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.
Midwest Ear, Nose, And Throat Surgery, P.S.C. (Midwest ENT) is required by law to maintain the privacy of protected health information (PHI) and to provide individuals with notice of its legal duties and privacy practices with respect to PHI.
This Notice describes how we may use or disclose your PHI for various purposes. It also describes your rights to access and control your PHI. Protected health information is information about you that may identify you and relates to your past, present or future physical or mental health or condition and related health services.
Midwest ENT is required to abide by the terms of the Notice of Privacy Practices currently in effect. We reserve the right to change the terms of this notice and to make the new notice provisions effective for all PHI that we maintain. Upon your request, we will provide you with any revised notice of privacy practices.
Uses and Disclosures of Protected Health Information for Treatment, Payment and Health Care Operations:
Your PHI may be used and disclosed by your physician, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you. Your PHI may also be used and disclosed to pay your health care bills and to support health care operations.
The following are examples of the types of uses and disclosures of your PHI that our practice is permitted to make. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by our office.
Treatment: We will use and disclose your PHI 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 to have access to your PHI. For example, we would disclose your PHI, as necessary, to a home health agency that provides care to you. We will also disclose your PHI to other physicians who may be treating you. For example, your PHI may be provided to a physician to whom you have been referred to ensure that he/she has information necessary for your treatment. In addition, we may disclose your PHI to another physician or health care provider (e.g., a specialist or laboratory) who, at our request becomes involved in your care. Finally, we may use and disclose your PHI for the treatment activities of another health care entity or provider.
Payment: Your PHI will be used, as needed, to obtain payment for 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 for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example, obtaining approval for a hospital stay may require that your relevant PHI be disclosed to your health insurance plan to obtain approval for the hospital admission.
Health care Operations: We may use or disclose, as needed, your PHI in order to support the business activities of this practice. These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, licensing, marketing, and conducting or arranging for other business activities.
For example, we may disclose your PHI 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. In addition, we may use or disclose your PHI to another entity in order for that entity to conduct specific health care operations, which include quality assessment activities and reviewing the competence of health care professionals.
We will share your PHI 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 PHI, 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 PHI, as necessary, to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you. You may contact our HIPAA Officer to request that these materials not be sent to you.
Uses and Disclosures That May Be Made With Your Written Authorization:
Other uses and disclosures of your PHI will be made only with your written authorization, unless otherwise permitted or required by law as described below. You may revoke such an authorization, at any time in writing, except to the extent that your physician or the practice has taken an action in reliance on the use or disclosure indicated in the authorization.
Uses and Disclosures That May Be Made Unless You Object:
We may also use and disclose your PHI in the following instances. In these instances, you have the opportunity to agree or object to the use or disclosure of all or part of your PHI. If you are not present or able to agree or object to the use or disclosure of the PHI, then your physician may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the PHI that is relevant to your health care will be disclosed.
Others Involved in Your Health care: Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your PHI that directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary, if we determine that it is in your best interest based on our professional judgement. We may use or disclose PHI to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death.
Disclosures That May Be Made Without Your Authorization or Opportunity to Object:
We may use or disclose your PHI in the following situations without your authorization:
Required By Law: We may use or disclose your PHI to the extent that the use or disclosure is required by law: The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law.
Public Health: We may disclose your PHI for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury or disability. We may also disclose your PHI, if directed by the public health authority, to foreign government agency that is collaborating with the public health authority
Communicable Diseases: We may disclose your PHI, as authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.
Health Oversight: We may disclose your PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.
Abuse or Neglect: We may disclose your PHI to public officials who are authorized by law to receive reports of abuse, neglect or domestic violence.
Food and Drug Administration: We may disclose your PHI to a person or company required by the Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations, track products; to enable product recalls; to make repairs or replacements, or to conduct post marketing surveillance, as required.
Legal Proceedings: We may disclose your PHI in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), and in certain conditions in response to a subpoena, discovery request or other lawful process.
Law Enforcement: We may also disclose your PHI for law enforcement purposes. These law enforcement purposes include (1) legal processes and otherwise required by law, (2) requests for limited information for identification and location purposes, (3) requests pertaining to victims of a crime, and (4) alerting law enforcement officials when (a) there is a suspicion that death has occurred as a result of criminal conduct (b) in the event that a crime occurs on the practice’s premises, or (c) a medical emergency exists (not on the practice’s premises) and it is likely that a crime has occurred.
Coroners, Funeral Directors, and Organ Donation: We may disclose your PHI to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law. We may also disclose protected health information to a funeral director to carry out their duties. We may also disclose such information in reasonable anticipation of death. Your PHI may be used and disclosed for cadaver organ, eye or tissue donation purposes.
Threatening Activity: Consistent with applicable federal and state laws, we may disclose your PHI, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose your PHI if it is necessary for law enforcement authorities to identify or apprehend an individual.
Military Activity and National Security: When the appropriate conditions apply, we may use or disclose PHI of individuals who are Armed Forces personnel (1) for activities deemed necessary by appropriate military command authorities (2) for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits, or (3) to foreign military authority if you are a member of that foreign military services. We may also disclose your PHI to authorized federal officials for conducting national security and intelligence activities including for the provision of protective services to the President or others legally authorized.
Workers’ Compensation: Your PHI may be disclosed by us as authorized to comply with workers’ compensation laws and other similar legally established programs.
Inmates: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release your PHI to the correctional institution or law enforcement official.
Your Rights Regarding Your Protected Health Information (PHI):
Required Uses and Disclosures: Under the law, we must make sure to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the privacy standards applicable to your protected health information.
The following is a statement of your rights with respect to your PHI and a brief description of how you may exercise these rights.
• You have the right to inspect and copy your PHI. This means you may inspect and obtain a copy of PHI about you that is contained in a designated record set for as long as we maintain the PHI. A “designated record set” contains medical and billing records and any other records that your physician and the practice use for making decisions about you. Under federal law, however, you may not inspect or copy the following records; psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and PHI that is subject to law that prohibits access to PHI. Depending on the circumstances, a decision to deny access may be reviewable. In some circumstances, you may have a right to have this decision reviewed. Please contact our HIPM Officer if you have questions regarding access to your medical record.
• You have the right to request a restriction of your PHI. This means you may ask us not to use or disclose any part of your PHI for the purposes of treatment, payment or health care operations. You may also request that any part of your PHI not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply. Your physician is not required to agree to a restriction that you may request. If your physician does agree to the requested restriction, we may not use or disclose your PHI in violation of that restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request with your physician. You must request the restriction in writing.
• You have the right to request to receive confidential communications from us by alternative means or at an alternative location. We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. We will not request an explanation from you as to the basis for the request. Please make this request in writing to our HIPAA Officer.
• You may have the right to have your physician amend your PHI. This means you may request an amendment of PHI about you in a designated record set for as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact our HIPAA Officer to determine if you have questions about amending your medical record.
• You have the right to receive an accounting of certain disclosures we have made, if any, of your PHI. This right applies to disclosures for this notice of privacy practices, as well as disclosures made pursuant to your authorization. It also excludes disclosures we may have made to you, to family members or friends involved in your care, or for notification purposes. You have the right to receive specific information regarding these disclosures that occurred after April 14, 2003. The right to receive this information is subject to certain exceptions, restrictions and limitations.
Making a Complaint:
You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our HIPAA officer. We will not retaliate against you for filing a complaint.
You may contact our HIPAA Officer, Julie Gentry at (270) 685-5946 for further information about the complaint process.
This notice was published and becomes effective on April 14, 2003.
The “Red Flags” Rule: In order to comply with the Federal Trade Commission’s implementation of the Fair and Accurate Credit Transactions (FACT) Act of 2003 (16 CFR § 681.2), Midwest Ear, Nose & Throat, Head & Neck Surgery, P.S.C., as of November 1, 2009, will require:
- All new patients to submit a valid photo identification issued by a local, slate, or federal government agency for the visit and to be copied for the practice’s records (e.g., driver’s license, passport, military ID, etc.)
- In the case where a new patient does not have a valid photo ID, two forms of non-photo ID, one of which is issued by a slate or federal agency, will be obtained (e.g., birth certificate, Social Security card, voters registration card, lawful permanent residence card or “Green Card”. etc.)
All existing patients must have their identification verified at each visit or before giving out personal information by matching photo identification to the one on record.
We appreciate your cooperation in complying with this legislation.