HIPAA NOTICE OF PRIVACY PRACTICES
I.
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.
II.
It is my legal duty to safeguard your Protected Health Information (PHI).
By
law I am required to insure that your PHI is kept private. The PHI constitutes
information
created
or noted by me that can be used to identify you. It contains data about your
past,
present,
or future health or condition, the provision of health care services to you, or
the
payment
for such health care. I am required to provide you with this Notice about my
privacy
procedures.
This Notice must explain when, why, and how I would use and/or disclose your
PHI.
Use of PHI means when I share, apply, utilize, examine, or analyze information
within my
practice;
PHI is disclosed when I release, transfer, give, or otherwise reveal it to a
third party
outside
my practice. With some exceptions, I may not use or disclose more of your PHI
than is necessary to accomplish the purpose for which the use or disclosure is
made; however, I am
always
legally required to follow the privacy practices described in this Notice.
Please
note that I reserve the right to change the terms of this Notice and my privacy
policies at
any
time. Any changes will apply to PHI already on file with me. Before I make any
important
changes
to my policies, I will immediately change this Notice and post a new copy of it
in my
office
and on my website. You may also request a copy of this Notice from me,
or
you can view a copy of it in my office or on this website.
III.
How i will use and disclose your PHI.
I
will use and disclose your PHI for many different reasons. Some of the uses or
disclosures will
require
your prior written authorization; others, however, will not. Below you will find
the
different
categories of my uses and disclosures, with some examples.
A.
Uses and Disclosures Related to Treatment, Payment, or Health Care
Operations
Do Not Require Your Prior Written Consent.
I
may use and disclose your PHI without your consent for the following reasons:
1.
For treatment. I may disclose your PHI to
physicians, psychiatrists, psychologists, and other
licensed
health care providers who provide you with health care services or are otherwise
involved
in your care. Example: If a psychiatrist is treating you, I may disclose your
PHI to
her/him
in order to coordinate your care.
2.
For health care operations. I may disclose
your PHI to facilitate the efficient and correct
operation
of my practice. Examples: Quality control - I might use your PHI in the
evaluation of
the
quality of health care services that you have received or to evaluate the
performance of the
health
care professionals who provided you with these services. I may also provide your
PHI to
my
attorneys, accountants, consultants, and others to make sure that I am in
compliance with
applicable
laws.
3.
To obtain payment for treatment. I may use
and disclose your PHI to bill and collect
payment
for the treatment and services I provided you. Example: I might send your PHI to
your
insurance
company or health plan in order to get payment for the health care services that
I have
provided
to you. I could also provide your PHI to business associates, such as billing
companies,
claims
processing companies, and others that process health care claims for my office.
4.
Other disclosures. Examples: Your consent
isn't required if you need emergency treatment
provided
that I attempt to get your consent after treatment is rendered. In the event
that I try to
get
your consent but you are unable to communicate with me (for example, if you are
unconscious
or in severe pain) but I think that you would consent to such treatment if you
could,
I
may disclose your PHI.
B.
Certain Other Uses and Disclosures Do Not Require Your Consent.
I
may use and/or disclose your PHI without your consent or authorization for the
following reasons:
1.
When disclosure is required by federal, state, or local law; judicial, board, or
administrative
proceedings; or, law enforcement. Example:
I may make a disclosure to
the
appropriate officials when a law requires me to report information to government
agencies,
law enforcement personnel and/or in an administrative proceeding.
2.
If disclosure is compelled by a party to a proceeding before a court of an
administrative
agency pursuant to its lawful
authority.
3.
If disclosure is required by a search warrant lawfully issued to a governmental
law
enforcement
agency.
4.
If disclosure is compelled by the patient or the patient’s representative
pursuant to
California Health and Safety Codes or to corresponding federal statutes of regulations,
such as the Privacy Rule that requires this Notice.
5. To avoid harm. I may provide PHI to law enforcement personnel or persons able to prevent
or mitigate a serious threat to the health or safety of a person or the public.
6.
If disclosure is compelled or permitted by the fact that you are in such mental
or
emotional
condition as to be dangerous to yourself or the person or property of others,
and
if I determine that disclosure is necessary to prevent the threatened danger.
7.
If disclosure is mandated by the California Child Abuse and Neglect Reporting
law.
For example, if I have a reasonable suspicion of child abuse or neglect.
8.
If disclosure is mandated by the California Elder/Dependent Adult Abuse
Reporting
law. For example, if I have a reasonable suspicion of elder abuse or dependent adult abuse.
9.
If disclosure is compelled or permitted by the fact that you tell me of a
serious/imminent
threat of physical violence by you against a reasonably identifiable
victim
or victims.
10. For public health activities. Example: In the event of your death, if a disclosure is
permitted or compelled, I may need to give the county coroner information about you.
11. For health oversight activities. Example: I may be required to provide information to
assist the government in the course of an investigation or inspection of a health care
organization or provider.
12. For specific government functions. Examples: I may disclose PHI of military personnel
and veterans under certain circumstances. Also, I may disclose PHI in the interests of
national security, such as protecting the President of the United States or assisting with
intelligence operations.
13. For research purposes. In certain circumstances, I may provide PHI in order to conduct
medical research.
14. For Workers' Compensation purposes. I may provide PHI in order to comply with
Workers' Compensation laws.
15. Appointment reminders and health related benefits or services. Examples: I may use
PHI to provide appointment reminders. I may use PHI to give you information about
alternative treatment options, or other health care services or benefits I offer.
16. If an arbitrator or arbitration panel compels disclosure, when arbitration is lawfully
requested by either party, pursuant to subpoena duces tectum (e.g., a subpoena for mental
health records) or any other provision authorizing disclosure in a proceeding before an
arbitrator or arbitration panel.
17.
I am permitted to contact you, without your prior authorization, to provide
appointment
reminders or information about alternative or other heath-related
benefits
and services that may be of interest to you.
18.
If disclosure is required or permitted to a health oversight agency for
oversight
activities authorized by law. Example: When compelled by U.S. Secretary of Health and
Human Services to investigate or assess my compliance with HIPAA regulations.
19.
If disclosure is otherwise specifically required by law.
C.
Certain Uses and Disclosures Require You to Have the Opportunity to
Object.
1. Disclosures to family, friends, or others. I may provide your PHI to a family member,
friend, or other individual who you indicate is involved in your care or responsible for the payment
for your health care, unless you object in whole or in part. Retroactive consent may beobtained in
emergency situations.
D. Other Uses and Disclosures Require Your Prior Written Authorization. In
any other situation not described in Sections IIIA, IIIB, and IIIC above, I will request your
written authorization before using or disclosing any of your PHI. Even if you have signed an
authorization to disclose your PHI, you may later revoke that authorization, in writing, to stop
any future uses and disclosures (assuming that I haven't taken any action subsequent to the
original authorization) of your PHI by me.
IV.
What rights you have regarding your PHI
These
are your rights with respect to your PHI:
A. The Right to See and Get Copies of Your PHI. In general, you have the right to see your
PHI that is in my possession, or to get copies of it; however, you must request it in writing. If I
do not have your PHI, but I know who does, I will advise you how you can get it. You will
receive a response from me within 30 days of my receiving your written request. Under certain
circumstances, I may feel I must deny your request, but if I do, I will give you, in writing, the
reasons for the denial. I will also explain your right to have my denial reviewed.
If you ask for copies of your PHI, I will charge you not more than $.25 per page. I may see fit to
provide you with a summary or explanation of the PHI, but only if you agree to it, as well as to
the cost, in advance.
B. The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to
ask that I limit how I use and disclose your PHI. While I will consider your request, I am not
legally bound to agree. If I do agree to your request, I will put those limits in writing and abide
by them except in emergency situations. You do not have the right to limit the uses and
disclosures that I am legally required or permitted to make.
C. The Right to Choose How I Send Your PHI to You. It is your right to ask that your PHI be
sent to you at an alternate address (for example, sending information to your work address rather
than your home address) or by an alternate method (for example, via email instead of by regular
mail). I am obliged to agree to your request providing that I can give you the PHI, in the format
you requested, without undue inconvenience.
D. The Right to Get a List of the Disclosures I Have Made. You are entitled to a list of
disclosures of your PHI that I have made. The list will not include uses or disclosures to which
you have already consented, i.e., those for treatment, payment, or health care operations, sent
directly to you, or to your family; neither will the list include disclosures made for national
security purposes, to corrections or law enforcement personnel, or disclosures made before April
15, 2003. After April 15, 2003, disclosure records will be held for six years.
I will respond to your request for an accounting of disclosures within 60 days of receiving your
request. The list I give you will include disclosures made in the previous six years (the first six
year period being 2003-2009) unless you indicate a shorter period. The list will include the date
of the disclosure, to whom PHI was disclosed (including their address, if known), a description
of the information disclosed, and the reason for the disclosure. I will provide the list to you at no
cost, unless you make more than one request in the same year, in which case I will charge you a
reasonable sum based on a set fee for each additional request.
E. The Right to Amend Your PHI. If you believe that there is some error in your PHI or that
important information has been omitted, it is your right to request that I correct the existing
information or add the missing information. Your request and the reason for the request must be
made in writing. You will receive a response within 60 days of my receipt of your request. I may
deny your request, in writing, if I find that: the PHI is (a) correct and complete, (b) forbidden to
be
disclosed, (c) not part of my records, or (d) written by someone other than me.
My denial must be in writing and must state the
reasons for the denial. It must also explain your right to file
a
written statement objecting to the denial. If you do not file a written
objection, you still have
the
right to ask that your request and my denial be attached to any future
disclosures of your
PHI.
If I approve your request, I will make the change(s) to your PHI. Additionally,
I will tell
you
that the changes have been made, and I will advise all others who need to know
about the
change(s)
to your PHI.
F.
The Right to Get This Notice by Email You
have the right to get this notice by email. You
have
the right to request a paper copy of it, as well.
V.
How to complain about my privacy practices
If,
in your opinion, I may have violated your privacy rights, or if you object to a
decision I made
about
access to your PHI, you are entitled to file a complaint with the person listed
in Section VI
below.
You may also send a written complaint to the Secretary of the Department of
Health and
Human
Services at 200 Independence Avenue S.W. Washington, D.C. 20201. If you file a
complaint
about my privacy practices, I will take no retaliatory action against you.
VI.
Person to contact for information about this notice or to complain about my
privacy practices
If
you have any questions about this notice or any complaints about my privacy
practices, or
would
like to know how to file a complaint with the Secretary of the Department of
Health and
Human
Services, please contact me at: Jay Earley, 140 Marina Vista Ave., Larkspur, CA
94939, 415-924-5200, jay@earley.org
VII.
Effective date of this notice
This
notice went into effect on April 14, 2003.