Effective Date: July 1, 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 about this notice, please contact Dr. Kristina Thompson.
OUR OBLIGATIONS:
We are required by law to:
- Maintain the privacy of protected health information
- Give you this notice of our legal duties and privacy practices regarding
health information about you
- Follow the terms of our notice that is currently in effect
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION:
The following describes the ways we may use and disclose health information that
identifies you ("Health Information"). Except for the purposes described below, we will
use and disclose Health Information only with your written permission. You may revoke
such permission at any time by writing to our practice Privacy Officer.
For Treatment. We may use and disclose Health Information for your treatment and to
provide you with treatment-related health care services. For example, we may disclose
Health Information to doctors, nurses, technicians, or other personnel, including people
outside our office, who are involved in your medical care and need the information to
provide you with medical care.
For Payment. We may use and disclose Health Information so that we or others may
bill and receive payment from you, an insurance company or a third party for the
treatment and sen/ices you received. For example, we may give your health plan
information about you so that they will pay for your treatment.
For Health Care Operations. We may use and
disclose Health Information for health
care operations purposes. These uses and disclosures are necessary to
make sure
that all of our patients receive quality care and to operate and manage
our office. For example, we may use and disclose information to make sure the
obstetrical or gynecological care you receive is of the highest quality. We also may
share information with other entities that have a relationship with you
(for example, your health plan) for their health care operation activities.
Appointment Reminders, Treatment Alternatives and Health Related Benefits and
Services. We may use and disclose Health Information to contact you to remind you
that you have an appointment with us. We also may use and disclose Health
Information to tell you about treatment alternatives or health-related benefits and
services that may be of interest to you.
Individuals Involved in Your Care or Payment for Your Care. When appropriate, we
may share Health Information with a person who is involved in your medical care or
payment for your care, such as your family or a close friend. We also may notify your
family about your location or general condition or disclose such information to an entity
assisting in a disaster relief effort.
Research. Under certain circumstances, we may use and disclose Health Information
for research. For example, a research project may involve comparing the health of
patients who received one treatment to those who received another, for the same
condition. Before we use or disclose Health Information for research, the project will go
through a special approval process. Even without special approval, we may permit
researchers to look at records to help them identify patients who may be included in
their research project or for other similar purposes, as long as they do not remove or
take a copy of any Health Information.
SPECIAL SITUATIONS:
As Required by Law. We will disclose Health Information when required to do so by
international, federal, state or local law.
To Avert a Serious Threat to Health or Safety. We may use and disclose Health
Information when necessary to prevent a serious threat to your health and safety or the
health and safety of the public or another person. Disclosures, however, will be made
only to someone who may be able to help prevent the threat.
Business Associates. We may disclose Health Information to our business associates
that perform functions on our behalf or provide us with services if the information is
necessary for such functions or services. For example, we may use another company
to perform billing services on our behalf. All of our business associates are obligated to
protect the privacy of your information and are not allowed to use or disclose any
information other than as specified in our contract.
Organ and Tissue Donation. If you are an organ
donor, we may use or release Health Information to organizations that
handle organ procurement or other entities engaged in procurement,
banking or transportation of organs, eyes or tissues to facilitate
organ, eye or tissue donation and transplantation.
Military and Veterans. If you are a member of the armed forces, we may release
Health Information as required by military command authorities. We also
may release Health Information to the appropriate foreign military
authority if you are a member of a foreign military.
Workers' Compensation. We may release Health information for workers'
compensation or similar programs. These programs provide benefits for work-related
injuries or illness.
Public Health Risks: We may disclose Health Information for public health activities.
These activities generally include disclosures to prevent or control disease, injury or
disability; report births and deaths; report child abuse or neglect; report reactions to
medications or problems with products; notify people of recalls of products they may be
using; a person who may have been exposed to a disease or may be at risk for
contracting or spreading a disease or condition; and the appropriate government
authority if we believe a patient has been the victim of abuse, neglect or domestic
violence. We will only make this disclosure if you agree or when required or authorized
by law.
Health Oversight Activities. We may disclose Health information to a health oversight
agency for activities authorized by law. These oversight activities include, for example,
audits, investigations, inspections, and licensure. These activities are necessary for the
government to monitor the health care system, government programs, and compliance
with civil rights laws.
Data Breach Notification Purposes. We may use or disclose your Protected Health
Information to provide legally required notices of unauthorized access to or disclosure of
your health information.
Lawsuits and Disputes. if you are involved in a lawsuit or a dispute, we may disclose
Health information in response to a court or administrative order. We also may disclose
Health Information 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 requested.
Law Enforcement. We may release Health information if asked by a law enforcement
official if the information is:
(1) in response to a court order, subpoena, warrant,
summons or similar process;
(2) limited information to identify or locate a suspect,
fugitive, material witness, or missing person;
(3) about the victim of a crime even if, under certain very limited circumstances, we are unable to obtain the person's
agreement; (4) about a death we believe may be the result of criminal conduct;
(5) about criminal conduct on our premises; and (6) in an emergency to report a crime, the
location of the crime or victims, or the identity, description or location of the person who
committed the crime.
Coroners, Medical Examiners and Funeral Directors. We may release Health
Information to a coroner or medical examiner. This may be necessary, for example, to
identify a deceased person or determine the cause of death. We also may release
Health Information to funeral directors as necessary for their duties.
National Security and Intelligence Activities. We may release Health information to
authorized federal officials for intelligence, counter-intelligence, and other national
security activities authorized by law.
Protective Sen/ices for the President and Others. We may disclose Health
Information to authorized federal officials so they may provide protection to the
President, other authorized persons or foreign heads of state or to conduct special
investigations.
Inmates or Individuals in Custody. If you are an inmate of a correctional institution or
under the custody of a law enforcement official, we may release Health Information to
the correctional institution or law enforcement official. This release would be if
necessary:
(1) for the institution to provide you with health care;
(2) to protect your health and safety or the health and safety of others; or
(3) the safety and security of the
correctional institution.
USES AND DISCLOSURES THAT REQUIRE US TO GIVE YOU AN OPPORTUNITY TO OBJECT AND OPT
Individuals Involved in Your Care or Payment for Your Care. Unless you object, we
may disclose to a member of your family, a relative, a close friend or any other person
you identify, your Protected, Health Information that directly relates to that person's
involvement in your health care. If you are unable to agree or object to such a
disclosure, we may disclose such information as necessary if we determine that it is in
your best interest based on our professional judgment.
Disaster Relief. We may disclose your Protected Health information to disaster relief
organizations that seek your Protected Health Information to coordinate your care, or
notify family and friends of your location or condition in a disaster. We will provide you
with an opportunity to agree or object to such a disclosure whenever we practically can
do so.
YOUR WRITTEN AUTHORIZATION IS REQUIRED FOR OTHER USES AND DISCLOSURES
The following uses and disclosures of your Protected Health information will be made
only with your written authorization:
1. Uses and disclosures of Protected Health Information for marketing purposes; and
2. Disclosures that constitute a sale of your Protected Health Information
Other uses and disclosures of Protected Health Information not covered by this Notice
or the laws that apply to us will be made only with your written authorization. If you do
give us an authorization, you may revoke it at any time by submitting a written
revocation to our Privacy Officer and we will no longer disclose Protected Health
information under the authorization. But disclosure that we made in reliance on your
authorization before you revoked it will not be affected by the revocation.
YOUR RIGHTS:
You have the following rights regarding Health Information we have about you:
Right to Inspect and Copy. You have a right to inspect and copy Health Information
that may be used to make decisions about your care or payment for your care. This
includes medical and billing records, other than psychotherapy notes. To inspect and
copy this Health Information, you must make your request, in writing, to Dr. Kristina
Thompson. We have up to 30 days to make your Protected Health Information
available to you and we may charge you a reasonable fee for the costs of copying,
mailing or other supplies associated with your request. We may not charge you a fee if
you need the information for a claim for benefits under the Social Security Act or any
other state of federal needs-based benefit program. We may deny your request in
certain limited circumstances. If we do deny your request, you have the right to have
the denial reviewed by a licensed healthcare professional who was not directly involved
in the denial of your request, and we will comply with the outcome of the review.
Right to an Electronic Copy of Electronic Medical Records. If your Protected Health
Information is maintained in an electronic format (known as an electronic medical record
or an electronic health record), you have the right to request that an electronic copy of
your record be given to you or transmitted to another individual or entity. We will make
every effort to provide access to your Protected Health Information in the form or format
you request, if it is readily producible in such form or format. If the Protected Health
Information is not readily producible in the form or format you request your record will be
provided in either our standard electronic format or if you do not want this form or
format, a readable hard copy form. We may charge you a reasonable, cost-based fee
for the labor associated with transmitting the electronic medical record.
Right to Get Notice of a Breach. You have the right to be notified upon a breach of
any of your unsecured Protected Health Information.
Right to Amend. If you feel that Health Information we have is incorrect or incomplete,
you may ask us to amend the information. You have the right to request an amendment
for as long as the information is kept by or for our office. To request an amendment,
you must make your request, in writing, to Dr. Kristina Thompson.
Right to an Accounting of Disclosures. You have the right to request a list of certain
disclosures we made of Health Information for purposes other than treatment, payment
and health care operations or for which you provided written authorization. To request
an accounting of disclosures, you must make your request, in writing, to Dr. Kristina
Thompson.
Right to Request Restrictions. You have the right to request a restriction or limitation
on the Health Information we use or disclose for treatment, payment, or health care
operations. You also have the right to request a limit on the Health Information we
disclose to someone involved in your care or the payment for your care, like a family
member or friend. For example, you could ask that we not share information about a
particular diagnosis or treatment with your spouse. To request a restriction, you must
make your request, in writing, to Dr. Kristina Thompson. We are not
required to agree to your request unless you are asking us to restrict
the use and disclosure of your Protected Health Information to a health
plan for payment or health care operation purposes and such information
you wish to restrict pertains solely to a health care item or service
for which you have paid us “out-of-pocket" in full. If we agree, we will
comply with your request unless the information is needed to provide
you with emergency treatment.
Out-of-Pocket-Payments. If you paid out-of-pocket (or in
other words, you have requested that we not bill your health plan) in
full for a specific item or service, you have the right to ask that your
Protected Health Information with respect to that item or sen/ice not
be disclosed to a health plan for purposes of payment or health care
operations, and we will honor that request.
Right to Request Confidential Communications. You have the
right to request that we communicate with you about medical matters in a
certain way or at a certain location. For example, you can ask that we
only contact you by mail or at work. To request confidential
communications, you must make your request, in writing, to Dr. Kristina
Thompson. Your request must specify how or where you wish to be
contacted. We will accommodate reasonable requests.
Right to a Paper Copy of This Notice. You have the right
to a paper copy of this notice. You may ask us 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.
You may obtain a copy of this notice at our web site, http://drkristinathompson.com. To obtain a paper copy of this notice contact Dr. Kristina Thompson.
CHANGES TO THIS NOTICE:
We reserve the right to change this notice and make the new notice apply
to Health information we already have as well as any information we
receive in the future. We will post a copy of our current notice at our
office. The notice will contain the effective date on the first page, in
the top right-hand corner.
COMPLAINTS:
If you believe your privacy rights have been violated, you may file a
complaint with our office or with the Secretary of the Department of
Health and Human Services. To file a complaint with our office, contact
Dr. Kristina Thompson. All complaints must be made in writing. You will not be penalized for filing a complaint.