Important Patient Info. |
HIPAA Acknowledgement |
Notice of Privacy
Notice of Privacy Practices Desert Pain Institute 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. Effective Date: April 13, 2003 Use and Disclosure This Notice of Privacy Practices describes how Desert Pain Institute may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. Protected health information is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services. Such information may include documenting your symptoms, medical history, examination and test results, diagnoses, treatment, and applying for future care or treatment. It also includes billing documents for those services. We are required to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice, at any time. The new notice will be effective for all protected health information that we maintain at that time. Upon your request, we will provide you with any revised Notice of Privacy Practices by calling the office and requesting that a revised copy be sent to you in the mail or asking for one at the time of your next appointment. Desert Pain Institute is required to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices. This office/hospital will not use or disclose your health information except as described in this Notice. Treatment Desert Pain Institute will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party that has already obtained your permission; consultation between health care providers relating to you the patient; or the referral of a patient for health care from one health care provider to another For example, we would disclose your protected health information, as necessary, to a home health agency that provides care to you. We will also disclose protected health information to other physicians who may be treating you or to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you. Payment Your protected health information will be used, as needed, to obtain or provide reimbursement for providing your health care services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we recommend for you such as; making a determination of eligibility or coverage, risk adjusting amounts due based on your health status and demographic characteristics, reviewing of the health care services provided to you for medical necessity, and undertaking utilization review activities including pre-certification and pre-authorization of services. For example, obtaining approval for a hospital stay may require that the minimum necessary protected health information be disclosed to the health plan to obtain approval for your hospital admission. Healthcare Operations Desert Pain Institute may use or disclose your protected health information in order to support the business activities of Desert Pain Institute. These activities include, but are not limited to, quality assessment and improvement, employee reviews, conducting training programs, underwriting, premium rating, conducting medical review or legal services, business planning and development, business management and general administration. For example, we may disclose your protected health information to medical school students that see patients at our office. In addition, we may use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your physician. We may also call you by name in the waiting room when your physician is ready to see you. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment. We will share your protected health information with third party “business associates” that perform various activities (e.g., billing, transcription services) for the practice. Whenever an arrangement between our office and a business associate involves the use or disclosure of your protected health information, we will have a written contract that contains terms that will protect the privacy of your protected health information. We may use or disclose your protected health information, as necessary, to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you. Specific Uses and Disclosures Emergency Circumstances Communication with Family/Friends Notification of Family and/or Friends Disaster Relief Public Health Authority Food and Drug Administration (FDA) Abuse, Neglect or Domestic Violence Health Oversight Judicial/Administrative Proceedings Law Enforcement Deceased Persons Organ Procurement Organization Research Health or Safety Threat For Specialized Governmental Functions Workers Compensation Appointment Reminders Your Rights With Respect To Your Protected Health Information You have the right to request restrictions on certain uses and disclosures of your protected health information by delivering the request in writing to us (using the form we provide to you upon request). We are not required to agree to a restriction but we will comply with any request that we agree to. You have the right to receive confidential communications of protected health information by alternative means or at alternative locations, if requested in writing using the form we provide to you upon request. (We will permit and accommodate any reasonable request by you that clearly states that the disclosure of all or part of your information could endanger an individual.) You have the right to inspect and copy your designated record set including your health record and billing record. You may exercise this right by delivering the request in writing to us using the form we provide to you upon request. Fees may be assessed to cover the cost of the copying, postage and/or preparing an explanation or summary of the protected health information as applicable. If we deny access, in whole or in part, you can appeal this denial to your protected health information except in certain circumstances. You have the right to amend your protected health information. You can request that your designated record set be amended to correct incomplete or incorrect information by delivering a written request to us (using the form we provide to you upon request). You can file a statement of disagreement if your amendment is denied, and require that the request for amendment and any denial be attached in all future disclosures of your protected health information. You have the right to an accounting of disclosures of your protected health information. You can request an accounting of disclosures of your health information as required to be maintained by law by delivering a written request to us (using the form we provide to you upon request). An accounting will not include internal uses of information for treatment, payment, or operations, disclosures made to you or made at your request, or disclosures made to family members or friends in the course of providing care. You have the right to review this notice before signing it authorizing use and disclosure of your protected health information for treatment, payment, and health care operations purposes as well as the specific use and disclosures described previously. Note: If you want to exercise any of the above rights, please use the contact information listed at the end of this notice, during normal hours. She will provide you with assistance on the steps [and forms] needed to exercise your rights. Desert Pain Institute Responsibilities We have the right to terminate an agreement to a restriction made by you if we notify you. Such a restriction is only effective with respect to protected health information created or received after you have been informed. We have the right to deny your request for access your health information. We will provide a written denial to you that will explain a basis for the denial. We have the right to deny your request for amendment if we determine that the protected health information or record that is the subject of the request was not created by us, is not part of your designated record set. We will provide you with a written denial that will explain the basis for the denial. The written denial will include a statement outlining how you can submit a written statement disagreeing with the denial. If you have submitted a statement of disagreement, we will include that statement with any subsequent disclosure of your protected health information to which the disagreement relates. If you have not submitted a written statement of disagreement we will include your original request for amendment and its denial with any subsequent disclosure of your protected health information to which the disagreement relates. We are required to provide you with a written accounting of your personal health information disclosures upon written request from you. We are required by law to maintain the privacy of your protected health information as required by law and provide you with a notice as to our legal duties and privacy practices with respect to your protected health information. We are required to abide by the terms of this notice currently in effect. We reserve the right to amend, change, or eliminate provisions in our Notice of Privacy Practices and access practices and to enact new provisions regarding all protected health information we maintain. If we revise our notice you can receive a revised copy of the notice by calling and requesting a copy of our “Notice” or by visiting our office and picking up a copy. Questions and Complaints If you have questions concerning Desert Pain Institute privacy practices or any other questions or concerns, please contact us. If you disagree with a with a decision that Desert Pain Institute made concerning access to your personal health information, a request concerning an amendment to you personal health information, a request to restrict the use or disclosure of your personal health information or a request to have us communicate with you by alternative means or alternative locations, you may complain to Desert Pain Institute using the contact information listed at the end of this notice. If you are concerned that we have violated your privacy rights you may submit a complaint by filling out a complaint form that can be provided to you by Desert Pain Institute using the contact information listed at the end of this notice. Additionally, you may also file a complaint by mailing it or e-mailing it to the Secretary of Health and Human Services. We will provide to you with the address to file your complaint with the Department of Health and Human Services. Desert Pain Institute supports your right to the privacy or your personal health information and we cannot, and will not, require you to waive the right to file a complaint with the Secretary of Health and Human Services (HHS) or Office of Civil Rights (OCR) as a condition of receiving treatment from the office/hospital. Contact Information Contact Officer: Karen Pierucci - Director of Operations
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