HIPAA COMPLIANCE ASSURANCE NOTIFICATION FOR OUR PATIENTS
April 2003
To Our Valued Patients:
The misuse of Personal Health Information (PHI) has been identified as a
national problem. We want you to know that all of our employees,
managers and doctors continually undergo training so that they may
understand and comply with government rules and regulations regarding
the Health Insurance Portability and Accountability Act (HIPPA) with
particular emphasis on the “Privacy Rule”. We strive to achieve the very
highest standards of ethics and integrity in performing services for our
patients.
Our office is fully committed to compliance with HIPAA guidelines by
providing appropriate security for our patient records, protecting the
privacy of our patients’ medical information, providing our patients with
proper access to their medical records, and appropriately maintaining our
patient information and billing processes in compliance with the national
HIPAA standards. As part of this plan, we have implemented a
Compliance Program that we believe will help us prevent any
inappropriate use of PHI. The Notice Of Privacy Practices is posted in
the waiting room and you may ask for a copy at anytime.
We also know that we are not perfect! Because of this fact, our policy is
to listen to our employees and our patients without any thought of
penalization if they feel that an event in any way compromises our policy.
If you ever have any questions or concerns about your services or
charges, we encourage you to write to our Compliance Officer.
Thank you
NOTICE OF PRIVACY PRACTICES FOR:
JDC Pediatrics
Effective date: April 14, 2003
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT
YOU MAY BE USED AND DISCLOSED AND HOW TO GET ACCESS
TO THIS INFORMATION. PLEASE READ IT CAREFULLY.
If you have any questions regarding this notice, you may contact our
privacy officer at:
Address: 2025 Technology Parkway, Suite 108, Mechanicsburg, PA 17050
Telephone: 717-791-2680
Facsimile: 717-791-2686
I. YOUR PROTECTED HEALTH INFORMATION
JDC Pediatrics is required by the federal privacy rule to maintain the
privacy of your health information that is protected by the rule, and to
provide you with notice of our legal duties and privacy practices with
respect to your protected health care information. We are required to
abide by the terms of the notice currently in effect.
Generally speaking, your protected health information is any information
that relates to your past, present or future physical or mental health or
condition, the provision of health care to you, or payment for health care
provided to you, and individually identifies you or reasonably can be used
to identify you.
Your medical and billing records at our practice are examples of
information that usually will be regarded as your protected health
information.
II. USES AND DISCLOSURES OF YOUR PROTECTED
HEALTH INFORMATION
A. Treatment, payment, and health care operations
This section describes how we may use and disclose your protected
health information for treatment, payment, and health care operations
purposes. The descriptions include examples. Not every possible use
or disclosure for treatment, payment, and health care operations purposes
will be listed.
1. Treatment
We may use and disclose your protected health information for
our treatment purposes as well as the treatment purposes of our
health care providers. Treatment includes the provision,
coordination, or management of health care services to you by
one or more health care providers. Some other examples of
treatment uses and disclosures include:
We may page you in the waiting room when it is time
for you to go to an examining room.
We may contact you to provide appointment
reminders.
We may transport your medical records to our other
office location or the hospital if you are being treated
there for any reason.
We may contact your home and leave a message
providing appointment information including patient
name, date, time and location.
2. Payment
We may use and disclose your protected health information for
our payment purposes as well as the payment purposes of other
health care providers and health plans. Payment uses and
disclosures include activities conducted to obtain payment for
the care provided to you or so that you can obtain
reimbursement for that care, for example, submission of a claim
form to your health insurer; contacting health insurer to check
eligibility; or providing bill to a family member or other
designated party for payment of services rendered.
3. Health care operations
We may use and disclose your protected health information for
our health care operation purposes as well as certain health
care operation purposes of other health care providers and
health plans. Some examples of health care operation
purposes include:
Quality assessment and improvement activities
Health care fraud and abuse detection and compliance
programs.
B. Uses and disclosures for other purposes
We may use and disclose your protected health information for other
purposes. This section generally describes those purposes by category.
1. Individuals involved in care or payment for care- such as
spouse, a family member, or close friend. For example, if you
have another person accompany your child (ren) to an
appointment, we may discuss medical care with that individual
and they will need to have some knowledge of your insurance
coverage.
2. Notification purposes- to notify a family member, a person
responsible for your care, regarding your location, general
condition, or death.
3. Required by law or law enforcement purposes – when
required by federal, state, or local law. For example, we may
disclose protected health information in response to a court
order or subpoena.
4. Public health activities- For example, filing communicable
disease reports with public health agencies.
5. Business associates – certain functions of the practice
performed by a business associates such as a consulting firm,
an accounting firm, or a law firm. We may disclose protected
health information to our business associates and allow them to
create and receive protected health information on our behalf.
For example, we may share with our attorney information
regarding your care and payment for your care in the event a
legal situation occurs.
C. Uses and disclosures with authorization
For all other purposes which do not fall under a category listed under
section II (subsections A and B), we will obtain your written authorization
to use or disclose your protected health information. Your authorization
can be revoked at any time except to the extent that we have relied on
the authorization
III. PATIENT PRIVACY RIGHTS
A. Further restriction on use or disclosure
You have a right to request that we further restrict use and disclosure of
your protected health information to carry out treatment, payment, or
health care operations, to someone who is involved in your care or the
payment for your care, or for notification purposes. We are not required
to agree to a request for a further restriction.
To request a further restriction, you must submit a written request to our
privacy officer. The request must tell us: (a) what information you want
restricted; (b) how you want the information restricted; and (c) to whom
you want the restriction to apply.
B. Confidential communication
You have a right to request that we communicate your protected health
information to you by a certain means or at a certain location. For
example, you might request that we only contact you by mail or at work.
We are not required to agree to requests for confidential communications
that are unreasonable.
To make a request for confidential communications, you must submit a
written request to our privacy officer. The request must tell us how or
where you want to be contacted.
C. Accounting of disclosures
You have a right to obtain, upon request, an “accounting” of certain
disclosures of your protected health information by us (or a business
associate for us). This right is limited to disclosures within six years of
the request and other limitations. Also in limited circumstances we may
charge you for providing the accounting. To request an accounting, you
must submit a written request to our privacy officer. The request should
designate the applicable time period.
D. Inspection and Copying
You have a right to inspect and obtain a copy of your protected health
information that we maintain in a designated records set. This right is
subject to limitations and we may impose a charge for the labor and
supplies involved in providing copies.
To exercise your right to access, you must submit a written request to
our privacy officer. The request must: (a) describe the health information
to which access is requested. (b) state how you want to access the
information, such as inspection, pick-up of copy, mailing of copy, (c)
specify any requested form or format, such as paper copy or an
electronic means, and (d) include the mailing address, if applicable.
E. Right to amendment
You have the right to request that we amend protected health information
that we maintain about you in a designated records set if the information
is incorrect or incomplete. This right is subject to limitations. To request
an amendment, you must submit a written request to our privacy officer.
The request must specify each change that you want and provide a
reason to support each requested change.
F. Paper copy of privacy notice
You have a right to receive, upon request, a paper copy of our Notice of
Privacy Practices. To obtain a paper copy, contact our privacy officer.
IV. CHANGES TO THIS NOTICE
We reserve the right to change this notice at any time. We further
reserve the right to make any change effective for all protected health
information that we maintain at the time of the change – including
information that we created or received prior to the effective date of the
change.
We will post a copy of our current notice in the waiting room for the
practice. Any questions may be directed to our privacy officer.
V. COMPLAINTS
If you believe that we have violated your privacy rights, you may submit a
complaint to the practice or the Secretary of Health and Human Services.
To file a complaint with the practice, submit the complaint in writing to our
privacy officer. We will not retaliate against you for filing a complaint.
VI. LEGAL EFFECT OF THIS NOTICE
This notice is not intended to create a contractual or other rights
independent of those created in the federal privacy rule.