NOTICE OF PRIVACY PRACTICES
Sandra Eason, M.Ed., LPC, NCC, RPT
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Effective Date: January 17, 2019
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 understand the importance of privacy and are committed to maintaining the confidentiality of your medical information. We record the medical care we provide and may receive such records from others. We use these records to provide or enable other healthcare providers to provide quality medical care, to obtain payment for services provided to you as allowed by your health plan, and to enable us to meet our professional and legal obligations to operate this medical practice properly. We are required by law to maintain the privacy of protected health information, to provide individuals with notice of our legal duties and privacy practices with respect to protected health information, and to notify affected individuals following a breach of unsecuredprotected health information. This notice describes how we may use and disclose your medicalinformation. It also describes your rights and our legal obligations with respect to your medicalinformation. If you have any questions about this Notice, please contact our Privacy Officer listed above.
TABLE OF CONTENTS .
A.How This Medical Practice May Use or Disclose Your Health Information
B. When This Medical Practice May Not Use or Disclose Your Health Information
C. Your Health Information Rights
1. Right to Request Special Privacy Protections
2. Right to Request Confidential Communications
3. Right to Inspect and Copy
4. Right to Amend or Supplement
5. Right to an Accounting of Disclosures
6. Right to a Paper or Electronic Copy of this Notice
D. Changes to this Notice of Privacy Practices
E. Complaints
A. How This Medical Practice May Use or Disclose Your Health Information
This medical practice collects health information about you and stores it in a chart, and on acomputer in an electronic health record/personal health record. This is your medical record. Themedical record is the property of this medical practice, but the information in the medical recordbelongs to you. The law permits us to use or disclose your health information for the followingpurposes:
1. Treatment. We use medical information about you to provide your medical care. Wedisclose medical information to our employees and others who are involved in providingthe care you need. For example, we may share your medical information with otherphysicians or other health care providers who will provide services that we do notprovide. Or we may share this information with a pharmacist who needs it to dispense aprescription to you, or a laboratory that performs a test. We may also disclose medicalinformation to members of your family or others who can help you when you are sick orinjured, or after you die.
2. Payment. We use and disclose medical information about you to obtain payment for theservices we provide. For example, we give your health plan the information it requiresbefore it will pay us. We may also disclose information to other health care providers toassist them in obtaining payment for services they have provided to you.
3. Health Care Operations. We may use and disclose medical information about you tooperate this medical practice. For example, we may use and disclose this information toreview and improve the quality of care we provide, or the competence and qualificationsof our professional staff. Or we may use and disclose this information to get your healthplan to authorize services or referrals. We may also use and disclose this information asnecessary for medical reviews, legal services and audits, including fraud and abusedetection and compliance programs and business planning and management. We mayalso share your medical information with our "business associates," such as our billingservice, that perform administrative services for us. We have a written contract with eachof these business associates that contains terms requiring them and their subcontractors toprotect the confidentiality and security of your protected health information. We may alsoshare your information with other health care providers, health care clearinghouses orhealth plans that have a relationship with you, when they request this information to helpthem with their quality assessment and improvement activities, their patient-safety 3 activities, their population-based efforts to improve health or reduce health care costs,their protocol development, case management or care-coordination activities, their reviewof competence, qualifications and performance of health care professionals, their trainingprograms, their accreditation, certification or licensing activities, or their health carefraud and abuse detection and compliance efforts. We may also share medicalinformation about you with the other health care providers, health care clearinghousesand health plans that participate with us in "organized health care arrangements"(OHCAs) for any of the OHCAs' health care operations. OHCAs include hospitals,physician organizations, health plans, and other entities, which collectively providehealth care services. A listing of the OHCAs we participate in is available from thePrivacy Official.]
4. Appointment Reminders. We may use and disclose medical information to contact andremind you about appointments. If you are not home, we may leave this information onyour answering machine or in a message left with the person answering the phone.]
5. Sign In Sheet. We may use and disclose medical information about you by having yousign in when you arrive at our office. We may also call out your name when we are readyto see you.
6. Notification and Communication With Family. We may disclose your healthinformation to notify or assist in notifying a family member, your personal representativeor another person responsible for your care about your location, your general conditionor, unless you had instructed us otherwise, in the event of your death. In the event of adisaster, we may disclose information to a relief organization so that they may coordinatethese notification efforts. We may also disclose information to someone who is involvedwith your care or helps pay for your care. If you are able and available to agree or object,we will give you the opportunity to object prior to making these disclosures, although wemay disclose this information in a disaster even over your objection if we believe it isnecessary to respond to the emergency circumstances. If you are unable or unavailable toagree or object, our health professionals will use their best judgment in communicationwith your family and others.
7. Marketing. Provided we do not receive any payment for making these communications,we may contact you to give you information about products or services related to yourtreatment, case management or care coordination, or to direct or recommend othertreatments, therapies, health care providers or settings of care that may be of interest toyou. We may similarly describe products or services provided by this practice and tellyou which health plans this practice participates in. We may also encourage you tomaintain a healthy lifestyle and get recommended tests, participate in a diseasemanagement program, provide you with small gifts, tell you about government sponsoredhealth programs or encourage you to purchase a product or service when we see you, forwhich we may be paid. Finally, we may receive compensation which covers our cost ofreminding you to take and refill your medication, or otherwise communicate about a drugor biologic that is currently prescribed for you. We will not otherwise use or discloseyour medical information for marketing purposes or accept any payment for othermarketing communications without your prior written authorization. The authorizationwill disclose whether we receive any compensation for any marketing activity youauthorize, and we will stop any future marketing activity to the extent you revoke thatauthorization.
8. Sale of Health Information. We will not sell your health information without your priorwritten authorization. The authorization will disclose that we will receive compensationfor your health information if you authorize us to sell it, and we will stop any future salesof your information to the extent that you revoke that authorization. 4
9. Required by Law. As required by law, we will use and disclose your health information,but we will limit our use or disclosure to the relevant requirements of the law. When thelaw requires us to report abuse, neglect or domestic violence, or respond to judicial oradministrative proceedings, or to law enforcement officials, we will further comply withthe requirement set forth below concerning those activities.
10. Public Health. We may, and are sometimes required by law, to disclose your healthinformation to public health authorities for purposes related to: preventing or controllingdisease, injury or disability; reporting child, elder or dependent adult abuse or neglect;reporting domestic violence; reporting to the Food and Drug Administration problemswith products and reactions to medications; and reporting disease or infection exposure.When we report suspected elder or dependent adult abuse or domestic violence, we willinform you or your personal representative promptly unless in our best professionaljudgment, we believe the notification would place you at risk of serious harm or wouldrequire informing a personal representative we believe is responsible for the abuse orharm.
11. Health Oversight Activities. We may, and are sometimes required by law, to discloseyour health information to health oversight agencies during the course of audits,investigations, inspections, licensure and other proceedings, subject to the limitationsimposed by law.
12. Judicial and Administrative Proceedings. We may, and are sometimes required by law,to disclose your health information in the course of any administrative or judicialproceeding to the extent expressly authorized by a court or administrative order. We mayalso disclose information about you in response to a subpoena, discovery request or otherlawful process if reasonable efforts have been made to notify you of the request and youhave not objected, or if your objections have been resolved by a court or administrativeorder.
13. Law Enforcement. We may, and are sometimes required by law, to disclose your healthinformation to a law enforcement official for purposes such as identifying or locating asuspect, fugitive, material witness or missing person, complying with a court order,warrant, grand jury subpoena and other law enforcement purposes.
14. Public Safety. We may, and are sometimes required by law, to disclose your healthinformation to appropriate persons in order to prevent or lessen a serious and imminentthreat to the health or safety of a particular person or the general public.
15. Specialized Government Functions. We may disclose your health information formilitary or national security purposes or to correctional institutions or law enforcementofficers that have you in their lawful custody.
16. Workers’ Compensation. We may disclose your health information as necessary tocomply with workers’ compensation laws. For example, to the extent your care iscovered by workers' compensation, we will make periodic reports to your employer aboutyour condition. We are also required by law to report cases of occupational injury oroccupational illness to the employer or workers' compensation insurer.
17. Change of Ownership. In the event that this medical practice is sold or merged withanother organization, your health information/record will become the property of the newowner, although you will maintain the right to request that copies of your healthinformation be transferred to another physician or medical group. 5
18. Breach Notification. In the case of a breach of unsecured protected health information,we will notify you as required by law. If you have provided us with a current e-mailaddress, we may use e-mail to communicate information related to the breach. In somecircumstances our business associate may provide the notification. We may also providenotification by other methods as appropriate. [Note: Only use e-mail notification if youare certain it will not contain PHI and it will not disclose inappropriate information. Forexample if your e- mail address is "digestivediseaseassociates.com" an e-mail sent withthis address could, if intercepted, identify the patient and their condition.]
19. Psychotherapy Notes. We will not use or disclose your psychotherapy notes withoutyour prior written authorization except for the following: 1) use by the originator of thenotes for your treatment, 2) for training our staff, students and other trainees, 3) to defendourselves if you sue us or bring some other legal proceeding, 4) if the law requires us todisclose the information to you or the Secretary of HHS or for some other reason, 5) inresponse to health oversight activities concerning your psychotherapist, 6) to avert aserious and imminent threat to health or safety, or 7) to the coroner or medical examinerafter you die. To the extent you revoke an authorization to use or disclose yourpsychotherapy notes, we will stop using or disclosing these notes.
B. When This Medical Practice May Not Use or Disclose Your Health Information
Except as described in this Notice of Privacy Practices, this medical practice will, consistent withits legal obligations, not use or disclose health information which identifies you without yourwritten authorization. If you do authorize this medical practice to use or disclose your healthinformation for another purpose, you may revoke your authorization in writing at any time.
C. Your Health Information Rights
1. Right to Request Special Privacy Protections. You have the right to request restrictionson certain uses and disclosures of your health information by a written request specifying what information you want to limit, and what limitations on our use or disclosure of thatinformation you wish to have imposed. If you tell us not to disclose information to yourcommercial health plan concerning health care items or services for which you paid for infull out-of-pocket, we will abide by your request, unless we must disclose the informationfor treatment or legal reasons. We reserve the right to accept or reject any other request,and will notify you of our decision.
2. Right to Request Confidential Communications. You have the right to request that youreceive your health information in a specific way or at a specific location. For example,you may ask that we send information to a particular e-mail account or to your workaddress. We will comply with all reasonable requests submitted in writing which specifyhow or where you wish to receive these communications.
3. Right to Inspect and Copy. You have the right to inspect and copy your healthinformation, with limited exceptions. To access your medical information, you mustsubmit a written request detailing what information you want access to, whether you wantto inspect it or get a copy of it, and if you want a copy, your preferred form and format.We will provide copies in your requested form and format if it is readily producible, orwe will provide you with an alternative format you find acceptable, or if we can’t agreeand we maintain the record in an electronic format, your choice of a readable electronicor hardcopy format. We will also send a copy to any other person you designate inwriting. We will charge a reasonable fee which covers our costs for labor, supplies,postage, and if requested and agreed to in advance, the cost of preparing an explanation 6 or summary. We may deny your request under limited circumstances. If we deny yourrequest to access your child's records or the records of an incapacitated adult you arerepresenting because we believe allowing access would be reasonably likely to causesubstantial harm to the patient, you will have a right to appeal our decision. If we denyyour request to access your psychotherapy notes, you will have the right to have themtransferred to another mental health professional.
4. Right to Amend or Supplement. You have a right to request that we amend your healthinformation that you believe is incorrect or incomplete. You must make a request toamend in writing, and include the reasons you believe the information is inaccurate orincomplete. We are not required to change your health information, and will provide youwith information about this medical practice's denial and how you can disagree with thedenial. We may deny your request if we do not have the information, if we did not createthe information (unless the person or entity that created the information is no longeravailable to make the amendment), if you would not be permitted to inspect or copy theinformation at issue, or if the information is accurate and complete as is. If we deny yourrequest, you may submit a written statement of your disagreement with that decision, andwe may, in turn, prepare a written rebuttal. All information related to any request toamend will be maintained and disclosed in conjunction with any subsequent disclosure ofthe disputed information.
5. Right to an Accounting of Disclosures. You have a right to receive an accounting ofdisclosures of your health information made by this medical practice, except that thismedical practice does not have to account for the disclosures provided to you or pursuantto your written authorization, or as described in paragraphs 1 (treatment), 2 (payment), 3(health care operations), 6 (notification and communication with family) and 18(specialized government functions) of Section A of this Notice of Privacy Practices ordisclosures for purposes of research or public health which exclude direct patientidentifiers, or which are incident to a use or disclosure otherwise permitted or authorizedby law, or the disclosures to a health oversight agency or law enforcement official to theextent this medical practice has received notice from that agency or official thatproviding this accounting would be reasonably likely to impede their activities.
6. Right to a Paper or Electronic Copy of this Notice. You have a right to notice of ourlegal duties and privacy practices with respect to your health information, including aright to a paper copy of this Notice of Privacy Practices, even if you have previouslyrequested its receipt by e-mail.
If you would like to have a more detailed explanation of these rights or if you would like toexercise one or more of these rights, contact our Privacy Officer listed at the top of this Notice ofPrivacy Practices.
D. Changes to this Notice of Privacy Practices
We reserve the right to amend this Notice of Privacy Practices at any time in the future. Untilsuch amendment is made, we are required by law to comply with the terms of this Noticecurrently in effect. After an amendment is made, the revised Notice of Privacy Protections willapply to all protected health information that we maintain, regardless of when it was created orreceived. We will keep a copy of the current notice posted in our reception area, and a copy willbe available at each appointment. 7
E. Complaints
Complaints about this Notice of Privacy Practices or how this medical practice handles yourhealth information should be directed to our Privacy Officer listed at the top of this Notice ofPrivacy Practices.
If you are not satisfied with the manner in which this office handles a complaint, you may submita formal complaint to:
[Virginia Department of Social Services 801 E. Main Street, Richmond, VA 23219-the localDHHS Office of Civil Rights]
OCRMail@hhs.gov
The complaint form may be found at www.hhs.gov/ocr/privacy/hipaa/complaints/hipcomplaint.pdf. You will not be penalized in anyway for filing a complaint.