
the correctional institution.
Pursuant to an Authorization. We will require a signed authorization form before we
disclose your PHI to a third party for reasons other than those listed
above. We will retain a
copy of any signed authorization you give us that is attached to a
request to us for your PHI. We
will also keep a record of when, to whom and what we provided in
response to the request for disclosure.
If you have signed an authorization for us to use or disclose
your PHI, and decide you want to revoke the authorization, you have the
right to revoke it. You
must revoke the specific authorization in writing and deliver it to the
Privacy Officer, whose address is located at the end of this document,
before your revocation is effective.
Once we receive the revocation, or have actual knowledge that you
have revoked the authorization, we will make a note of it to assure that
we do not make future disclosures pursuant to your original
authorization.
YOUR RIGHTS
REGARDING PHI ABOUT YOU
You have the following rights regarding PHI we
maintain about you:
Right to Inspect and Copy. You
have the right to inspect and copy PHI that may be used to make
decisions about your care. Usually,
this includes medical and billing records, but does not include
psychotherapy notes.
To inspect and copy PHI
that may be used to make decisions about you, you must submit your
request in writing to the Privacy Officer. (Address located at the end
of this document.) If you
request a copy of the information, we may charge a fee for the costs of
copying, mailing or other supplies associated with your request.
We may deny your request to inspect and copy in
certain very limited circumstances.
If you are denied access to PHI, you may request that the denial
be reviewed. Another
licensed health care professional chosen by us 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.
Right to Amend. If
you feel that PHI we have about you is incorrect or incomplete, you may
ask us to amend the information. You
have the right to request an amendment for as long as the information is
kept by or for BAYVIEW/NOWCARE.
To request an amendment,
your request must be made in writing and submitted to the Privacy
Officer. (Address located at the end of this document.)
In addition, you must provide a reason that supports your
request.
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:
·
Was not created by us, unless the person or entity that
created the information is no longer available to make the amendment;
·
Is not part of the PHI kept by or for us;
·
Is not part of the information which you would be
permitted to inspect and copy; or
·
Is accurate and complete.
Right to an Accounting of Disclosures. You have the right to request an accounting of certain
disclosures of your PHI that we have made.
(We do not have to provide an accounting of disclosures made for
treatment, payment or healthcare operations, or pursuant to a signed
authorization or where you did not orally deny authorization, or of
certain disclosures required by law.)
To request this list or
accounting of disclosures, you must submit your request in writing to
the Privacy Officer. (Address located at the end of this document.)
Your request must state a time period which may not be longer
than six years and may not include dates before April 14, 2003.
Your request should indicate in what form you want the list (for
example, on paper or electronically).
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.
Right to Request Restrictions.
You have the right to request a restriction or limitation on
the PHI we use or disclose about you for treatment, payment or health
care operations. You also
have the right to request a limit on the PHI we disclose about you to
someone who is involved in your care or the payment for your care, like
a family member or friend. For
example, you could ask that we not use or disclose information about a
procedure you had.
We are not required to agree to
your request. If we
do agree, we will comply with your request unless the information is
needed to provide you emergency treatment.
To request restrictions,
you must make your request in writing to the Privacy Officer. (Address
located at the end of this document.)
In your request, you must tell us (1) what information you want
to limit; (2) whether you want to limit our use, disclosure or both; and
(3) to whom you want the limits to apply, for example, disclosures to
your spouse.
Right to Request Confidential Communications.
You have the right to request that we communicate with you
about medical matters in a certain way or at a certain location.
For example, you can ask that we only contact you at work or by
mail.
To request confidential
communications, you must make your request in writing to the Privacy
Officer. (Address located
at the end of this document.) We
will not ask you the reason for your request.
We will accommodate all reasonable requests.
Your request must specify how or where you wish to be contacted.
Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice.
You may ask us to give you a copy of this notice at any time.
Even if you have agreed to receive this notice electronically,
you are still entitled to a paper copy of this notice.
You may obtain a copy of this notice at our
website, www.BayviewPhysicians.com.
To obtain a paper copy
of this notice, send your written request to the Privacy Officer at the
address located at the end of this document.
Our current Privacy Notice will also be posted
in our office for you to review.
COMPLAINTS
If you believe your
privacy rights have been violated, you may file a complaint with us.
To file a complaint with us, contact the Privacy
Officer at (757) 686-3500. All
complaints must be submitted in writing to the Privacy Officer at 3241
Western Branch Boulevard, Chesapeake, Virginia, 23321.
You also have the right
to complain to the Secretary of the Department of Health and Human
Services. The Secretary’s
contact information is as follows:
Office of Civil Rights,
Region III
US Department of Health
and Human Services
150 S. Independence Mall
West, Suite 372
Public Ledger Building
Philadelphia, PA
19106-9111.
You will not
be penalized for filing a complaint.
CONTACT INFORMATION
Contact information for this facility is:
Phone: 757 609-3380
Address:
Compliance Officer
Chesapeake Sleep
Medicine
300 Medical Parkway
Suite 208
Chesapeake, VA 23320
END OF DOCUMENT
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