 |
 |
|
NOTICE OF PRIVACY PRACTICES
THIS NOTICE OF PRIVACY PRACTICES DESCRIBES HOW
MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU
CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY
1. Introduction
This Notice of Privacy Practices
describes how Three Rivers Family Practice may use and disclose your
protected health information ("PHI") to provide treatment to you; to
seek payment for the medical services you receive; and to support
the legitimate health care operations of our practice.
"PHI" includes your demographic information such as name,
address, telephone number, and family; past, present, or future
information about your physical or mental health or condition; and
information about the medical services provided to you, including
payment information, if any of that information may be used to
identify you.
The Notice describes uses and disclosures of PHI to which you
have consented, that you may be asked to authorize in the future,
and that are permitted or required by state or federal law. Also, it
advises you of your rights to access and control your PHI.
We may amend this Notice of Privacy Practices periodically and
you may obtain a current copy of the Notice by contacting the office
staff at any time.
We regard the safeguarding of your PHI as an important duty. The
elements of this Notice, the consent you have signed, and any
authorizations you may sign are required by state and federal law
for your protection and to ensure your informed consent to the use
and disclosure of PHI necessary to support your relationship with
Three Rivers Family Practice.
If you have any questions about Three Rivers
Family Practice's Notice of Privacy Practices, please contact our
Privacy Contact, Debbie "DJ" Nixon, at phone (207) 873-3753/e-mail
address djnixon@trfponline.com .
2. Safeguarding PHI Within the Office
We have in place appropriate administrative, technical, and
physical safeguards to protect the privacy of your PHI. We regularly
train our staff on the obligation to protect the privacy of your
PHI. We hold medical records in a secure area within the office.
Only staff members who have a "need to know" are permitted access to
your medical records and other PHI. Our staff understands the legal
and ethical obligation to protect your PHI and that a violation of
this Notice of Privacy Practices will result in discipline in
accordance with our personnel policy.
3. Uses and Disclosures of PHI Based Upon Your Written
Consent
You signed our "Consent to Use and Disclosure of Protected Health
Information" when you joined our practice. Based upon this consent,
our practice will use and disclose your PHI for the following types
of activities.
Treatment.
Treatment means the provision, coordination, or management of your
health care and related services by Three Rivers Family Practice and
other health care providers involved in your care. It includes the
coordination or management of health care by a provider with a third
party, consultation between our practice and other health care
providers relating to your care, or our practice's referral of you
to a specialist physician or other practitioner or facility, such as
a laboratory.
Payment.
Payment means our activities to obtain reimbursement for the medical
services provided to you, including billing, claims management, and
collection activities. Payment also may include your insurance
carrier's work in determining eligibility, claims processing,
assessing medical necessity, and utilization review.
Health Care Operations. Health care operations means the legitimate business
activities of our medical practice. These activities include, for
example, quality assessment and improvement activities; practitioner
performance evaluation; fraud & abuse compliance; business
planning & development; and business management & general
administrative activities. For example, we may use a patient sign-in
sheet at the front desk; we may call you by name in the waiting room
when we are ready to serve you; and we may leave a reminder of your
appointment on your answering machine or voicemail. Also, we may
send you a newsletter about our practice. When we involve third
parties, such as billing services, in our business activities, we
will have them sign a "business associate" agreement obligating them
to safeguard your PHI according to the same legal standards we
follow. If we maintain a facility directory, we will include your
name, a general statement about your condition, your religious
preference, and your location in the facility.
Family & Close Friends Involved in Your Care. You have consented to disclosure
of PHI that, in Three Rivers Family Practice's judgment, is in your
best interest to disclose to your family members and close friends
who are involved in your health care.
4. Uses and Disclosures of PHI Based Upon Your Written
Authorization
From time to time, you may request that Three Rivers Family
Practice disclose limited PHI to specified individuals or companies
for a defined purpose and timeframe. These situations may include
disclosures of sensitive PHI, such as HIV status or information
about sexually-transmitted diseases, mental health or psychiatric
treatment, or substance abuse services. Also, you may authorize
disclosures to individuals who are not involved in treatment,
payment, or health care operations, such as attorneys if you are
involved in litigation either on your own or another's behalf. If
you wish us to make disclosures in these situations, we will ask you
to sign our "Authorization to Use and Disclose Protected Health
Information."
5. Uses and Disclosures of PHI that are Permitted or Required
by Law
In some circumstances, we may use or
disclose your PHI without your consent or authorization. State and
federal privacy law permit or require such use or disclosure
regardless of your consent or authorization because it is in the
best interest of our society at large that the use or disclosure of
PHI be made in these situations.
Emergencies. If
you are incapacitated and require emergency medical treatment, we
will use and disclose your PHI to ensure you receive the necessary
medical services. We will attempt to obtain your consent as soon as
practical following your treatment.
Communication barriers. If we try but cannot obtain your consent to use or
disclose your PHI because of substantial communication barriers and
your physician, using his or her professional judgment, infers that
you consent to the use or disclosure, Three Rivers Family Practice
will make the use or disclosure.
Required by law. We may disclose PHI to the extent required by law and in a
manner limited to the specific requirements of the law.
Public health activities. We may disclose your PHI to an authorized public
health authority to prevent or control disease, injury, or
disability or to comply with state child or adult abuse or neglect
law.
Health oversight activities. We may disclose your PHI to a health oversight
agency for audits, investigations, inspections, and other activities
necessary for the appropriate oversight of the health care system
and the government benefit programs such as Medicaid and Medicare.
Judicial and administrative proceedings. We may disclose your PHI in the
course of any judicial or administrative proceeding in response to
an order expressly directing disclosure and within certain limits in
response to a subpoena, discovery request, or other lawful process.
Law enforcement activities. We may disclose your PHI to a law enforcement
officer for law enforcement purposes.
Coroners, medical examiners, & funeral directors. We may disclose your PHI to
a coroner or medical examiner for the purpose of identifying a
deceased person, determining a cause of death, or other lawful
duties. We also may disclose your PHI to enable a funeral director
to carry out his or her lawful duties.
Serious threats to health or safety. We may disclose your PHI to prevent or lessen
a serious and imminent threat to the health or safety of a person or
the public.
Armed forces personnel & national security. We may disclose the PHI of
members of the armed forces for activities deemed necessary by
appropriate military command authorities to assure proper execution
of the military mission. We also may disclose your PHI to certain
federal officials for lawful intelligence, counterintelligence, and
other national security activities.
Workers' compensation. We may disclose your PHI as authorized by and to
the extent necessary to comply with the Maine Workers' Compensation
Act or other similar programs that provide benefits for work-related
injuries or illness without regard to fault.
You & DHHS.
We must disclose your PHI to you upon request and to the Secretary
of the U.S. Department of Health & Human Services to investigate
or determine Three Rivers Family Practice's compliance with the
privacy laws.
6. Your Rights Regarding PHI
Right to request restriction of uses and disclosures. You have the right to
request that we not use or disclose any part of your PHI unless it
is a use or disclosure required by law. Please advise us of the
specific PHI you wish restricted and the individual(s) who should
not receive the restricted PHI. We are not required to agree to your
restriction request, but if we do agree to the request, we will not
use or disclose the restricted PHI unless it is necessary for
emergency treatment. In that case, we will ask that the recipient
not further use or disclose the restricted PHI.
Right of access to PHI. You have the right to inspect and obtain a copy of your PHI
in a "designated record set" (your medical and billing records) as
long as we maintain the PHI in such format. However, you do not have
a right of access to psychotherapy notes or information compiled in
reasonable anticipation of a civil, criminal, or administrative
proceeding. Also, your right of access may be limited if providing
certain PHI to you may endanger the health or safety of yourself or
others. To request access to your PHI, please make your request in
writing to our Privacy Contact. We will respond to your request as
soon as possible, but no later than 30 days from the date of your
request. We have the right to charge a reasonable fee for providing
copies of your PHI.
Right to confidential communications. You have the right to reasonable
accommodation of a request to receive communication of PHI by
alternative means or at alternative locations. Please make your
request in writing to our Privacy Contact. We will not require an
explanation of your reasons for the request, but we will ask that
you specify the alternative address or other method of contact and
that you inform us of how payment for our medical services will be
handled.
Right to amend PHI. You have the right to request that we amend the PHI in your
"designated record set" for as long as we maintain the PHI in such
format. Please make your request in writing to our Privacy Contact.
We will respond to your request as soon as possible, but no later
than 60 days from the date of your request. If we deny your request
for amendment, you have the right to submit a written statement of
reasonable length disagreeing with the denial and we have the right
to submit a rebuttal statement. A record of any disagreement about
amendment will become part of your medical records and may be
included in subsequent disclosures of your PHI.
Right to accounting of disclosures. Subject to certain limitations, you have the
right to a written accounting of disclosures by us of your PHI for
not more than 6 years prior to the date of your request. Your right
to an accounting applies to disclosures other than those for
treatment, payment, or health care operations; to yourself; for a
facility directory; to your family or close friends involved in your
care; or for notification purposes. Please make your request in
writing to our Privacy Contact. We will respond to your request as
soon as possible, but no later than 60 days from the date of your
request. We will provide you with one accounting every 12 months
free of charge. We will charge a reasonable fee based upon our costs
for any subsequent accounting requests.
Right to a copy of our Notice of Privacy Practices. We will ask you to sign a
written acknowledgement of receipt of our Notice of Privacy
Practices. We may periodically amend this Notice of Privacy
Practices and you may obtain an updated Notice from our Privacy
Contact at any time.
7. Complaint Procedure
Within the practice. If you have a complaint about the denial of any of the
specific rights listed in Section 6 above, about our Notice of
Privacy Practices, or about our compliance with state and federal
privacy law, please make your complaint in writing to our Privacy
Contact. We will respond to your complaint in writing within the
timeframes listed in Section 6 above or in any case within 60 days
of the date of your complaint.
Outside of the practice. If you believe that we are not complying with our
legal obligations to protect the privacy of your PHI, you may file a
complaint with the Secretary of the U.S. Department of Health &
Human Services. You must make your complaint to the Secretary in
writing within 180 days of the act or omission forming the basis of
your complaint.
Privacy Contact:
Debbie "DJ" Nixon
Office Manager
djnixon@trfponline.com
|
|
 |
 |
