GCPS Privacy Notice
This notice describes how medical information about you may be used and disclosed and how you can get access to this information.
Our practice is dedicated to maintaining the privacy of your individually identifiable health information (IIHI). In conducting our business, we will create records regarding you and the treatment and services we provide to you. We are required by law to maintain the confidentiality of health information that identifies you. We also are 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 IIHI. By federal and state law, we must follow the terms of the notice of privacy practices that we have in effect at the time.
Examples of uses of your health information for treatment purposes:
A nurse obtains treatment information about you and records it in a health record. During the course of your treatment, Dr. Pisarski determines if he will need to consult with another specialist in the area. He will share the information with such specialist and obtain his/her input.
Example of use of your health information for payment purposes:
We submit requests for payment to your health insurance company. The health insurance company or business associate helping us obtain payment requests information from us regarding your medical care given. We will provide information to them about you and the care given.
Example of Use of Your Information for Health Care Operations:
Our practice may use and disclose your IIHI to operate our business. As examples of the ways in which we may use and disclose your information for our operations, our practice may use your IIHI to evaluate the quality of care you received from us, or to conduct cost-management and business planning activities for our practice. We may disclose your IIHI to other health care providers and entities to assist in their health care operations.
Your Health Information Rights
The health and billing records we maintain are the physical property of Gulf Coast Plasitc Surgery. You have the following rights with respect to your Protected Health Information.
Request a restriction on certain uses and disclosures of your health information by delivering the request in writing to our office - we are not required to grant the request but we will comply with any request granted; except when otherwise requested by law, in emergencies, or when the information is necessary to treat you. Your request must describe in a clear and concise fashion:
a) information you wish restricted
b) whether you are requesting to limit our practice’s use, disclosure or both;
c) and to who you want the limits to apply.
Obtain a paper copy of the Notice of Privacy Practices for Protected Health Information by making a request at our office.Right to inspect and obtain a copy of your health record and billing record - you may exercise this right by delivering the request in writing to our office using the form we provide to you upon request. Our office may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial. Our office may charge a fee for the cost of copying, mailing, labor and supplies associated with your request.
Right to request that your health care record be amended to correct incomplete or incorrect information by delivering a written request to our office/hospital using the form we provide to you upon request. You must provide us with a reason that support you request for amendment. (The physician or other health care provider is not required to make such amendments); you may file a statement of disagreement if your amendment is denied, and require that the request for amendment and any denial be attached in all future disclosures of your protected health information. Our practice will deny your request if you fail to submit your request (and the reason supporting your request) in writing. Also, we may deny your request if you ask us to amend information that is in our opinion:
a) accurate and complete
b) not part of the IIHI kept by the practice.
c) not part of the IIHI 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.
Right to receive an accounting of disclosures of your health information as required to be maintained by law by delivering a written request to our office using the form we provide to you upon request. An accounting will not include internal uses of information for treatment, payment, or operations, disclosures made to you or made at your request, or disclosures made to family members or friends in the course of providing care. All requests for an “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 you request within a 12-month period is free of charge, but our practice may charge you for additional lists with in the same 12-month period. Our practice will notify you of the costs involved with additional requests, and you may withdraw before you incur any cost.
Right to request that our practice 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. In order to request a type of confidential communication, you must make a written request to Linda Morris or Carly New, at 979-297-9289 specifying that requested method of contact, or the location where you wish to be contacted. Our practice will accommodate reasonable requests. You do not need to give a reason for your request.
Right to file a complaint. If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services. All complaints must be submitted in writing. You will not be penalized for filing a compliant.
Right to provide an authorization for other uses and disclosures. 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 regarding the use and disclosure of you IIHI may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose you IIHI for the reasons described in the authorization. Please note, we are required to retain records of your care.
You have the right to review this Notice before signing the consent authorizing use and disclosure of your protected health information for treatment, payment, and health care operations purposes.
The office is required to:
• Maintain the privacy of your health information as required by law;
• Provide you with a notice as to our duties and privacy practices as to the information we collect and maintain about you
• Abide by the terms of this Notice;
• Notify you if we cannot accommodate a requested restriction or request;
• Accommodate your reasonable requests regarding methods to communicate health information with you.
• Accommodate your request for an accounting of disclosures.
We reserve the right to amend, change, or eliminate provisions in our privacy practices and access practices and to enact new provisions regarding the protected health information we maintain. If our information practices change, we will amend our Notice. You are entitled to receive a revised copy of the Notice by calling and requesting a copy of our “Notice” or by visiting our office and picking up a copy.
To request information or file a complaint:
If you have questions, would like additional information, or want to report a problem regarding the handling of your information, you may contactLinda Morris, at 979-297-9289. Additionally, if you believe your privacy rights have been violated, you may file a written complaint at our office by delivering the written complaint to Linda Morris. You may also file a complaint by mailing it or e-mailing it to the Secretary of Health and Human Services.
• We cannot, and will not, require you to waive the right to file a complaint with the Secretary of Health and Human Services (HHS) as a condition of receiving treatment from the office.
• We cannot, and will not, retaliate against you for filing a complaint with the Secretary of Health and Human Services.
Following is a List of Other Uses and Disclosures allowed by the Privacy Rule
We may contact you to provide you with appointment reminders, with information about treatment alternatives, or with information about other health-related benefits and services that may be of interest to you. We may contact you as part of a fund raising effort.
Notification – Opportunity to Agree or Object
• Unless you object we may use or disclose your protected health information to notify, or assist in notifying, a family member, personal representative, or person responsible for your care, about your location, your general condition, and/or your death.
• Communication with Family - Using our best judgment, we may disclose to a family member, other relative, close personal friend, or any other person you identify, health information relevant to that person's involvement in your care or in payment for such care if you do not object or in an emergency.
• We may use and disclose your protected health information to assist in disaster relief efforts.
Oppourtunites to Agree or Object Not Required
PUBLIC HEALTH ACTIVITIES
Controlling Disease - As required by law, we may disclose your protected health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.
Child Abuse & Neglect - We may disclose protected health information to public authorities as allowed by law to report child abuse or neglect.
Food and Drug Administration (FDA) - We may disclose to the FDA your protected health information relating to adverse events with respect to food, supplements, products and product defects, or post-marketing surveillance information to enable product recalls, repairs, or replacements.
VICTIMS OF ABUSE, NEGLECT, OR DOMESTIC VIOLENCE
We can disclose protected health information to governmental authorities to the extent the disclosure is authorized by statute or regulation and in the exercise of professional judgment the doctor believes the disclosure is necessary to prevent serious harm to the individual or other potential victim.
Federal law allows us to release your protected health information to appropriate health oversight agencies or for health oversight activities to include audits, civil, administrative or criminal investigations: inspections; licensures or disciplinary actions, and for similar reasons related to the administration of healthcare.
We may disclose your protected health information in the course of any judicial or administrative proceeding as allowed or required by law, with your consent, or as directed by a proper court order or administrative tribunal, provided that only the protected health information released is expressly authorized by such order, or in response to a subpoena, discovery request or other lawful process.
We may disclose your protected health information for law enforcement purposes as required by law, such as when required by court order, including laws that require reporting of certain types of wounds or other physical injury.
CORONERS, MEDICAL EXAMINERS AND FUNERAL DIRECTORS
We may disclose your protected health information to funeral directors or coroners consistent with applicable law to allow them to carry out their duties.
ORGAN PROCUREMENT ORGANIZATIONS
Consistent with applicable law, we may disclose your protected health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs, eyes, or tissue for the purpose of donation and transplant.
We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information.
THREAT TO HEALTH AND SAFETY
To avert a serious threat to health or safety, we may disclose your protected health information consistent with applicable law to prevent or lessen a serious, imminent threat to the health or safety of a person or the public.
FOR SPECIALIZED GOVERNMENTAL FUNCTIONS
We may disclose your protected health information for specialized government functions as authorized by law such as to Armed Forces personnel, for national security purposes, or to public assistance program personnel.
If you are an inmate of a correctional institution, we may disclose to the institution or it’s agents the protected health information necessary for your health and the health and safety of other individuals.
Other Uses and Disclosures
Other uses and disclosures besides those identified in this Notice will be made only as otherwise authorized by law or with your written authorization which you may revoke except to the extent information or action has already been taken.
How to Contact Us
If you have any questions about this privacy statement, the practices of this site, or your dealings with this Web site, please contact us at firstname.lastname@example.org