HIPAA NOTICE OF PRIVACY PRACTICES
Effective Date: April 14, 2003
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.
We (Rocky Mountain Pediatric Endocrinology: RMPE) understand that medical information about you is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive to provide quality care and to comply with legal requirements. This notice applies to all of the records of your care that we maintain, whether created by your doctor, health care provider (HCP), office staff, or acquired from another HCP.
We are required by law to maintain the privacy of, and provide individuals with, this notice of our legal duties and privacy practices with respect to protected health information (PHI). If you have any objections to this form, please ask to speak with our Privacy Officer in at our main office number (below).
This Notice of Privacy Practices describes how we may use and disclose your PHI for treatment, payment, health care operations, or other purposes that are permitted or required by law. It also describes your rights to access and control your PHI. PHI is personal information about you, including demographic information, that may identify you. It relates to your past, present, or future physical or mental health or condition and related health services.
Uses and Disclosures of PHI
Your PHI may be used and disclosed by your health care provider (HCP), office staff, and other third party agents that are involved in your care and treatment for the purpose of providing health services to you, to pay your health care bills, to support the operation of the HCP’s practice, and any other use required by law.
We will use and disclose your PHI to provide, coordinate, or manage your health care and any related services. This includes coordination or management of your health care with a third party. For example, your PHI may be provided to another physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.
Your PHI will be used, as needed, to obtain payment for your health care services. For example, obtaining approval for a stimulation test may require that your relevant PHI be disclosed to the health plan.
We may use or disclose your PHI in order to support the business activities of your provider’s practice. These activities include, but are not limited to, quality assurance, utilization review, medical review, internal auditing, accreditation, certification, licensing, training of HCPs and/or students, and conducting or arranging for other business activities. Our waiting rooms are shared, and your name will be called when the provider is ready for your appointment. If you object to this manner of notification, please tell us. We may also use or disclose your PHI to contact you to remind you for appointment reminders or to tell you about or recommend possible treatment options, alternatives, health-related benefits, or services that may be of interest to you.
Uses and Disclosures that are required or permitted without consent or authorization
a) Research: Under certain circumstances, we may use or disclose your PHI to approved clinical research studies. While most clinical research studies require specific patient consent, there are some instances where a retrospective record review with no patient contact may be conducted by such researchers.
b) Regulatory Agencies: We may use or disclose your PHI as required by law to government and certain private health oversight agencies including, but not limited to, public health issues, child abuse or neglect, and communicable diseases.
c) Law Enforcement/Litigation: We may use or disclose your PHI for law enforcement purposes as required by law or in response to a court order.
d) Workers’ Compensation: We may use or disclose your PHI for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illnesses.
e) Military/Veterans: We may use or disclose your PHI as required by military command authorities.
f) Coroners, Funeral Directors, Organ Donation Programs: We may use or disclose your PHI to these entities, subject to certain requirements.
Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements. Other permitted and required uses and disclosures will be made only with your consent, authorization, or opportunity to object unless required by law.
You make revoke this authorization at any time, in writing, except to the extent that your HCP has taken an action in reliance on the use or disclosure indicated in the authorization.
Your rights regarding medical information about you.
Following is a statement of your rights with respect to your PHI. Although all records concerns your treatment obtained at RMPE are the property of RMPE, you have the following rights concerning your health information.
Right to inspect and copy your PHI. Under Federal Law, however, you may not inspect or copy the following records: psychotherapy notes, information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and PHI that is subject to law that prohibits access to PHI. A form for this purpose may be obtained at the registration desk or by calling the main office number. If you request copies, we may charge a fee for the cost of copying, mailing, or other related supplies.
Right to request a restriction of your PHI. This means you may ask us not to use or disclose any part of your PHI for the purposes or treatment, payment, or healthcare operations. You may also request that any part of your PHI not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in the Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply. Your HCP is not required to agree to a restriction that you may request. If the HCP believes it is in your best interest to permit use and disclosure of your PHI, then your PHI will not be restricted. You have the right to transfer to a different HCP.
Right to request to that medical information about you be communicated to you in a confidential manner. This includes sending mail to an address other than your home. You may request this by notifying us in writing of the specific way or location for us to use to communicate with you.
Right to have your HCP amend your PHI. If you believe that information in your record is incorrect or if important information is missing, you have the right to request that we correct the records by submitting a request in writing that provides your reason for requesting the amendment. We may deny your request to amend a record if the information was not created by us, if it is not part of the medical information obtained by us, or if we determine that the record is accurate. You may appeal in writing a decision by us not to amend a record.
We reserve the right to change the terms of this notice and will inform you by mail of any changes. You then have the right to object or withdraw as provided in this notice.
Complaints and Concerns
If you are concerned that your privacy rights have been violated or you disagree with a decision we made about access to your records, you may contact our Privacy Officer at the main office number (below). You may also send a written complaint to the U.S. Department of Health and Human Services Office of Civil Rights. Our privacy officer can give you the address. Under no circmstances will you be penalized or retaliated against for filing a complaint or concern.