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.
Original Effective Date: September 23, 2013
A federal regulation known as the “HIPAA Privacy Rule” requires that we provide a detailed notice of privacy practices to all of our patients. We know that this Notice is long. The HIPAA Privacy Rule requires us to address many specific things in this Notice.
I. OUR COMMITMENT TO PROTECTING HEALTH INFORMATION ABOUT YOU
The HIPAA Privacy Rule requires that we protect the privacy of health information that identifies a patient, or where there is a reasonable basis to believe the information can be used to identify a patient. This information is called “protected health information” or “PHI”. This notice describes your rights as our patient and our obligations regarding the use and disclosure of PHI.
II. HOW WE MAY USE AND DISCLOSE PROTECTED HEALTH INFORMATION ABOUT YOUUSES AND DISCLOSURES FOR TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS
The following categories describe the different ways we may use and disclose PHI for treatment, payment, or health care operations without your consent or authorization. The examples included in each category do not list every type of use or disclosure that may fall within that category.
We may use and disclose PHI about you to provide, coordinate, or manage your health care and related services. We may consult other health care providers regarding you treatment and coordinate and manage your health care and related services. For example, we may use and disclose PHI when you need a prescription, lab work, an X-ray, or other health care services. In addition, we may use and disclose PHI about you when referring you to another health care provider. For example, we may send a report about you to a physician that we refer you to so that the other physician may treat you.
OTHER USES AND DISCLOSURES WE CAN MAKE WITHOUT YOUR WRITTEN AUTHORIZATION FOR WHICH YOU HAVE THE OPPORTUNITY TO OPT OUT
We may use and disclose your PHI in some situations where you have the opportunity to agree or object to those uses and disclosures of your PHI. If you do not object (Opt Out), we may use or make the following disclosures of your PHI:
• We may disclose PHI about you to your Primary Care Physician or to the physician that referred you to see us.
• We may disclose PHI about you to your family member, close friend, or any other person identified by you, if that information is directly relevant to the person’s involvement in your care or payment for you care.
• If you are present and able to consent or object (or if you are available in advance), then we may only use or disclose PHI if you do not object and after you have been informed of your opportunity to object.
• If you are not present or you are unable to consent or object, we may exercise professional judgment in determining whether the use or disclosure of PHI is in your best interest. For example, if you are brought into this office and are unable to communicate normally with you physician for some reason, we may find it is in your best interest to give your prescription and other medical supplies to the friend or relative who brought you in for treatment.
• We may also use and disclose PHI to notify such persons of you location, general condition, or death. We also may coordinate with disaster relief agencies to make this type of notification.
• We may use professional judgment and our experience with common practice to make reasonable decisions about your best interests in allowing a person to act on your behalf to pick up filled prescriptions, medical supplies, X-rays, or other things that contain PHI about you.
OTHER USES AND DISCLOSURES WE CAN MAKE WITHOUT YOUR WRITTEN AUTHORIZATION OR OPPORTUNITY TO AGREE OR OBJECT
We may disclose PHI about you in the following circumstances without your authorization or opportunity to agree or object, provided that we comply with certain conditions that may apply.
We may use and disclose PHI as required by federal, state, or local law to the extent that the use or disclosure complies with the law and is limited to the requirements of the law.
III. YOUR RIGHTS REGARDING PROTECTED HEALTH INFORMATION ABOUT YOU
Under federal law, you have the following rights regarding PHI about you:
You have the right to request additional restrictions on the PHI that we may use or disclose for treatment, payment, and health care operations. You may also request additional restrictions on our disclosure of PHI to certain individuals involved in your care that otherwise are permitted by the Privacy Rule. We are not required to agree to your request. If we do agree to your request, we are required to comply with our agreement except in certain cases, including where the information is needed to treat you in the case of an emergency. To request restrictions you must make your request in writing to our Privacy Officer. In your request, please include (1) the information that you want to restrict; (2) how you want to restrict the information (for example, restricting use to this office, only restricting disclosure to persons outside this office, or restricting both): and (3) to whom you want those restrictions to apply. Additionally, you have the right to request that we restrict PHI about you from disclosure to health plans when you have paid out of pocket, in full for the care you are requesting restrictions on. We are required to agree to this specific request when it meets the necessary criteria.
IV. COMPLAINTS
you may file a complaint with our Privacy Officer or the Secretary of the United States Department of Human Services. To file a complaint with our office, please contact our Privacy Officer at the address and/or telephone number listed below. We will not retaliate or take action against you for filing a complaint.
V. QUESTIONS
please don’t hesitate to contact our Privacy Officer at the address and/or telephone number listed below.
VI. PRIVACY OFFICER CONTACT INFORMATION
Privacy Officer: Cheryl Davis
Address: 2720 Fairview Avenue N Suite 200, Roseville, MN 55113
Telephone Number: 651-633-6883
E-mail Address: cheryl@tareendermatology.com
This notice was published on September 30, 2013, and first became effective on September 23, 2013.