This
Privacy Notice describes how medical information
about you, as a patient of
The Allergy Center at Brookstone, P.C.,
may be used and disclosed and how you can get
access
to this information. We
advise that you please review this notice carefully.
If you
have any questions, please contact the person
listed at the bottom of this notice.
OUR
COMMITMENT TO YOUR PRIVACY
The
Allergy Center at Brookstone, P.C. is
committed to maintaining the privacy of your
Protected Health Information (PHI). As we provide
treatment and services to you, we create records
that contain your medical and personal information,
referred to as Protected Health Information,
or PHI. We need these records to provide you
with quality care and to comply with various
legal requirements. The terms of this Privacy
Notice apply to all records containing your PHI
that are created or retained by our practice.
We are required by federal and state law to provide
you with this Privacy Notice of our legal duties
and the privacy practices that we maintain in
our practice concerning your PHI. We must follow
the terms of the Privacy Notice that we have
in effect at the time.
CHANGES
TO THIS PRIVACY NOTICE
We reserve the right to revise or amend this Privacy
Notice. Any revision or amendment to
this Privacy Notice
will be effective for all of your records that our
practice has created or maintained in the past and
for any of your records that we may create or maintain
in the future. We will post a copy of our current notice
in our offices in a visible location at all times and
you may request a copy of our most current notice at
any time.
HOW
WE MAY USE AND DISCLOSE YOUR (OR YOUR CHILD’S)
PHI
The following categories describe and give some examples
of the different ways in which we may use and disclose
your PHI. Not every use or disclosure in a category
will be listed. However, all of the ways we are permitted
to use and disclose PHI will fall within one of the
categories below.
Treatment
-
We may use your PHI to treat you. For example, we
may suggest that you have x-rays or diagnostic tests
and we may use the results to help us reach a diagnosis.
Your PHI may be disclosed to the facility at which
you have your diagnostic tests in order for the healthcare
providers at such diagnostic facilities to provide
services to you. We might disclose your PHI to a
pharmacy when we order a prescription for you.
Payment - We may use and disclose your PHI in order to bill
and collect payment from you, an insurance company,
or other designated third party payer for the treatment
and services we provide to you. For example, we may
contact your health plan to certify that you are
eligible for benefits and provide your plan with
details regarding your treatment to determine if
the plan will cover, or pay for, your treatment.
Healthcare
Operations - We may use and disclose your PHI to
operate our business. For example, our practice may
use your PHI to conduct quality assessment and improvement
activities, review the performance of our healthcare
professionals, or for general management or business
planning. We may also remove identifying information
from your health information so that it might be
used by others to study healthcare without learning
who specific patients are.
Appointment
Reminders - We may use and disclose your phone number
and address to contact you and remind you of an appointment.
USE
AND DISCLOSURE OF YOUR PHI IN CERTAIN CIRCUMSTANCES
The following categories describe special situations
in which we may use or disclose your PHI:
As
Required by Law - We will disclose PHI when required
to do so by federal, state, or
local law.
Public
Health Risks - We will disclose your PHI to public
health or government authorities that are authorized
by law to collect information for purposes such as,
but not limited to, the following:
- Maintaining vital records, such as births or deaths;
- Reporting child abuse or neglect;
- Preventing or controlling disease, injury, or
disability;
- Reporting reactions to drugs or problems with
products or devices;
- Notifying individuals if a product or device has
been recalled;
- Notifying your employer under limited circumstances
required by law, primarily relating to workplace
injury or illness or medical surveillance.
CLINICAL RESEARCH PREPARATORY ACTIVITIES
We
may review your (or your child’s) PHI as necessary
to prepare a Research protocol or a similar purpose
preparatory to Research. The use or disclosure is
sought by the Clinical Research Department of THE
ALLERGY CENTER AT BROOKSTONE, P.C. solely to review
PHI as necessary to prepare a Research protocol or
for a similar purpose preparatory to Research. Only
the PHI necessary for the Research purposes will
be sought. No PHI will be
removed from THE ALLERGY CENTER AT BROOKSTONE, P.C.
in the course of the review. Preparatory to research,
we may use your name and phone number to contact
you regarding potential research activities. Your name,
addresses, social security number, telephone/fax
numbers, and medical record number will only be used
here at THE ALLERGY CENTER AT BROOKSTONE, P.C.
HEALTH
OVERSIGHT ACTIVITIES
We may disclose your PHI to a health oversight agency
for oversight activities authorized by law. Oversight
activities can include, for example, investigations,
inspections, audits, surveys, licensure and disciplinary
action, or other activities necessary for the government
to monitor government programs, compliance with civil
rights laws and the healthcare system in general.
LAWSUITS AND SIMILAR PROCEEDINGS
We may use and disclose your PHI in response to a
court or administrative order, if you are involved
in a lawsuit or similar proceeding. We also may disclose
your PHI in response to a discovery request, subpoena,
or other lawful process by another party involved in
the dispute, but only if the requesting party has made
an effort to inform you of the request or to obtain
a qualified protection order protecting the information
the party has requested.
LAW
ENFORCEMENT
We may release PHI if asked to do so by law enforcement
for the following reasons:
- Reporting certain types of wounds and physical
injures, as required by law
- To identify/locate a suspect, material witness,
fugitive, or missing person
- In an emergency or to report a crime
SERIOUS
THREATS TO HEALTH OR SAFETY
We may use and disclose your PHI when necessary to
reduce or prevent a serious threat to your health and
safety or the health and safety of another individual
or the public. Under these circumstances, we will only
make disclosures to a person or organization able to
help prevent the threat.
MILITARY
If you are a member (or veteran) of U.S. or foreign
military forces, we may release your PHI as required
by the appropriate authorities.
NATIONAL
SECURITY
We may disclose your PHI to federal officials for
intelligence and national security activities authorized
by law. We also may disclose your PHI to federal officials
in order to protect the President, other officials
or foreign heads of state, or to conduct investigations.
INMATES
If you are an inmate of a correctional institution
or under the custody of law enforcement officials,
we may disclose your PHI to such correctional institutions
or law enforcement officials. Disclosure for these
purposes would be necessary: (a.) for the institution
to provide healthcare services to you, (b) for the
safety and security of the institution, and/or (c)
to protect your health and safety or the health and
safety of other individuals.
WORKER’S
COMPENSATION
We
may disclose your PHI for worker’s compensation
and similar programs, as required by applicable laws.
PATIENTS’ RIGHTS
REGARDING THEIR PHI
You have the following rights regarding the PHI that
we maintain about you:
Requesting
Restrictions - You have the right to request a restriction
on our use or disclosure of your (or your child’s)
PHI for treatment, payment, and/or healthcare operations.
Additionally, you have the right to request that we
restrict our disclosure of your PHI to only certain
individuals involved in your care or the payment for
your care, such as family members and friends. We are
not required to agree to your request. However, if
we do agree, we are bound by our agreement, except
when otherwise required or permitted by law or when
the restricted information is necessary to treat you
in an emergency. In order to request a restriction
of our use or disclosure of your PHI, you must make
your request in writing to THE ALLERGY CENTER AT BROOKSTONE,
P.C. in accordance with our practice’s policies.
Your request
must be in writing and describe in a clear and concise
fashion the following:
The information you wish restricted and how you want
it restricted;
- Whether
you are requesting to limit our practice’s
use, disclosure, or both; and
- To whom you want the limits to apply.
Confidential
Communications - You have the right to request
that our practice communicate with you about your
health and related issues in a particular manner
or at a certain location. For instance, you may ask
that we contact you at home rather than work, or
by mail rather than telephone. We will accommodate
reasonable requests, but we are not required to accommodate
all requests. In order to request a type of confidential
communication, you must make a written request to The
Allergy Center at Brookstone, P.C. specifying
the requested method of contact or the location where
you wish to be contacted. You do not need to give a
reason for your request.
Access
and Copies - You have the right to inspect
and obtain a copy of the PHI that we maintain about
you, including patient medical records and billing
records, but not including psychotherapy notes or
certain other information that may be restricted
by law or pursuant to a legal or administrative process
or proceeding. You must submit your request in writing
to The Allergy Center at Brookstone,
P.C. in order to inspect
and/or obtain a copy of your PHI. Our practice may
charge a fee for the costs of copying, mailing, labor,
and supplies associated with your request in accordance
with Georgia law. Please contact the person named
at the end of this notice for information about such
fees. We may deny your request to inspect and/or
copy portions of your PHI in certain limited circumstances.
However, you may request a review of our denial.
A licensed healthcare professional, who was not involved
in the denial, will be chosen by us to conduct reviews
of denials. We will comply with the outcome of the
review.
RIGHT
TO AMEND
If
you feel that PHI we have about you is incorrect
or incomplete, you may ask us to amend the information.
You have the right to request an amendment for as long
as the
information is kept
by our practice. To request an amendment, your request must be made in writing
and submitted to The Allergy Center at Brookstone, P.C. In addition, we may deny your request if you ask
us to amend information that:
- Was not created by us, unless the person or entity
that created the information is no longer available
to make the amendment;
- Is not part of the medical information kept by
or for our practice;
- Is not part of the information you would be permitted
to inspect and copy; and/or
- Is accurate and complete.
ACCOUNTING
OF DISCLOSURES
You
have the right to request an “accounting
of disclosures.” An accounting of disclosures
is a list of certain non-routine disclosures our practice
has made of your PHI for non-treatment or operations
purposes. We are NOT required to provide you with an
accounting of the following disclosures:
- Disclosures for treatment, payment, or the healthcare
operations of our practice;
- Disclosures to you;
- Disclosures incident to uses or disclosure of
your information for permitted purposes;
- Disclosures
(from our facility’s directory)
to others involved in your care or for notifying
your family member or personal representative
about your general condition, location, or
death when you have had the opportunity to
agree to such disclosures (or they were otherwise
permitted);
- Disclosures you have authorized us to make;
- Disclosures for national security or law enforcement;
- Disclosures
that were part of a “Limited
Data Set,” which is a set of information
containing only limited amounts of identifiable
information as permitted by the HIPAA Privacy
Rules; and/or
- Disclosures that occurred prior to April 14, 2003.
- Disclosures
for activities preparatory to a Research protocol
or for a similar purpose preparatory to Research.
In
order to obtain an accounting of disclosures, you
must submit your request in writing to
The
Allergy Center at Brookstone, P.C.. All requests for an accounting
of disclosures must state a time period, which may
not be longer than six (6) years from the date of disclosure
and may not include dates before April 14, 2003. The
first list you request within a 12-month period is
free of charge, but our practice may charge you for
additional lists within the same 12 month period. Our
practice will notify you of the costs involved with
additional requests and you may withdraw or modify
your request before you incur any costs.
RIGHT TO A PAPER COPY OF THIS NOTICE
You
are entitled to receive a paper copy of our notice
of privacy practices. You may ask us to give you a
copy of this notice at any time. To obtain a paper
copy of this notice, see the contact information at
the bottom of this notice.
RIGHT TO FILE A COMPLAINT
If you believe your privacy rights have been violated
by our practice or an employee of our practice, you
may file a complaint with our practice or with the
Secretary of the Department of Health and Human Services.
Because we are always interested in improving the quality
of services provided to you, we would encourage you
to contact The Allergy Center at Brookstone,
P.C. first.
All complaints must be in writing. You will not
be penalized for filing a complaint.
AUTHORIZATION
FOR OTHER USES AND DISCLOSURES
We will obtain your written authorization for uses
and disclosures that are not identified by this notice
or permitted or required by applicable law. Any authorization
you provide to us regarding the use and disclosure
of your PHI may be revoked at any time in writing.
After you revoke your authorization, we will no longer
use or disclose your PHI for the reasons described
in the authorization.
IF
YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE
CONTACT:
Sue
Foreman
Office Manager
1400
Bradley Lake Blvd
Columbus
, Georgia
706-324-4012
706-324-0396
(Fax)
