THE ALLERGY & ASTHMA CENTER, P.C.
NOTICE OF PRIVACY PRACTICES
(Effective September 23,
2013)
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.
If you have any
questions or need any additional information about this Notice
of Privacy Practices (Notice”), please contact the Allergy &
Asthma Center, P.C.’s
Contact
Person at (260) 432-5005.
A.
AAC’s DUTIES
The Allergy & Asthma Center, P.C.
(“AAC”) is required by the final Standards for Privacy of
Individually Identifiable Health Information (the “Privacy
Standards”) to maintain the privacy of your protected health
information. In
addition, AAC is required by law to provide you with adequate
notice of AAC’s uses and disclosures of your protected health
information, notice of your rights with respect to your
protected health information, and notice of AAC’s legal duties
with respect to your protected health information. This Notice
is given to you to satisfy AAC’s legal obligations to provide
adequate notice to you. AAC agrees to abide by the terms of its
Notice then in effect.
AAC is required to give this
Notice to you no later than its first delivery of services to
you. If the first
service delivery to you is delivered electronically, AAC will
provide electronic notice of its privacy practices automatically
and contemporaneously in response to your first request for
service. In
addition, AAC is required to make its Notice available to you at
any time upon your request, and to post the Notice in a clear
and conspicuous location in the waiting room of each of AAC’s
offices. A copy of this Notice will be posted on AAC’s website.
For purposes of the Privacy
Standards and this Notice, the term “protected health
information” means “individually identifiable health
information”. The
term “individually identifiable health information” means health
information (whether oral or recorded in any form or medium),
including demographic information collected from you, that
identifies you, or could reasonably be used to identify you and
which: is created or received by a health care provider, health
plan, public health authority, employer, life insurer, school or
university, or health care clearinghouse; and, relates to your
past, present, or future physical or mental health or condition,
the provision of health care to you, or the past, present, or
future payment for the provision of health care to you.
B.
How AAC May Use or Disclose YOUR Protected Health
Information
As a general rule, AAC may not
use, disclose or request protected health information about you
except as required or permitted by the Privacy Standards.
Furthermore, except in limited circumstances, AAC must
use, disclose or
request only the minimum necessary protected health information
to accomplish the purpose of the use, disclosure or request.
1.
Required Disclosures.
The following
categories describe the instances in which AAC is required to
disclose your protected health information:
●
To You.
AAC is required to
disclose protected health information about you to you when
requested by you in certain circumstances. Pursuant to the
Privacy Standards, you have the right to request access to your
protected health information for inspection and copying purposes
and to request an accounting of disclosures.
Each of those rights in discussed in more detail in the
“Your Rights Regarding Protected Health Information About You”
section of this Notice.
●
To the Secretary.
AAC is required to disclose
protected health information to the Secretary of the Department
of Health and Human Services when the information is required in
order for the Secretary to investigate or determine whether AAC
is in compliance with the Privacy Standards.
2.
Permitted Uses and Disclosures.
The following
categories describe the instances in which AAC is permitted to
use and disclose protected health information about you without
obtaining your written authorization. For each category, AAC has
attempted to explain what it means and has given examples.
Not every use or disclosure in a category will be listed.
However, all of the ways AAC may use and disclose
information without authorization will fall within one of the
following:
●
Treatment.
AAC may use your protected health information to provide
you with medical treatment or services.
AAC may disclose protected health information about you
to doctors, nurses, or other health care professionals who are
involved in taking care of you.
For example, if you have a medical condition that might
affect the provision of allergy or asthma services to you, AAC
may want to consult with another health care provider about that
condition. In
addition, during your course of treatment with AAC, you might
develop another medical condition, like high blood pressure, for
which another doctor will provide care to you.
That doctor may need to know that you are receiving
allergy and asthma services from AAC as those services might
affect the treatment for your high blood pressure.
AAC may disclose information about your allergy and
asthma services to the doctor treating you for your high blood
pressure.
●
Payment.
AAC may use or
disclose your protected health information for purposes of
receiving payment for treatment and services you receive.
For example, AAC may give your insurance company
information about your treatment so the insurance company will
pay AAC or reimburse you.
AAC may also tell your insurance company about treatment
you are going to receive to determine whether your insurance
company will pay for it.
●
Health Care Operations.
AAC may use and disclose protected health information
about you for operational purposes.
For example, your protected health information may be
disclosed to AAC’s health care professionals to evaluate the
performance of the health care professionals, to assess the
quality of care and outcomes in your cases and similar cases, to
learn how to improve AAC’s facilities and services, and, to
determine how to continually improve the quality and
effectiveness of the health care AAC provides.
●
Incidental Uses and Disclosures.
AAC may use and disclose protected health information
about you incident to a use or disclosure permitted or required
by the Privacy Standards so long as AAC has complied with the
minimum necessary and safeguards requirements imposed under the
Privacy Standards.
For example, AAC’s nurses may discuss information about your
care at the nursing station, and if someone overhears that
discussion, the disclosure to that person will be permitted so
long as the nurses discussed only the minimum necessary and AAC
took appropriate steps to put safeguards in place.
●
Appointment Reminders.
AAC may use and disclose
protected health information about you to contact you as a
reminder that you have an appointment for treatment or medical
care or to remind you to schedule an appointment. The
appointment reminder may be via phone (including a voice
message), mail (including a reminder postcard), email or
otherwise.
●
Treatment Alternatives.
AAC may use and
disclose your protected health information to tell you about or
to recommend possible treatment options or alternatives that may
be of interest to you so long as AAC is not receiving financial
remuneration in exchange for making the communication.
●
Health-Related Benefits and Services.
AAC may use and
disclose your protected health information to tell you about
health-related benefits or services that may be of interest to
you so long as AAC is not receiving financial remuneration in
exchange for making the communication..
●
Fundraising Activities.
AAC may use
protected health information about you to contact you in
an effort to conduct fundraising activities.
With each fundraising communication, AAC must provide you
with a clear and conspicuous opportunity to elect not to receive
any further fundraising communications.
●
Business Associates.
AAC contracts with others outside of AAC’s organization
to perform or assist AAC in performing functions that involve
the use and disclosure of protected health information.
For example, AAC may contract with a billing company to
do billing for AAC.
The billing company will need protected health information in
order to perform its job.
As such, AAC may disclose protected health information
about you to business associates of AAC so that the business
associates can perform the job AAC has asked them to do.
In order to protect your protected health information,
AAC will require all of its business associates to make
assurances to AAC they will each appropriately safeguard your
protected health information. Further, business associates will
be required to report to AAC any breaches with respect to your
information about which they know or in the exercise of
reasonable diligence should know.
●
Individuals Involved in Your Care.
In certain circumstances, AAC may use or disclose protected health
information about you to a family member, relative
or close personal friend who is involved in your medical
care. In addition, AAC may disclose protected health information
about you to notify or assist in the notification of a family
member, relative or
close personal friend who is involved in your medical care of
your condition, location and status.
●
Disaster Relief Efforts.
In certain
circumstances, AAC may use or disclose protected health
information about you to a public or private entity authorized
by law to assist in disaster relief efforts for the purpose of
coordinating with such entities.
●
Personal Representatives.
Except in limited circumstances, AAC must treat a
personal representative of a decedent as the individual about
who the protected health information relates.
As such, AAC may disclose protected health information to
your personal representative.
●
Adults and Emancipated Minors.
If a person has authority to act on behalf of an adult or
an emancipated minor in making decisions related to health care,
AAC must treat that person as a personal representative.
As such, except in limited circumstances, AAC may
disclose protected health information to your personal
representative as if the disclosure was being made to you.
●
Unemancipated Minors.
If, under
applicable law, a parent, guardian or other person acting in
loco parentis has authority to obtain access to protected health
information about an unemancipated minor, then AAC may disclose
protected health information to the person acting in loco
parentis as if the disclosure was being made to the
unemancipated minor.
●
Required by Law.
AAC will
disclose protected health information about you when it is
required to do so by federal, state or local law, rule or
regulation. For
example, AAC may disclose information for the following
purposes: for judicial and administrative proceedings pursuant
to legal authority; to report information related to victims of
abuse, neglect or domestic violence; and, to assist law
enforcement officials in their law enforcement duties.
●
Public Health/Health Oversight.
AAC may use or
disclose protected health information about you for public
health activities such as assisting public health authorities or
other legal authorities to prevent or control disease, injury,
or disability, or for other health oversight activities.
●
Deceased Individuals.
AAC may disclose protected health Information to funeral
directors, medical examiners and/or coroners to enable them to
carry out their lawful duties.
●
Organ/Tissue Donation.
AAC may use or
disclose protected health information about you for cadaveric
organ, eye or tissue donation purposes.
●
Research.
AAC may use or
disclose protected health information about you for research
purposes. For
example, a research project may involve comparing the health and
recover of patients who received one medication to those who
received another medication.
All research projects are subject to a special approval
process. Before AAC
will use or disclose protected health information about you, the
project will be approved through the special approval process.
●
Health and Safety.
AAC. may use or
disclose your protected health information to avert a serious
threat to the health or safety of you or any other person
pursuant to applicable law.
●
Specialized Government Functions.
AAC may use and
disclose your protected health information for military and
veterans activities, for national security and intelligence
activities, for protective services of the President and others,
and to correctional institutions and other law enforcement
custodial situations.
●
Workers’ Compensation.
AAC may use and
disclose protected health information about you for workers’
compensation or similar programs to the extent authorized by and
to the extent necessary to comply with laws regarding said
programs.
●
Military and Veterans.
If you are a
member of the armed forces, AAC may disclose your protected
health information as required by military authorities. AAC may
also use and disclose protected health information about you to
the Department of Veterans Affairs to determine whether you are
eligible for certain benefits.
●
Inmates.
If you are an inmate
at a correctional facility or under the custody of a law
enforcement official, AAC may disclose protected health
information about you to the correctional facility or law
enforcement official.
●
FDA Reporting.
In the event AAC is
subject to the jurisdiction of the federal Food and Drug
Administration with respect to a product or activity for which
AAC has a duty to make reports of quality, safety or
effectiveness, AAC may use and disclose protected health
information about you to make any fulfill any requirements
imposed by the FDA.
●
Lawsuits. If
you are involved in a lawsuit, AAC may disclose your protected
health information in response to a court order.
AAC may also disclose protected health information about
you in response to a subpoena, discovery request or other lawful
process by someone else involved in the dispute, but only if
efforts have been made to tell you about the request or to
obtain an order protecting the information.
3.
Uses and Disclosures For Which Authorization is Required.
The following
categories describe the instances in which
AAC may only use and disclose protected health
information about you after first obtaining your written
authorization:
a.
All Instances Except as Required or Permitted.
Except as
required or permitted by the Privacy Standards, AAC may not use
or disclose protected health information about you without your
written
authorization. When
AAC receives your authorization to use or disclose your
protected health information, AAC must make its use and
disclosure consistent with such authorization.
If you provide AAC authorization to use or disclose your
protected health information, you may revoke that authorization,
in writing, at any time.
If you revoke your authorization, AAC will no longer use
or disclose your protected health information for the reasons
covered by your authorization.
However, your revocation will not be applicable to
disclosures that AAC already made prior to its receipt of your
written revocation.
b.
Psychotherapy Notes.
AAC may not use and disclose psychotherapy notes without
your authorization except: to carry out certain treatment,
payment and health care operation activities; as required by
law; for health oversight activities; to coroners and medical
examiners; and, to prevent or lessen a serious and imminent
threat to the health and safety of a person or the public.
c.
Marketing. AAC
may not use and disclose protected health information about you
for marketing without your authorization. Marketing means a
communication about a product or service that encourages the
recipient of the communication to purchase or use the product or
service. Marketing
does not include a face to face communication made by AAC to you
and/or a promotional gift of nominal value provided by AAC.
Marketing also does not include refill reminders or other
communications about drugs, communications to recommend
alternative treatments for you and/or communications to describe
health-related product or services, so long as AAC is not
receiving any financial remuneration in exchange for making the
communication.
d.
Sale of PHI.
AAC may not use and disclose PHI about you if such use or
disclosure is a sale of PHI, without your authorization.
Your authorization must state that you acknowledge that
the disclosure will result in remuneration to AAC.
C.
YOUR RIGHTS REGARDING PROTECTED HEALTH INFORMATION ABOUT
YOU
You have the following rights
regarding protected health information AAC maintains about you:
1.
Request Restrictions.
You have the right to request that AAC restrict or limit
how it uses or discloses your protected health information for
treatment, payment or health care operations.
AAC will consider your request, but AAC is not generally
required to agree to your request.
Notwithstanding the foregoing, AAC must agree to your
request to restrict disclosure of PHI about you to a health plan
if: the disclosure
by AAC is for payment or health care operations and is not
otherwise required by law; and, the PHI to be restricted relates
only to a health care item or service for which you have paid
AAC in full. AAC
cannot agree to limit uses and disclosures that are required by
the Privacy Standards.
If AAC agrees to your request, AAC will comply with your
request unless the information is needed to provide you
emergency treatment or in other limited circumstances. To
request a restriction, you must make your request in writing to
the Privacy Officer of AAC. In your request, you must provide
AAC with your name, address, a specific description of the
requested restriction, and the requested duration of the
restriction. The
request must also be signed and dated.
Please refer to 45 C.F.R §164.522 for a more detailed
description of your rights.
2.
Request Confidential Communications.
You have the right to request that AAC communicate with
you about medical matters in a certain way or at a certain
location. For
example, you can ask that AAC only contact you at work or by
mail. To request
confidential communications, you must make your request in
writing to the Privacy Officer of AAC.
In your request, your must provide AAC with your name,
address, a specific description of the request, an
identification of the alternate method of communication and/or
alternate address, and the duration of the request.
The request must also be signed and dated.
AAC will not ask you the reason for your request and AAC
will accommodate all reasonable requests.
Please refer to 45 C.F.R §164.522 for a more detailed
description of your rights.
3.
Request Access to Inspect and Copy.
You have the right to request access for purposes of inspecting and
copying your PHI. To
request access, you must make your request in writing to the
Privacy Officer of AAC. In your request, you must provide AAC
with your name, address, a description of the requested access
(i.e., inspection, copying, both) and a statement as to the
requested form or format of the information.
AAC will provide the information in the form and format
requested by you if it is readily producible in such form or
forma, and if not, it will be provided in a readable hard copy
form. The request
must also be signed and dated.
AAC will respond to your request within 30 days.
If AAC is unable to respond within that time, AAC may
have an additional 30 days if it notifies you in writing as to
the reason for the delay and gives you the date on which it will
respond. In some
instances, AAC may deny your request to inspect and copy.
If you are denied access to your PHI, you may request
that the denial be reviewed in certain circumstances.
If you are entitled to a review, another licensed health
care professional chosen by AAC will review your request and the
denial. The person
conducting the review will not be the person who denied your
request. AAC will
comply with the outcome of the review.
If you request a copy of the information, AAC may charge
a fee for the cost of copying, mailing and other supplies
associated with your request.
Please refer to 45 C.F.R §164.524 for a more detailed
description of your rights.
4.
Request Amendments.
If you feel
that protected health information AAC has about you is incorrect
or incomplete, you have the right to request that AAC to amend
the information. You
have the right to request an amendment for as long as the
information is kept by or for AAC.
To request an amendment, you must make your request in
writing to the Privacy Officer of AAC. In your request, you must
provide AAC with your name, address, a specific description of
the requested amendment and a description of the reason or basis
for the amendment. The request must also be signed and dated.
AAC will respond to your request within 60 days.
If AAC is unable to respond within that time, AAC may
have an additional 30 days if it notifies you in writing as to
the reason for the delay and gives you the date on which it will
respond. In some
instances, AAC may deny your request for an amendment.
If AAC denies your request, you will be given the
opportunity to submit a written statement of disagreement and/or
request in writing that AAC include your request with any future
disclosures of the affected information.
In the event you file a written statement of
disagreement, AAC will be allowed to prepare a written rebuttal.
In some instances, the future disclosures of the affected
information will include your request, the denial, your written
statement and the rebuttal.
Please refer to 45 C.F.R §164.526 for a more detailed
description of your rights.
5.
Request an Accounting of Disclosures.
You have the right to request an accounting of
disclosures describing certain of the disclosures AAC has made
of protected health information about you. To request an
accounting, you must make your request in writing to the Privacy
Officer of AAC. In
your request, you must provide AAC with your name, address, and
a statement of the period of time for the accounting (which may
not be longer than six (6) years and may not include dates
before April 14, 2003).
Your request should indicate in what form you want the
accounting (for example, on paper, electronically, etc.) The
request must also be signed and dated.
AAC will respond to your request within 60 days.
If AAC is unable to respond within that time, AAC may
have an additional 30 days if it notifies you in writing as to
the reason for the delay and gives you the date on which it will
respond. The first
accounting you request within a twelve (12) month period will be
free of charge. For
additional accountings during a twelve (12) month period, AAC
may charge you for the cost of providing the accounting.
AAC will notify you of the cost involved in advance and
you may choose to withdraw or modify your request at that time
before any costs are incurred.
Please refer to 45 C.F.R §164.528 for a more detailed
description of your rights.
6.
Request Paper Copy of this Notice.
You have the right to a paper copy of this Notice.
You may ask AAC to give you a copy of this Notice at any
time. Even if you
have agreed to receive this Notice electronically, you are still
entitled to a paper copy of this Notice.
To obtain a paper copy of this Notice, contact the
Contact Person of AAC.
7.
Receive Notification of Breach.
AAC is required to provide notification to you and to the
Secretary of the Department of Health and Human Services in the
event AAC discovers a breach with respect to unsecured protected
health information affecting you. The notification to you shall
be made without unreasonable delay and in no case later than 60
days after the date the breach was discovered by AAC. The notice
shall contain various information about the breach, including:
a description of what happened and the date of the breach
if known; a description of the types of information involved in
the breach; any steps you should take to protect yourself from
potential harm resulting from the breach; and, a brief
description of what AAC is doing to investigate the breach,
mitigate harm, improve security, and impose sanctions on
offending individuals. The notification will be provided to you
in writing by first class mail. If you have agreed to accept
electronic notice, AAC may send the notification to you
electronically. If
AAC has insufficient or out-of-date contact information for you,
the notification may be provided by other means, such as
telephone or email.
In some instances, AAC may be required to post a notice on its
web site or post a notice in major print or broadcast media
where you are likely to reside.
In addition, AAC is required to notify the Secretary of
the Department of Health and Human Services upon its discovery
of a breach involving unsecured protected health information.
If the breach involves 500 or more individuals, then the
notification to the Secretary shall be made concurrently with
the notice to affected individuals.
If the breach involves fewer than 500 individuals, then
the notice to the Secretary shall be made annually.
D.
COMPLAINTS
If you believe your privacy
rights have been violated, you may file a complaint.
To file a complaint with AAC, contact the
Contact
Person of AAC at (260) 432-5005.
The Contact Person will inform you as to the formal
procedure for filing a complaint with AAC and the Contact Person
can assist you with respect to making a complaint. You will not
be retaliated against for filing a complaint.
You may also file a complaint
with the Secretary of the Department of Health and Human
Services. To file a
compliant with the Secretary of the
Department of Health and Human Services, you should
contact the Department of Health and Human Services at: The
U.S. Department of Health and Human Services, 200 Independence
Avenue, S.W., Washington, D.C. 20201;
(877)-696-6775 within one hundred eighty (180) days of
when you knew or should have known that the act or omission
complained of occurred (this time limit can be waived by the
Secretary for good cause shown)).You will not be retaliated against for filing a
complaint.
E.
CHANGES TO THIS NOTICE
AAC reserves the right to change
its privacy practices and this Notice at any time.
AAC will promptly revise and distribute a revised Notice
whenever required by law or when there is a material change to:
the uses or disclosures that may be made by AAC; your rights
with respect to your protected health information; AAC’s legal
duties; and/or AAC’s other privacy practices described in this
Notice. AAC
reserves the right to make the revised or changed privacy
practices and Notice effective for protected health information
AAC already has about you as well as any information AAC
receives in the future.
AAC will post a copy of the
current Notice in the waiting room of each of AAC’s offices.
The Notice will contain on the first page, in the top
center section, the effective date.
In addition, each time you register at AAC’s office for
treatment or health care services, AAC will make available to
you a copy of the current Notice then in effect. AAC will also
post a copy of its current Notice on its website.
F.
EFFECTIVE DATE
This Notice shall be effective on
and after September 23, 2013.
G.
YOUR WRITTEN ACKNOWLEDGMENT OF RECEIPT OF THIS NOTICE
If you are a new patient, AAC is
required to make a good faith effort to obtain your written
acknowledgement of your receipt of this Notice.
As such, please complete the attached form acknowledging
your receipt of this Notice and give the completed form to a
member of AAC.