Notice of Privacy Practices

Clay Platte Family Medicine Clinic
The 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.

Background
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires health providers, such as Clay Platte Family Medicine Clinic (the clinic) to notify patients about their policies and practices to protect the confidentiality of patient health information. This notice tells you the ways the clinic may use and disclose health information about you, describes your rights, and states the obligations the clinic has regarding the use and disclosure of your health information.

Our Promise Regarding Your Health Information Privacy
The privacy policies and practices of the clinic protect confidential health information that identifies you or could be used to identify you and relates to a physical or mental health condition or the payment of your health care expenses. This individually identifiable health information is known as “protecting health information” (PHI). Your PHI will not be used or disclosed without a written authorization from you, except as described in this notice or as otherwise permitted by federal and state health information privacy laws.

How The Clinic May Use And Disclose Health Information About You
The following are the different ways the Clinic may use and disclosure your PHI without first having to obtain your written authorization:

For Treatment. The Clinic may disclose your PHI to physician, nurses and other health-care professionals. We may also disclose your PHI to other health care providers not affiliated with the clinic who are providing you treatment, such as a specialist physician, hospital or nursing home.

For Payment. The Clinic may use and disclose your PHI so claims for health care treatment, services, and supplies you received may be paid. For example. The Clinic may submit claims to your insurer or other parties responsible for payment of your care.

For Health Care Operations. The Clinic may use and disclose your PHI to enable it to operate more efficiently. For example, the Clinic may use your PHI to plan our future operations, for case management, to conduct compliance reviews, audits, quality assurance, or to evaluate our staff’s performance.

Other Benefits and Services. The Clinic may use and disclose your PHI to tell you about possible treatment options or alternatives or other health related benefits or services that may be of interest to you. The Clinic may use and disclose your PHI to remind you of appointments for health care services.

How The Clinic May Use And Disclose Health Information About You If You Do Not Object
The following are the different ways that Clinic may use and disclose your PHI if you do not object:

Individuals Involved In Your Care or Payment of Your Care. The Clinics may disclose PHI to a close friend of family member involved in or who helps pay for your health care. In an emergency situation, the Clinic may also disclose PHI to a disaster relief agency, such as the Red Cross, to help notify your friends or family of your Location and Office Hours.

Special Uses And Disclosures
The law allows the clinic to use or disclose your PHI under the following special circumstances without having to obtain your written authorization:

As Required by Law. The clinic will disclose your PHI when required to do so by federal, state, or local law, including those that require the reporting of certain types of injuries.

Lawsuits and Disputes. If you become involved in a lawsuit or other legal action, the clinic may disclose your PHI in response to a court or administrative order, a subpoena, or search warrant.

Law Enforcement. The clinic may release your PHI if asked to do so by a law enforcement official, for example, to identify or locate a suspect, witness, or missing person or to report details of a crime.

Workers’ Compensation. The clinic may disclose your PHI as authorized by and to comply with workers’ compensation laws.

Military and Veterans. If you are or become a member of the U.S. armed forces, the clinic may release medical information about you if required by military command authorities.

To Avert Serious Threat to Health or Safety. The Clinic may use and disclose your PHI when necessary to prevent a serious threat to you health and safety, or the Health and Safety of the public or another person.

Public Health Risks. The Clinic may disclose health information about you for public health activities. These activities include preventing or controlling disease, injury or disability; report teen births and deaths; reporting child abuse or neglect; or reporting reactions to medication or problems with medical products or to notify people of recalls of products they have been using.

Health Oversight Activities. The Clinic may disclose your PHI to a health oversight agency for audits, investigations, inspections, and licensure necessary for the government to monitor the health care system and government programs.
Research. Under certain circumstances, the Clinic may use and disclose your PHI for medical research purposes.

National Security Services. The Clinic may release your PHI to authorize federal officials for protection of the president of for national security and intelligence activities.

Organ and Tissue Donation. If you are an organ donor, the Clinic may release your PHI to organizations that handle organ, eye, or tissue donation and transplantation.

Coroners, Medical Examiners, and Funeral Directors. The Clinic may release your PHI to a coroner or medical examiner for identifying a deceased person or determining the cause of death. The Clinic may also release your PHI to a funeral director, as necessary, to carry out his/her duties.

Your Rights Regarding Your Health Information

Your rights regarding the health information the Clinic maintains about you are as follows:

Right to Inspect and Copy. You have the right to inspect and copy your PHI. To inspect and copy your health information, submit your request in writing to the Clinic Manager (see Contacts below). The Clinic may charge a fee for the cost of copying and/or mailing your request. In limited circumstances, the Clinic may deny your request to inspect and copy your PHI. Generally, if you are denied access to your health information, you may request a review of the denial.

Right to Amend. If you think that health information the Clinic has about you is incorrect or incomplete, you may ask to have it amended. To request an amendment, send a detailed request in writing to the Clinic Manager.

Right to an Accounting of Disclosures. You have a right to request an “accounting of disclosures”. This is a list of disclosures of your PHI that tht Clinic has made to others, except for those necessary to carry out health care treatment, payment, or operations and disclosures you have you have authorized. To request an accounting of disclosures, submit, you request in writing to the Clinic Manager.

Right to Request Restrictions. You have the right to request a restriction of the health information the clinic used or disclosed about your for treatment, payment, or health care operation. You also have the right to request a limit on the health information the clinic discloses about you to someone who is involved in you care for the payment for your care, like a family member or friend. To request restrictions, make your request in writing to the Clinic Manager.

Note: the Clinic is not required to agree to your request.

Right to Request Confidential Communications. You have the right to request that the Clinic communicate with you about health matters in a certain way or at a certain Location and Office Hours. For example, you can ask that the Clinic send you bills or reminders at a specified address. To request confidential communication, make your request in writing to the Clinic Manager.

Note: the Clinic is not required to agree to your request.

Right to a Paper Copy of the Notice. You have the right to a copy of this notice, You may write to the Clinic Manager to request a written copy of this notice at any time.

Changes to this Notice

The Clinic reserves the right to change this notice at any time and to make the revised or changed notice effective for health information the Clinic already has about you. A copy of the current notice is posted in the Clinic’s waiting room.

Complaints

If you believe your privacy rights under this policy have been violated, you may file a written complaint with the Compliance Officer at Clay Platte Family Medicine Clinic.

Note: you will not be penalized or retaliated against for filing a complaint.

Other Uses and Disclosures of Health Information

Other uses and disclosures of Health Information not covered by this notice of by the laws that apply to the Clinic will be made only with your written authorization. If you authorize the Clinic to use or disclose your PHI, you may revoke the authorization, in writing, at any time. If you revoke the authorization, the Clinic will not longer use or disclose your PHI for the reasons covered by your written authorization; however, the Clinic will not reverse any uses or disclosures already made in reliance on your prior authorization.

Contacts

If you have any questions about this notice, please contact the Clinic Manager.

Effective date: April 14th, 2003.

"Partnering for Excellence in Healthcare"

Notice of Privacy Practices