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 READ IT CAREFULLY.
Our goal is to take appropriate steps to attempt to safeguard any medical, personal or protected health information (PHI) that is provided to us. We are required to: (i) maintain the privacy of PHI 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, staff and physicians and osteopaths who are members of, or provide services to or for, the above named entities as well as:
Our business and billing office, our attorneys, collection agents, professional certification agencies, hospitals, your health insurance company, business associates to whom we release information for lawful purposes, certain governmental investigators/authorities as required by law, consultants, and other physicians that we must discuss your medical treatment with. All of these individuals, entities, sites, and locations will follow the terms of this notice. In addition, these individuals, entities, sites, and locations may share PHI with each other for the treatment, payment, or health care operations 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 PHI such as:
In addition, we will gather certain PHI about you and will create a record of the care provided to you. Some PHI also may be provided to us by other individuals or organizations that are part of your "circle of care"- such as a family member, other relative or a close personal friend - that is relevant to such person's involvement with your care or payment for your care.
HOW WE MAY USE AND DISCLOSE PHI ABOUT YOU
We may use and disclose PHI about you in different ways. All of the ways in which we may use and disclose PHI will fall within one of the following categories, but not every use or disclosure in a category will be listed.
For Treatment. We will use PHI about you to furnish services and supplies to you in accordance with our policies and procedures. For example, we will use your medical history, such as any presence or absence of heart disease, to assess your health and perform requested treatment or other diagnostic services. We are not required to seek your authorization before using or making a disclosure related to your treatment.
For Payment. We will use and disclose PHI 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 examinations or other services that we have furnished you. We may also need to inform your payer of the tests that you are going to receive in order to obtain prior approval or to determine whether the service is covered. We are not required to seek your authorization before using or making a disclosure for certain payment related activities.
For Health Care Operations. We may use and disclose PHI about you for the general operation of our business. For example, we sometimes arrange for accreditation organizations, auditors or other consultants to review our practice, evaluate our operations and tell us how to improve our services. Health care operations also may include quality assessment and improvement activities; reviewing the competence or qualifications of health care professionals, evaluating practitioner and provider performance; conducting training programs; accreditation, certification, licensing or credentialing activities; medical review, legal services and auditing, including fraud and abuse detection and compliance; business planning and development; and business management and general administrative activities, including management activities relating to privacy, customer service, resolution of internal grievances and creating de-identified medical information or a limited data set. We are not required to seek your authorization before using or making a disclosure related to certain health care operations.
Public Policy Uses and Disclosures. There are a number of public policy reasons why we may disclose PHI about you.
We may disclose PHI about you when we are required to do so by federal, state, or local law.
We may disclose PHI 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 PHI to a public health authority or other government authority authorized by law to receive reports of child abuse or neglect. Additionally we may disclose PHI 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 or to conduct post marketing surveillance.
We may disclose your PHI in situations of abuse as required by state law.
We may disclose PHI in connection with certain health oversight activities of licensing and other agencies. 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 PHI is relevant to determining beneficiary eligibility, 3) entities subject to governmental regulatory programs for which PHI is necessary for determining compliance with program standards, or 4) entities subject to civil rights laws for which PHI is necessary for determining compliance.
We may disclose PHI in response to a warrant or other order of a court or administrative hearing body, and in connection with certain government investigations and law enforcement activities.
We may release PHI to a coroner or medical examiner to identify a deceased person or determine the cause of death. We also may release PHI to organ procurement organizations, transplant centers and eye or tissue banks.
We may release your PHI as authorized by state law to workers' compensation or similar programs.
PHI about you also will be disclosed when necessary to prevent a serious threat to your health and safety or the health and safety of others. We may decline to disclose PHI if we determine that disclosure would be detrimental to your physical or mental health or likely to cause you to harm another.
We may use or disclose certain PHI 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 PHI to prepare or analyze a research protocol and for other research purposes.
If you are a member of the Armed Forces, we may release PHI about you as required by military command authorities. We also may release PHI about foreign military personnel to the appropriate foreign military authority.
We may disclose your PHI 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 PHI 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 PHI about you to a correctional institution where you are incarcerated or to law enforcement officials.
Finally, we may disclose PHI 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 individuals and businesses to whom we may disclose our PHI so that they can perform certain tasks for us. Our business associates must guarantee to us that they will respect the confidentiality of your PHI.
Individuals Involved in Your Care or Payment for Your Care. We may disclose PHI to individuals involved in your care or in the payment for your care, but we will provide you with an opportunity to agree to or prohibit or restrict the use or disclosure. This includes people and organizations that are part of your "circle of care" -- such as your spouse, family member, other relative, friend or individual you identify as assisting with your care or payment for your care. Although we must be able to speak with your other physicians or health care providers, you can let us know if we should not speak with other individuals, such as your spouse or family.
Appointment Reminders. We may use and disclose PHI 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 PHI in order to tell you about or recommend possible treatment options, alternatives or health-related services that may be of interest to you.
OTHER USES AND DISCLOSURES OF PERSONAL INFORMATION
We are required to obtain written authorization from you for any other uses and disclosures of PHI 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 PHI about you for the reasons covered by your written authorization. We will be unable to take back any disclosures already made based upon your original permission.
You have the right to ask for restrictions in the ways in which we use and disclose your PHI beyond those imposed by law. 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 PHI from us by alternative means or at alternative locations. For example, you may ask that we only contact you at home or by mail.
Except under certain circumstances, you have the right to inspect and copy medical and billing records about you. If you ask for copies of this information, we may charge you a fee for copying and mailing.
If you believe that PHI in your records is incorrect or incomplete, you have the right to ask us to correct the existing information or correct the missing information. Under certain circumstances, we may deny your request.
You have a right to ask for a list of instances when we have used or disclosed your PHI for reasons other than your treatment, payment for services furnished to you, our health care operations, disclosures you give us authorization to make and for certain other limited purposes. 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.
If you receive this notice on our web site or by electronic mail (e-mail), you are entitled to receive this notice in written form. Please contact us using the information listed at the end of this notice to obtain this notice in written form.
Any request for a copy of this notice or a correction/amendment to this notice must be made in writing. Please mail your request to: Compliance/Privacy Officer, Box 5602, Fort Wayne IN 46895-5602.
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 PHI 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 send a written request for a copy of the revised Notice at any time.