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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