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Notice of Privacy Practices As Required by the Privacy Regulations Promulgated Pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO YOUR IDENTIFIABLE HEALTH INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY. If you have any questions about this notice, please contact our Privacy Officer at 415-893-1518 ext. 300. OUR PLEDGE REGARDING INFORMATION: We are committed to protecting information about you and your health. We create a record of the care and services you receive from us. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of our records. We are required by law to: * Maintain the privacy of your information; * Give you this notice of our legal duties and privacy practices related to your information; and * Follow the terms of the notice that is currently in effect. How we May Use and Disclose Information About You: Treatment. We may use and disclose PHI to treat or provide services to you. For example, a physician ordering oxygen may need to be aware that you are also receiving respiratory medications from our Pharmacy. Payment. We may use and disclose PHI so that we can bill and be paid for the treatment and services you receive from us. For example, we may need to give information about your diagnosis to your insurance company so they will pay for the oxygen services. Health Care Operations. We may use and disclose PHI as needed to carry out our organizational needs. For example, we may use or disclose PHI about you to improve our quality of care. Organized Health Care Arrangement. For certain activities, we may disclose information about you to other healthcare providers participating in an organized healthcare arrangement. For example, we may share information with other healthcare providers in order to improve quality of care. Those Involved in Your Care. We may release relevant PHI to a friend, family member, or anyone else you designate that is involved in your care or payment related to your care. We may also disclose PHI to those assisting in disaster relief efforts so that your family can be notified about your condition, status and location. Other. We may use or disclose PHI for the following purposes: * As required by law * To avert a threat to health or safety * Worker’s compensation * Public health activities * Health oversight activities * Lawsuits and disputes * Government functions * Custodial law enforcement Your Rights Regarding Your Information You have the following rights regarding information we maintain about you: Right to Inspect and Copy. You have the right to inspect and obtain a copy of the PHI contained in your medical record. You must submit your request in writing to: Med-Mart / Pacific Pulmonary Services, ATTN: Privacy Officer, 88 Rowland Way, Suite 300, Novato, CA 94945. In some cases, we may deny your request. There may be a fee for the costs of copying, mailing or supplies associated with your request. Right to Amend. You have a right to amend your PHI. You must submit your request along with the reason for amendment in writing to: Med-Mart / Pacific Pulmonary Services, ATTN: Privacy Officer, 88 Rowland Way, Suite 300, Novato, CA 94945. Right to an Accounting of Disclosures. You have the right to request an "accounting of disclosures." This is a list of our disclosures of your PHI except any made (1) to you, (2) prior to April 14, 2003, (3) as a result of your specific written permission, or (4) for Treatment, Payment, Health Care Operations, Those Involved in Your Care, or for government functions. You may submit your request in writing to our Privacy Officer. The request must include the time period (not longer than six years) for the disclosures you wish to be listed. The first list you request will be free. We may charge you for the costs of providing other lists within a 12 month period. Right to Request Restrictions. You have the right to request restrictions on the PHI we use or disclose about you as described in the sections above for Treatment, Payment, Health Care Operations, and Those Involved in Your Care. In some cases, we may not agree to your request. You must submit your request for restrictions in writing. Right to Request Confidential Communications. You have the right to request that we communicate with you in a certain way or at a certain location. You must submit your request for confidential communications in writing. We will honor reasonable requests. Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice at any time. To obtain a paper copy of this notice, contact our Privacy Officer. You may also obtain a copy of this notice on our website, www.ppsc.com We reserve the right to change the terms of this notice, and apply any changes to all PHI that we maintain. We will post a current copy of this notice in our facilities and on our website. The effective date of the notice is located at the top, right-hand corner on the first page. COMPLAINTS If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. To file a complaint with us, contact our Privacy Officer at 415-893-1518 ext. 300. You will not be penalized for filing a complaint. OTHER USES AND DISCLOSURES OF INFORMATION Other uses and disclosures of PHI not covered by this notice will be made only with your authorization. You may also revoke the authorization at any time by sending a request in writing. After you revoke your authorization, we will no longer use or disclose your identifiable health information for the reasons described in the authorization. Please note, we are required to retain records of your care. |