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.
Our goal is to take appropriate steps to attempt to
safeguard any medical or other personal information that is provided
to us. The Privacy Rule under the Health Insurance Portability and
Accountability Act of 1996 (“HIPAA”) requires us to:
(i) maintain the privacy of medical information provided to us;
(ii) provide notice of our legal duties and privacy practices; and
(iii) abide by the terms of our Notice of Privacy Practices currently
in effect.
WHO WILL FOLLOW THIS
NOTICE
" This notice describes the practices of our employees
and staff of The Pain Management Center of Paducah, Ambulatory
Surgery Center, Paducah Physical Therapy and Psychology Center
and The Pain Management Center of Marion. This notice applies
to each of these individuals, entities, sites and locations.
In addition, these individuals, entities, sites and locations
may share medical information with each other for treatment,
payment and health care operation purposes described in this
notice."
INFORMATION COLLECTED ABOUT YOU
In the ordinary course of receiving treatment and
health care services from us, you will be providing us with personal
information such as:
• Your name, address, and phone number.
• Information relating to your medical history.
• Your insurance information and coverage.
• Information concerning your doctor, nurse or other medical providers.In
addition, we will gather certain medical information about you and will create
a record of the care provided to you. Some information also may be provided to
us by other individuals or organizations that are part of your “circle
of care”- such as clinical laboratories, diagnostic testing services, your
other doctors, your health plan, and close friends or family members.
HOW WE MAY USE AND DISCLOSE INFORMATION
ABOUT YOU.
We may use and disclose personal and identifiable health information
about you for a variety of purposes. All of the types of uses and disclosures
of information are described below, but not every use or disclosure in
a category is listed.
Required Disclosures. We are required to disclose health information
about you to the Secretary of Health and Human Services, upon request,
to determine our compliance with HIPAA and to you, in accordance with
your right to access and right to receive an accounting of disclosures,
as described below.
For Treatment. We may
use health information about you in your treatment. For example, we
may use your medical history, such as any presence or absence of persistent
back pain, to assess your health and perform interventional pain or
other diagnostic services.
For Payment. We may
use and disclose health information about you to bill for our services
and to collect payment from you or your insurance company. For example,
we may need to give a payer information about your current medical
condition so that it will pay us for the interventional pain or other
services that we have furnished you. We may also need to inform your
payer of the treatment that you are going to receive in order to obtain
prior approval or to determine whether the service is covered.
For Health Care Operations.
We may use and disclose information about you for the general operation
of our business. For example, we sometimes arrange for accreditation
organizations, auditors or other consultants to review our practices,
evaluate our operations, and tell us how to improve our services. Or,
for example, we may use and disclose your health information to review
the quality of services provided to you.
Public Policy Uses and Disclosures.
There are a number of public policy reasons why we may disclose information
about you, which are described below.
We may disclose health information about you when we are
required to do so by federal, state, or local law.
We may disclose protected health information about
you in connection with certain public health reporting activities.
For instance, we may disclose such information to a public health
authority authorized to collect or receive PHI for the purpose of
preventing or controlling disease, injury or disability, or at the
direction of a public health authority, to an official of a foreign
government agency that is acting in collaboration with a public health
authority. Public health authorities include state health departments,
the Center for Disease Control, the Food and Drug Administration,
the Occupational Safety and Health Administration and the Environmental
Protection Agency, to name a few.
We are also permitted to disclose protected health
information to a public health authority or other government authority
authorized by law to receive reports of child abuse or neglect. Additionally
we may disclose protected health information to a person subject
to the Food and Drug Administration’s power for the following
activities: to report adverse events, product defects or problems,
or biological product deviations; to track products; to enable product
recalls; repairs or replacements; to conduct post marketing surveillance.
We may also disclose a patient’s health information to a person
who may have been exposed to a communicable disease or to an employer
to conduct an evaluation relating to medical surveillance of the
workplace or to evaluate whether an individual has a work-related
illness or injury.
We may disclose a patient’s health information
where we reasonably believe a patient is a victim of abuse, neglect
or domestic violence and the patient authorizes the disclosure or
it is required or authorized by law.
We may disclose health information about you in
connection with certain health oversight activities of licensing
and other health oversight agencies which are authorized by law.
Health oversight activities include audit, investigation, inspection,
licensure or disciplinary actions, and civil, criminal, or administrative
proceedings or actions or any other activity necessary for the oversight
of 1) the health care system, 2) governmental benefit programs for
which health information is relevant to determining beneficiary eligibility,
3) entities subject to governmental regulatory programs for which
health information is necessary for determining compliance with program
standards, or 4) entities subject to civil rights laws for which
health information is necessary for determining compliance.
We may disclose your health information as required by law, including
in response to a warrant, subpoena, or other order of a court or administrative
hearing body or to assist law enforcement identify or locate a suspect,
fugitive, material witness or missing person. Disclosures for law enforcement
purposes also permit use to make disclosures about victims of crimes
and the death of an individual, among others.
We may release a patient’s health information
(1) to a coroner or medical examiner to identify a deceased person
or determine the cause of death and (2) to funeral directors. We
also may release your health information to organ procurement organizations,
transplant centers, and eye or tissue banks, if you are an organ
donor.
We may release your health information to workers’ compensation
or similar programs, which provide benefits for work-related injuries
or illnesses without regard to fault.
Health information about you also may be disclosed when necessary to
prevent a serious threat to your health and safety or the health and
safety of others.
We may use or disclose certain health information
about your condition and treatment for research purposes where an
Institutional Review Board or a similar body referred to as a Privacy
Board determines that your privacy interests will be adequately protected
in the study. We may also use and disclose your health information
to prepare or analyze a research protocol and for other research
purposes.
If you are a member of the Armed Forces, we may
release health information about you for activities deemed necessary
by military command authorities. We also may release health information
about foreign military personnel to their appropriate foreign military
authority.
We may disclose your protected health information
for legal or administrative proceedings that involve you. We may
release such information upon order of a court or administrative
tribunal. We may also release protected health information in the
absence of such an order and in response to a discovery or other
lawful request, if efforts have been made to notify you or secure
a protective order.
If you are an inmate, we may release protected health
information about you to a correctional institution where you are
incarcerated or to law enforcement officials in certain situations
such as where the information is necessary for your treatment, health
or safety, or the health or safety of others.
Finally, we may disclose protected health information
for national security and intelligence activities and for the provision
of protective services to the President of the United States and
other officials or foreign heads of state.
Our Business Associates. We
sometimes work with outside individuals and businesses who help us
operate our business successfully. We may disclose your health information
to these business associates so that they can perform the tasks that
we hire them to do. Our business associates must promise that they
will respect the confidentiality of your personal and identifiable
health information.
Disclosures to Persons Assisting in Your
Care or Payment for Your Care. We may disclose information
to individuals involved in your care or in the payment for your
care. This includes people and organizations that are part of your "circle
of care" -- such as your spouse, your other doctors, or an
aide who may be providing services to you. We may also use and
disclose health information about a patient for disaster relief
efforts and to notify persons responsible for a patient’s
care about a patient’s location, general condition or death.
Generally, we will obtain your verbal agreement before using or
disclosing health information in this way. However, under certain
circumstances, such as in an emergency situation, we may make these
uses and disclosures without your agreement. Appointment Reminders.
We may use and disclose medical information to contact you as a
reminder that you have an appointment or that you should schedule
an appointment.
Treatment Alternatives. We
may use and disclose your personal health information in order to tell
you about or recommend possible treatment options, alternatives or
health-related services that may be of interest to you.
Fundraising. We may use your protected health information
to contact you in an effort to raise funds for our operations.
OTHER USES AND DISCLOSURES OF PERSONAL INFORMATION
We are required to obtain written authorization from
you for any other uses and disclosures of medical information other
than those described above. If you provide us with such permission,
you may revoke that permission, in writing, at any time. If you revoke
your permission, we will no longer use or disclose personal information
about you for the reasons covered by your written authorization, except
to the extent we have already relied on your permission.
INDIVIDUAL RIGHTS
You have the right to ask for restrictions on the
ways we use and disclose your health information for treatment, payment
and health care operation purposes. You may also request that we limit
our disclosures to persons assisting your care or payment for your
care. We will consider your request, but we are not required, to accept
it.
You have the right to request that you receive communications
containing your protected health information from us by alternative
means or at alternative locations. For example, you may ask that we
only contact you at work, home or by mail.
Except under certain circumstances, you have the right
to inspect and copy medical, billing and other records used to make
decisions about you. If you ask for copies of this information, we
may charge you a fee for copying and mailing.
If you believe that information in your records is
incorrect or incomplete, you have the right to ask us to correct the
existing information or add missing information. Under certain circumstances,
we may deny your request, such as when the information is accurate
and complete.
You have a right to receive a list of certain instances
when we have used or disclosed your medical information. We are not
required to include in the list uses and disclosures for your treatment,
payment for services furnished to you, our health care operations;
disclosures to you; disclosures you give us authorization to make;
and uses and disclosures before April 14, 2003, among others. If you
ask for this information from us more than once every twelve months,
we may charge you a fee.
You have the right to a copy of this notice in paper
form. You may ask us for a copy at any time.
To exercise any of your rights, please contact us in writing at PMCP,
PSC, Attention Privacy Officer, 2831 Lone Oak Rd., Paducah, KY 42003.
When making a request for amendment, you must state a reason for making
the request.
CHANGES TO THIS NOTICE
We reserve the right to make changes to this notice at any time. We reserve
the right to make the revised notice effective for personal health
information we have about you as well as any information we receive
in the future. In the event there is a material change to this notice,
the revised notice will be posted. In addition, you may request a copy
of the revised notice at any time.
COMPLAINTS/COMMENTS
If you have any complaints concerning our privacy practices, you may
contact the Secretary of the Department of Health and Human Services,
at 200 Independence Avenue, S.W., Room 509F, HHH Building, Washington,
D.C. 20201 (e-mail: ocrmail@hhs.gov). You also may contact us at PMCP,
PSC, Attention Privacy Officer, 2831 Lone Oak Rd., Paducah, KY 42003.
(270) 554-8373 ext. 114.
YOU WILL NOT BE RETALIATED AGAINST OR PENALIZED
BY US FOR FILING A COMPLAINT.
To obtain more information concerning this notice, you may contact our
Privacy Officer at (270) 554-8373 ext. 114. This notice is effective
as of March 1, 2003.
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