The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA, Title II) required the Department of Health and Human Services (HHS) to establish national standards for electronic health care transactions and national identifiers for providers, health plans, and employers. It also addressed the security and privacy of health data. As the industry adopts these standards for the efficiency and effectiveness of the nation's health care system will improve the use of electronic data interchange.
GASTROENTEROLOGY OF SOUTHWEST MICHIGAN
NOTICE OF PRIVACY PRACTICES
Effective Date 1-1-2011
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
Understanding Your Health Record/Information:
Each time you visit our office, or another physician or health care provider contacts us concerning your medical needs or history, a record is made by our Office. This record contains medical information generated during your visits to our Office, received by our Office from other health care providers, or provided by you. In this “Notice of Health Information Practices,” we shall refer to the information contained in your record as your “health information.” This term shall have the same meaning as “protected health information” defined in the Health Insurance Portability and Accountability Act of 1996, as amended (:HIPAA”).
Your Health Information Rights:
Within the limits provided by federal and state law, you have the right to:
1. Request restrictions on certain uses and disclosures of your health information.
2. Receive confidential communications of your health information. You may request that we communicate with you about your health information by alternative means or at an alternative location.
3. Inspect and obtain a copy of your health information, except with regard to psychotherapy notes or information complied in reasonable anticipation of certain civil, criminal or administrative proceedings.
4. Request an amendment to your health information that we have created, except with regard to those portions of your health information that you are precluded from inspecting and copying as set forth above.
5. Obtain an accounting of certain disclosures of your health information.
6. Receive a paper copy of this Notice in addition to any electronic copy you may receive.
You may exercise any of the above rights by submitting a signed letter detailing your request and mailing or delivering the letter to our Office Manager. However, we encourage you to call first so that we can help you be as specific as possible with your request. We will promptly provide you with any forms needed to process your request.
Our Responsibilities:
This Office is required by law to:
1. Maintain the privacy of your health information.
2. Provide you with this Notice of our legal duties and privacy practices with respect to health information we collect and maintain about you.
3. Abide by the terms of this Notice, currently in effect, and as amended from time to time:
4. Notify you if we are unable to honor your request to restrict a use or disclosure of, or to amend, your health information.
5. Accommodate reasonable request you may have to communicate your health information by alternative means or at alternative locations.
We reserve the right to change our privacy practices and to make the new provisions effective for all of your health information we already have, as well as any health information we receive or create in the future. Should our privacy practices change, we will post a copy of the revised Notice in our waiting area, which indicates the effective date of the amended Notice. You may request and obtain a copy of our Notice of Privacy Practices anytime you visit our office.
If a use or disclosure of your health information is not permitted under law without a written authorization, we will not use or disclose your health information without that written authorization. You may at any time revoke a written authorization in writing, except to the extent that we have already taken action in reliance of your authorization.
If you have questions and would like additional information concerning this Notice, please call our Office Manager.
If you believe that we have violated any of your privacy rights, you may file a written complaint with our Office Manager or mail your written complaint to Digestive Health Associates of SW Michigan, P.C., 3304 Cooley Ct., Portage, MI 49024. You may also file your complaint with the Secretary of Health and Human Services. There will be no penalty or retaliation for filing a complaint.
Examples of Uses and Disclosures for Treatment,
Payment and Health Operations Permitted by Law:
We will use your health information for treatment. We will use your health information to provide medical services to you. Any of our staff involved in your care will have access to your health information. We may also provide your health information to other health care providers involved in your care to assist them in providing services to you.
However, we will not disclose psychotherapy notes to health care providers who are not the originators of those notes unless we have your written authorization to do so.
We will use your health information for payment. Your health plan or health insurer will require certain information about your condition and the services you receive from us, before payment will be made, or for pre-authorization purposes. Accordingly, for billing purposes, we may disclose your health information to your health plan or health insurer. We also may disclose health information to your health plan or health insurer when they require pre-authorization of a recommended procedure.
We will use your health information for regular health care operations.
Members of our staff may review and use health information from your record to access the care and outcomes in your case and others like it. This information will then be used by us in an effort to continually improve the quality and effort to continually improve the quality and effectiveness of our services.
Additional Uses and Disclosures
Business associates: Certain of our business operations may be performed by other businesses. We refer to these companies as “business associate.” In order for these business associates to perform the required service (billing, accounting services, etc.), we may need to disclose your health information to them so that they can perform the job we’ve asked them to do. To protect you, we require our business associates to appropriately safeguard your health information.
Communication with Persons Involved in Your Care: We may disclose your health information that is directly relevant to your care to individuals you wish to receive such information, including family members, relatives, close personal friends, or other persons you identify. Before we do so, we will ask you, and follow your instructions, as to whether or not to make such disclosures. If you are incapacitated, or involved in an emergency, we may use or make disclosures of your health information that we believe in our professional judgment are in your best interests, but only to the extent that such health information is directly relevant to the recipients’ involvement in your care.
Required by Law: We may use or disclose your health information to the extent such use or disclosure is required by law and is limited to the relevant requirements of such law.
Public Health, Health Oversight and the Food and Drug Administration (FDA):
As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability. We may also be required by law to disclose your health information to health oversight agencies responsible for regulating the health care system, government benefit programs, and civil rights laws, so that they may conduct, among other things, audits, investigations, and inspections. For the purpose of activities relating to the quality, safety or effectiveness or a FDA-regulated product or activity, we may disclose to the FDA your health information relating to adverse events with drugs, supplements, and other products, as well as information needed to enable product recalls, repairs, or replacements.
Victims of Abuse, Neglect or Domestic Violence: If we reasonably believe that you are the victim of abuse, neglect or domestic violence, we may disclose your health information to a governmental authority responsible for receiving these types of reports, to the extent the disclosure is required by law, or you agree to the disclosure. If the disclosure is authorized by law, but not required, we may disclose your information if we determine that disclosure is necessary to prevent serious harm to you or others.
Judicial and Administrative Procedures: If you are involved in a judicial or administrative proceeding, we may in response to an order of a court or administrative tribunal, or in response to a subpoena, discovery request, or other lawful process, disclose the specific portions of your health information that are requested. If the subpoena, discovery request or other lawful process is not accompanied by a court or administrative tribunal order, we may disclose your health information only after we are assured that reasonable efforts have been made to notify you of the request, and the time for you to raise objections to the request has expired, or reasonable efforts have been made by the requestor to seek a protective order concerning the requested health information.
Law Enforcement: We may disclose your health information to a law enforcement official for law enforcement purposes as required by law, a court ordered subpoena or summons, a grand jury subpoena or summons, or an administrative subpoena or summons, under certain circumstances.
In specific situations, the law also permits us to disclose limited pieces of your health information, when the information is needed by law enforcement officials to: 1) identify a suspect, fugitive, material witness, or missing persons; 2)identify a victim or a crime; 3) alert law enforcement officials concerning your death; 4) notify law enforcement officials when a crime has been committed on our premises; or 5) in an emergency, when necessary to alert law enforcement officials about a crime, its location, or the identity of a perpetrator.
Coroners Medical Examiners and Funeral Directors: We may disclose your health information to a coroner or medical examiner for the purpose of identifying you upon your passing, or to determine a cause of death. We may also disclose your health information to your funeral director if needed to complete his or her authorized duties.
Organ, Eye or Tissue Donations: If you are an organ, eye or tissue donor, we may release your health information to organizations that procure, band or transplant organs for the purpose of facilitation organ, eye or tissue donation and transplantation.
Research: We may disclose your health information to research when their research has been approved by an institutional review board or privacy board that has reviewed the research proposal and established protocols to ensure the privacy of your health information, thereby meeting the requirements under HIPAA. We may also disclose your health information for the purposes of research, public health or health care operations pursuant to a Data Use Agreement protecting that information as specified by HIPAA.
Avert a Serious Threat to Health or Safety: Consistent with applicable law and standards of ethical conduct, we may, in limited circumstances, use or disclose your health information if we, in good faith, believe such use or disclosure is necessary to prevent or lessen a serious and imminent threat to health or safety of a person or the public.
Military personnel: If you are a member of the United States Armed Services, we may disclose your health information to the appropriate military command authority when such information is deemed necessary to assure the proper execution of the military mission. Additionally, we may disclose your health information to the following entities if you are a part of the Departments of Defense, Transportation, State or Veterans Affairs.
National Security and Presidential Protective Services: We may disclose your health information to authorized federal officials for the conduct of lawful intelligence and national security activities as well as the provision of protective services to the President and other protected individuals.
Inmates and Individuals in Custody: If you are an inmate or otherwise in custody, we may disclose your health information to the correctional facility or law enforcement official having lawful custody of you.
Workers’ Compensation: We may disclose your health information to the extent authorized and necessary to comply with laws relating to workers’ compensation or other similar programs established by law.
Appointment Reminders and Information of Treatment Alternatives: We may contact you to provide appointment reminders, information concerning treatment alternatives or other health-related benefits, alternatives and services that may be of interest to you.
Our Pledge: We will endeavor to protect the privacy of your health information. If you have questions, comments, or concerns regarding the policies se forth above, please do not hesitate to discuss such matters with one of our Physicians or Office Manage.
KALAMAZOO ENDO CENTER
Notice of Privacy Practices
Effective Date: February, 2011
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.
WE ARE REQUIRED BY LAW TO MAINTAIN THE PRIVACY OF YOUR PROTECTED HEALTH INFORMATION AND TO PROVIDE YOU WITH A NOTICE OF OUR LEGAL DUTIES AND PRIVACY PRACTICES WITH RESPECT TO YOUR PROTECTED HEALTH INFORMATION. Protected Health Information is information about you, including demographic information that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.
You have the following RIGHTS with RESPECT to your PROTECTED HEALTH information:
1. Inspect and copy all or any part of your medical or health record, as provided by federal regulations.
2. Request restrictions on the use and disclosure of your PHI. However, Kalamazoo Endo Center is not required to agree to the restriction, except if you pay for a service entirely out-of-pocket. If you pay for a service entirely out-of-pocket, you may request that information regarding the service be withheld and not provided to a third party payor. Kalamazoo Endo Center is obligated by law to abide by such restriction. If you wish to request a restriction on the use and disclosure of your PHI, please provide a written request describing your requested disclosure to the Privacy Officer. We will notify you of our decision regarding the requested restriction.
3. Request that we amend your medical record, to the extent that such amendments are permissible under federal regulations.
4. Request and receive an accounting of disclosures made of your health information, except for disclosures made for the purpose of treatment, payment, health care operations and certain other purposes if such disclosures were made through a paper record or other health record that is not electronic, as set forth in federal regulations. On and after January 1, 2011, if you request an accounting of disclosures of your PHI, the accounting may include disclosures made for the purpose of treatment, payment and health care operations to the extent that disclosures are made through an electronic health record.
5. Obtain a paper copy of this Notice from Kalamazoo Endo Center upon request.
6. Receive communications regarding your health information by alternative means or have such communications addressed to an alternative location. For example, at your request, we will mail items to a post office box instead of your residence.
7. Receive notification if your unsecured (i.e. identifiable) PHI has been accessed by unauthorized individuals if we determine that there is a potential risk of harm as a result of the unauthorized access.
8. If you execute any authorization(s) for the use and disclosure of your health information, revoke such authorization(s), except to the extent that action has already been taken in reliance on such authorization.
9. Request and receive an electronic copy of your PHI if Kalamazoo Endo Center maintains your PHI in an electronic health record Kalamazoo Endo Center may charge you a reasonable fee to cover its costs for this service.
We may disclose your health information without your authorization for the following reasons:
1. We may disclose your PHI for the purpose of treatment, payment, or health care operations. Examples of these types of disclosures are provided below:
Treatment purposes
Example: Information obtained by your physician will be recorded in your medical record and used to assess and monitor your health status, determine the appropriate care and treatment for you, and prescribe treatments and medications for you, as necessary.
Payment purposes
Example: A bill may be sent to you or to a third party payor. The information on the bill or accompanying the bill may include information that identifies you, your diagnosis, the treatments rendered to you, and the medications, supplies and equipment used to perform the treatments.
Health care operations
Example: Employees of Kalamazoo Endo Center and its staff may use information in your health record to assess the quality of the care and treatment they provide to you. The information will then be used in an effort to continually improve the quality and effectiveness of the health care and services that we provide to all of our patients.
2. We may disclose your PHI in order to inform you of treatment alternatives, or other health-related benefits.
3. We may contact you to provide appointment reminders. In some instances, as required by law, we may seek your consent prior to providing you with certain materials.
4. We may disclose your PHI for the purpose of research. We will only disclose your PHI for research purposes without your express authorization if the research protocol has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.
5. We may disclose your PHI to public health officials.
6. We may disclose your PHI to law enforcement officials for law enforcement purposes. 7. We may disclose your PHI to an appropriate governmental authority if we reasonably believe that you may be a victim of abuse, neglect, or domestic violence.
8. If we believe it is necessary to avert a serious threat to the health or safety of yourself or the public, we may disclose your PHI to a person or persons who we believe are reasonably able to prevent or lessen the threat.
9. We may disclose your PHI as a source of data for business planning and for certain marketing purposes.
10. We may use your PHI as a tool for quality assurance and continuous quality improvement.
11. We may disclose your PHI as required by federal and state laws and regulations.
12. We may disclose your PHI to a health oversight agency, such as the Michigan Department of Community Health or the United States Department of Health and Human Services for purposes relating to the oversight of the health care system and government benefit programs such as Medicare or Medicaid.
13. We may disclose your PHI in the course of a judicial or administrative proceeding in response to a court order, subpoena, discovery request or other lawful process.
14. We may disclose your PHI to a coroner or medical examiner for the purpose of identifying a deceased person, determining a cause of death, or other purposes as authorized by law. We may also disclose your PHI to funeral directors as necessary to carry out their duties.
15. We may disclose your PHI to organizations involved in the procurement, banking, or transplantation of cadaveric organs, eyes or tissue, for the purpose of facilitating organ and tissue donation where applicable.
16. If you are a member of the United States or foreign Armed Forces, we may disclose your PHI for activities that are deemed necessary by appropriate military command authorities to assure the proper execution of a military mission.
17. We may disclose your PHI to authorized federal officials for the conduct of lawful intelligence, counter-intelligence and other national security functions authorized by law, or for the purpose of providing protective services to the President or foreign heads of state.
18. We may disclose your PHI to a correctional institution or a law enforcement official having lawful custody of you.
19. We may disclose your PHI as authorized by, and in compliance with, laws relating to workers’ compensation and similar programs established by law that provide benefits for work-related illnesses and injuries without regard to fault.
EXAMPLES OF OTHER PERMISSIBLE OR REQUIRED DISCLOSURES
Business associates: Some activities of Kalamazoo Endo Center are provided on our behalf through contracts with business associates. Examples of when we may use a business associate include consulting and quality assurance activities provided by an outside consultant, billing and coding audits performed by an outside auditor, and other legal and consulting services provided in response to billing and reimbursement issues which may arise from time to time. When we enter into contracts to obtain these services, we may need to disclose your health information to our business associate so that the associate may perform the job which we have requested. To protect your health information, however, we require our business associate to appropriately safeguard your information.
Notification: We may use or disclose information to notify or assist in notifying a family member, personal representative, close personal friend, or other person responsible for your care of your location and general condition. Kalamazoo Endo Center will not disclose your PHI to your family members, personal representative or close personal friends as described in this paragraph if you object to such disclosure. Please notify the Privacy Officer at the number provided below if you object to such disclosures.
Communication with family members: Health professionals, including those employed by or under contract with Kalamazoo Endo Center may disclose to a family member, other relative, close personal friend or any other person you identify, health information relative to that person’s involvement in your care or payment related to your care, unless you object to the disclosure.
Federal law allows for the release of your PHI to appropriate health oversight agencies, public health authorities or attorneys, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public.
Any use or disclosure of your PHI that is not listed above will be made only with your written authorization.
KALAMAZOO ENDO CENTER RESPONSIBILITIES
1. Maintain the privacy of your health information.
2. Provide you with this Notice as to our legal duties and privacy practices with respect to the information we maintain and collect about you.
3. Abide by the terms of this Notice.
4. Notify you if we are unable to agree to a requested restriction.
5. Provide you with a revised copy of this Notice if it is altered or amended.
6. Notify you if we discover a breach of any of your PHI that is not secured in accordance with federal guidelines.
7. Notify another covered entity if we inadvertently receive your PHI from a covered entity or a business associate thereof as a result of a breach of your PHI. In addition, we will return or destroy such protected health information to the extent required by law.
Kalamazoo Endo Center reserves the right to change its privacy practices for all protected health information that we maintain. If our privacy practices materially change, Kalamazoo Endo Center will revise this Notice and make this Notice available to you the next time you visit our office. If you request for us to do so, we will mail you a copy of this Notice. In addition, this Notice is available on our website at www.gsm-kec.com
Unless you authorize us to do so, Kalamazoo Endo Center will not use or disclose your personal health information in a manner inconsistent with this Notice.
FOR MORE INFORMATION OR TO REPORT A PROBLEM
If you believe your privacy rights have been violated, you may file a complaint with the Privacy Officer. Additionally, you may file a complaint with the Secretary of the Department of Health and Human Services. There will be no retaliation against you for filing a complaint.
If you have questions or would like additional information, or if you wish to file a complaint with us regarding our use or disclosure of your PHI, you may contact Vera Comer, the Kalamazoo Endo Center’s Privacy Officer at (269) 321-3390.