Notice
of Privacy Practices
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 that your health information is personal to you, and we
are committed to protect the information about you. This Notice of
privacy practices (or “Notice”) describes how we will use and
disclose protected information and data that we receive or create
related to your health care.
Our
Duties. We
are required by law to maintain the privacy of your health
information, and to give you this Notice describing our legal duties
and privacy practices. We are also required to follow terms of the Notice
currently in effect.
How
We May Use and Disclose Health Information About You. We will
not use or disclose your health information without your
authorization, except in the following situations:
Treatment: We will use and disclose your health information while
providing coordination or managing your health care. For example, information obtained by a nurse, physician, or
other member of your health care team will be recorded in your
record and used to determine the course of treatment that should
work best for you. Your
physician will put in your record his or her expectations of the
members of your healthcare team. Members of your healthcare team will then record the actions
they took and their observations. In that way, the physician will know how you are responding
to treatment. We may
also provide other healthcare providers with your information to
assist them in treating you.
Payment: We will use and disclose your medical information to obtain
or provide compensation of reimbursement for providing your health
care. For example, we
may send a bill to you or your health plan. The information on or accompanying the bill may include
information that identifies you, as well as your diagnosis,
procedures, and supplies used. As another example, we may disclose information about you to
your health plan so that the health plan may determine your
eligibility for payment for certain benefits.
Health
Care Operations: We
will use and disclose your health information to deal with certain
administrative aspects of your health care, and to manage our
business more efficiently. For
example, members of our medical staff may use information in your
health record to assess the quality of care and outcomes in your
case and others like it. This
information will then be used in an effort to improve the quality
and effectiveness of the healthcare and services we provide.
Business
Associates: There are
some services provided in our organization through contracts with
business associates. We may disclose your health information to our
business associates so they can perform the job we’ve asked them
to do. However, we
require business associates to take precautions to protect your
health information.
Notification
of Family: We may use
or disclose information to relay or assist in relaying your location
and general condition to a family member, personal representative,
or other person responsible for your care.
Communication
With Family: 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.
Research: Consistent with applicable law 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 health
information.
Funeral
Director, Coroner and Medical Examiner: Consistent with applicable law we may disclose health
information to funeral directors, coroners, and medical examiners to
help them carry out their duties.
Organ
Procurement Organizations: Consistent with applicable law, we may
disclose health information to organ procurement, banking, or
transplantation of organs for the purpose of tissue donation and
transplant.
Fundraising: We may use certain information for purposes of raising funds.
Food
and Drug Administration (FDA): We may disclose the FDA health
information relative to adverse events, product defects, or
post-marketing surveillance information to enable product recalls,
repairs or replacement.
Public
Health: As required by
law, we may disclose your health information to public health, or
legal authorities charged with preventing or controlling disease,
injury, or disability, including child abuse and neglect.
Victims
of Abuse, Neglect or Domestic Abuse: We may disclose your health information to appropriate
governmental agencies, such as adult protective or social services
agencies, if we reasonably believe you are a victim of abuse,
neglect, or domestic violence.
Health
Oversight: In order to
oversee the health care system, government benefits programs,
entities subject to governmental regulations and civil rights laws
for which health information is necessary to determine compliance,
we may disclose your health information form oversight activities
authorized by law, such as audits and civil administrative, or
criminal investigations.
Court
Proceeding: We may
disclose your health information in response to request made during
judicial and administrative proceedings, such as court orders or
subpoenas.
Law
Enforcement: Under certain circumstances, we may disclose your
health information to law enforcement officials. These circumstances include reporting required by certain
laws (such as the reporting of certain types of wounds), pursuant to
certain subpoenas or court orders, reporting limited information
concerning identification and location at the request of a law
enforcement official, reports regarding suspected victims of crimes
at the request of a law enforcement official, reporting death,
crimes on our premises, and crimes in emergencies.
Inmates: If you are an inmate of a correctional institution or under
the custody of a law enforcement official, we may release health
information 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.
Threats
to Public Health or Safety: We
may disclose or use health information when it is our good faith
belief, consistent with ethical and legal standards, that it is
necessary to prevent or lessen a serious and imminent threat or is
necessary to identify or apprehend an individual.
Specialized
Government Functions: Subject
to certain requirements, we may disclose or use health information
for military personnel and veterans, for national security and
intelligence activities, for protective services for the President
and others, for medical suitability determinations for the
Department of State, for correctional institutions and other law
enforcement custodial situations, and for government programs
providing public benefits.
Workers
Compensation: We may
disclose health information when authorized and necessary to comply
with laws relating to workers compensation or other similar
programs.
Other
Uses: We may also use and disclose your personal health information
for the following purposes:
*To
contact you to remind you of an appointment for treatment;
*To
describe or recommend treatment alternatives to you;
*To
furnish information about health-related benefits and services that
may be of interest to you; or
*For
certain charitable fundraising purposes.
Prohibition
on Other Uses or Disclosures: We
may not make any other use or disclosure of your personal health
information without your written authorization. Once given, you may
revoke the authorization by writing to the contact person listed on
the last page of this information. Understandably, we are unable to
take back any disclosure we have already made with your permission.
Individual
Rights. You
have many rights concerning the confidentiality of your health
information. You have the right to:
*Request
restrictions on the health information we may use and disclose for
treatment, payment, and health care operations. We are not required
to agree to this request. To request restrictions; please send a
written request to the contact person indicate on the last page of
this information.
*Receive
confidential communications of health information about you in a
certain manner or at a certain location. For instance, you may
request that we only contact you at work or by mail. To make such a
request, you must write to the contact person indicated on the last
page of this information and tell us how or where you wish to be
contacted.
*Inspect
or copy your health information. You must submit your request in
writing to the contact person on the last page of this information.
If you request a copy of your health information we may charge you a
fee for the cost of copying, mailing or other supplies. In certain
circumstances we may deny your request to inspect or copy your
health information. If you are denied access to your health
information, you may request 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.
*Amend
health information. If you feel that health information we have
about you is incorrect or incomplete, you may ask us to amend the
information. To request an amendment, you must write to the contact
person on the last page of this information. You must also give us a
reason to support your request. We may deny your request to amend
your health information if it is not in writing or does not provide
a reason to support your request.
We may also deny your request if the health information:
-was
not created by us, unless the person that created the information is
no longer available
to
make the amendment,
-is
not part of the health information kept by or for us,
-is
not part of the information you would be permitted to inspect or
copy, or
-is
accurate and complete.
*Receiving
an accounting of disclosures of your health information. You must submit a request in writing to the contact person
indicated on the last page of this information. Not all health
information is subject to this request. Your request must state a
time period, no longer than 6 years and may not include dates before
April 14, 2003. Your request must state how you would like to
receive the report (paper, electronically). The first accounting you
request within a 12-month period is free. For additional
accountings, we may charge you the cost of your request before
charges are incurred.
*Receive
a paper copy of this Notice upon request, even if you have agreed to
receive the Notice electronically. You must submit a request for a
paper notice in writing to the privacy officer at Premier Plastic
Surgery Center, Adbel Plaza Building, Suite 212,1401 Matthews
Township Parkway, Matthews, NC 28105. Or, visit our web site at www.beautifulresults.net.
All requests to restrict use of your health information for
treatment, payment and health care operations, to inspect and copy
health information must be made in writing to the privacy officer at Premier Plastic Surgery
Center. There may be a
fee for the cost of copying your medical record.
Contact
Person. Our
contact person for all questions, or for further information related
to the privacy of your health information is our privacy officer who
can be reached in writing at the Adbel Plaza Building, Suite 212,
1401 Matthews Township Parkway, Matthews, NC 28105 or by calling
(704) 844-8344. You may also submit a complaint to the Office of
Civil Rights, The U.S. Department of Health and Human Services,
Atlanta Federal Center, Suite 3870, and 61 Forsyth Street, S.W.,
Atlanta, Georgia 30303-8909 or call (404) 562-7886. We will not
retaliate against you for filing a complaint.
Changes
to This Notice. We reserve the right to change our privacy practices and to apply
the revised practices to health information about you that we
already have. Any revision to our privacy practices will be
described in a revised Notice that will be displayed in our
facility.
Notice Effective Date: April 14, 2003
|
