Our practice is
dedicated to maintaining the privacy of health information that identifies our
patients, or where there is a reasonable basis to believe that the information
can be used to identify a patient. In conducting the business of our practice,
we create records regarding you and the treatment and services we provide to
you. This information is called “protected health information” (PHI). We are
required by law to maintain the confidentiality of PHI that identifies you. We
are also 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. We
also are required to abide by the terms of our Notice of Privacy Practices that
is currently in effect. In this notice we describe the ways that we may use and
disclose your PHI, your privacy rights in your PHI and our obligations
concerning the use and disclosure of your PHI.
We are permitted to
use and disclose your PHI for treatment, payment and health care operations. The
following are descriptions and examples of how we use your PHI for those
purposes. Not ever use or disclosure in a category will be listed, however, all
ways we are permitted to use and disclose information will fall within one of
the categories.
Treatment:
We may use your PHI to treat you. For example, we may use your PHI to
write a prescription, order X-rays or laboratory tests, prescribe therapy, or
for other health care services. Many of the people who work for or in our
practice, including, our physicians, physician assistants, nurse practitioners,
nurses, medical students or other training health care professionals may use or
disclose your PHI in order to treat you or to assist others in 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.
Payment:
We may use and disclose your PHI so that the treatment and services we
provide you may be billed to and payment may be collected from you, an insurance
company or a third party. For example, we may contact your health insurer to
certify that you are eligible for 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. We may disclose your PHI to other health care providers and entities to
assist in their billing and collection efforts.
Health Care
Operations:
We may use and disclose your PHI to evaluate and promote the quality of
care and service provided to you and to support regular business activities. For
example, we may use PHI for evaluating the performance of staff, business
planning and financial management of our company. We may disclose your PHI to
other health care providers and entities to assist in their health care
operations.
Your PHI may also be
used:
·
To remind you of an
appointment, to respond to your phone call or to inform you of test results.
·
To inform you of
health related benefits and services that may be of interest to you.
·
To inform you of
potential treatment options or alternatives.
·
To disclose
information to family members, friends or other representatives who are involved
in your care or payment for your care, provided you do not object. For example,
a parent or guardian, in their absence, may ask that a babysitter take their
child to an appointment. In this example, the babysitter may have access to the
child’s PHI.
·
When required to do
so by federal, state or local law
There are also
certain special circumstances in which we may use or disclose your PHI without
your authorization as follows:
·
Public health
reporting purposes such as reporting communicable and other diseases and
injuries permitted by law, victims of abuse or neglect, work-related illnesses
or maintaining vital records, such as births and deaths.
·
For health oversight
agencies for activities authorized by law including investigations, inspections,
audits, surveys, licensure and disciplinary actions; civil, administrative and
criminal procedures or action; or other activities necessary for the government
to monitor government programs, compliance with civil rights and the health care
system in general.
·
For lawsuits or
similar proceedings. In response to a subpoena or court order.
·
If asked to do so by
law enforcement officials regarding a crime.
·
For organ and tissue
donations and transplantations if you are an organ donor.
·
For medical
examiners, coroners and funeral directors to identify a deceased individual, the
cause of death or other aspects of their job.
·
For research
purposes in certain limited circumstances approved under federal rules.
·
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.
·
If required by the
appropriate authorities of members of the
·
For specialized
government functions such as national security and intelligence activities.
·
If you are an inmate
or under the custody of a law enforcement official to provide health care
services to you, for the safety and security of the institution, and to protect
your health and safety or the health and safety of other individuals.
·
For workers
compensation and similar programs.
·
For disclosure to
the Secretary of the US Dept. of Health and Human Services when requested by the
Secretary to review our compliance of the HIPAA Privacy rule.
You have certain
rights under federal privacy standards regarding the PHI we maintain about you:
1.
You have the right to request that we 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.
2.
You have the right to request a restriction in our use or disclosure of
your PHI for treatment, payment or health care operations. In addition, you have
the right to request that we restrict our disclosure of your PHI to 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.
3.
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 records and billing
records. We may deny your access to specific information, in certain limited
circumstances, as allowed by law. We require that your request be made in
writing to our Privacy Officer. We may charge a fee for the costs of copying,
mailing, labor and supplies associated with your request.
4.
You may ask us to amend your PHI 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. You must provide us with a reason that supports
your request for amendment. Your request for amendment must be made in writing
and to our Privacy Officer. We may deny your request for amendment if it is our
opinion that the information is (a) accurate and complete; (b) not part of the
PHI kept by or for our 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.
You have the right to request an “accounting of disclosures” of your PHI
during a specified period of up to six years, excluding dates prior to April 14,
2003. The accounting does not include disclosures made for treatment, payment,
health care operations, disclosures required by law and other disclosures as
referred to in this notice. The first request in a 12-month period is free, but
we may charge you for our reasonable costs for additional requests in the same
12-month period.
6.
You have the right to receive a paper copy of this notice.
7.
If you believe your privacy rights have been violated, you may file a
complaint with our practice or with the Secretary of the US Dept. of Health and
Human Services. To file a complaint with our practice you must contact our
Privacy officer at the address listed below. All complaints must be in writing.
You will not be penalized for filing a complaint.
8.
Our practice will 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 may be revoked at any time in writing.
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 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 will 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.
If you would like
further information concerning our privacy practices, have a request or would
like to file a complaint, as described above, please contact:
Privacy Officer:
James B. Shea, Administrator
4141
Phone: (605)
341-9835
Toll Free:
800-253-5876
Email:
jshea@nssa.com
(© 8/24/07)
I acknowledge that I have received a copy of Neurosurgical & Spinal Surgery Associates, P.C.'s
Notice of Privacy Practices.
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Patient or Patient Personal Representative Signature
__________________________________________________________________________
Patient Name
__________________________________________________________________________
Date