HIPAA - Notice of Privacy Practice
NOTICE OF PRIVACY PRACTICES
SEWICKLEY VALLEY PEDIATRIC & ADOLESCENT MEDICINE
Effective Date: April 1, 2003
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW TO GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.
If you have any questions regarding this notice, you may contact our Privacy Officer at the following location:
Sewickley Valley Pediatrics
Attention Privacy Officer
701 Broad Street
Sewickley, PA 15143
412-741-8700 (office)
412-741-3710 (fax)
HEALTH INSURANCE PORTABILITY & ACCOUNTABILITY ACT – CODE OF CONDUCT
Sewickley Valley Pediatrics values each person as an individual with rights and dignity: the right to quality healthcare; the right to privacy; and the right to an assurance that health information is both confidential and secure. The individual and family members have the right to question their health information and the use of it. This facility requests permission for disclosures not already authorized by law. Employees are trained to keep secure, private, and confidential all patient health information. Employees are updated on regulations and new policies, which make adherence to the regulations operational.
It is the values of Sewickley Valley Pediatrics to assure our families that no breach of patient health information privacy, security, or confidentiality will be tolerated. There exists disciplinary measures, up to and including termination, for those found in violation.
Sewickley Valley Pediatrics will act on your behalf to ensure that care is of the utmost quality and all regulations are met or exceeded to provide a welcoming environment.
YOUR PROTECTED HEALTH INFORMATION
Sewickley Valley Pediatrics is required by the federal privacy rule to maintain the privacy of your health information that is protected by the rule, and to provide you with notice of our legal duties and privacy practices with respect to your protected health care information. We are required to abide by the terms of the notice currently in effect.
Generally speaking, your protected health information is any information that is related to your past, present, or future physical or mental health or condition, the provision of health care to you, or payment for health care provided to you, and individually identifies you or reasonably can be used to identify you.
Your medical and billing records at our practice are examples of information that usually will be regarded as your protected health information.
Our physicians & clinical staff will use information to treat you; our billing office will use information to bill you and your insurance company; and our office, in general, will use information for business purposes such as quality improvement.
USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION
A. Treatment, payment and health care operations
This section describes how we may use and disclose your protected health information for treatment, payment & health care operations purposes. The descriptions include examples. Not every possible use or disclosure for treatment, payment, and health care operations purposes will be listed.
1. Treatment
We may use and disclose your protected health information for our treatment purposes as well as the treatment purposes of other health care providers. Treatment includes the provision, coordination, or management of health care services to you by one or more health care providers. Some examples of treatment uses & disclosures would include:
*During an office visit, practice physicians and other staff involved in your care may review your medical record and share & discuss your medical information with each other.
*We may share and discuss your medical information with an outside physician to whom we have referred you for care.
*We may share and discuss your medical information with an outside physician with whom we are consulting regarding your care.
*We may share and discuss your medical information with an outside laboratory, radiology center, or other health care facility where we have referred you for testing.
*We may share and discuss your medical information with an outside home health agency, durable medical equipment agency or other health care provider to whom we have referred you for health care services and products.
*We may share and discuss your medical information with another health care provider who seeks this information for the purpose of treating you.
*We may use patient sign-in sheets in the waiting area that could be seen by other patients coming to the office.
*With regard to our telephone triage, we will request to speak only to parents or legal guardians about your child.
*We may call patients by name, in the waiting room when it is time for them to go to an examining and/or weigh-in room.
*We may share & discuss your medical information with medical students, nurse practitioner students, physician assistant students or other allied health professional students working in our office.
*We may place the patient’s medical information chart in a rack outside the exam room door where you are waiting for the physician and in a rack near the front office when are waiting to be called back initially to be seen by our clinical staff.
*We will utilize “weigh-in” rooms for the patient’s initial measurements and intake history. These rooms may not have doors that close for privacy. Our staff will maintain an acceptable voice level so as to minimize others from hearing your information.
*We will require that exam doors be kept closed for your visit.
*The physicians and clinical staff may carry on conversations about patient care and treatment within the entire inner aspect of the office. Voices will be kept to an acceptable low level.
*We may leave a message on your answering machine to contact us regarding the care of you or your child.
*We may send reminder cards to you via the United States mail regarding the patient. The envelopes will contain our practice name and address.
2. Billing & Payment
We may use and disclose your protected health information for our payment purposes as well as the payment purposes of other health care providers and health plans. Payment uses and disclosures include activities conducted to obtain payment for the care provided to you or so that you can obtain reimbursement for that care, for example, from your health insurer. Some examples of payment uses and disclosures would include:
*Sharing information with your health insurer to determine whether you are eligible for coverage or whether proposed treatment is a covered service.
*Submission of a claim form to your health insurer.
*Providing supplemental information to your health insurer so that you health insurer can obtain reimbursement from another health plan under a coordination of benefits clause in your subscriber agreement.
*Sharing your demographic information (address, telephone number) with other health care providers who seek this information to obtain payment for health care services provided to you.
*Mailing you bills in envelopes with our practice name and return address.
*Provision of a bill to a family member or other person designated as responsible for payment for services rendered to you.
*Providing medical records and other documentation to your health insurer to support the medical necessity of a health service.
*Allowing your health insurer access to your medical record for a medical necessity or quality review audit.
*Providing information to a collection agency, our attorney and/or our accountant for purposes of securing payment of a delinquent account.
*Disclosing information in a legal action for purposes of securing payment of a delinquent account.
3. Health Care Operations
We may use and disclose your protected health information (PHI) for our health care operation purposes as well as certain health care operation purposes of other health care providers and health plans. Some examples of health care operation purposes include:
*Quality assessment and improvement activities
*Population based activities relating to improving health or reducing health care costs
*Reviewing the competence, qualification or performance of health care professionals
*Conducting training programs for medical & other students
*Accreditation, certification, licensing, and credentialing activities
*Health care fraud and abuse detection and compliance programs
*Conducting other medical review, legal services, & auditing functions
*Business planning and development activities, such as conducting cost management
and planning related analyses
*Sharing information regarding patients with entities that are interested in purchasing
our practice and turning over patient records to entities that have purchased our
practice
*Other business management and general administrative activities, such as
compliance with the federal privacy rule and resolution of patient grievances
*Medical research in the office –performed in conjunction with our alliance with
Physicians Primary Research group
B. Uses and Disclosures for Other Purposes
We may use and disclose your protected health information for other purposes. This section generally describes those purposes by category. Each category includes one or more examples. Not every use or disclosure in a category will be listed. Some examples fall into more than one category – not just the category under which they are listed.
1. Individual involved in care or payment for care
We may disclose your protected health information to someone involved in your care or payment for your care, such as a spouse, a family member, or a close friend. For example, grandmother or a close friend brings the child in for a visit – we will obviously need to discuss the care and treatment for the child at that visit.
With regard to pediatric & adolescent medicine, we will share information with both parents, legal guardians and/or in the case of a custody dispute, to those persons identified in an Order from the Court. With regard to adolescent care, we reserve the right to adhere to patient confidentiality, except in situations involving possible abuse, and/or patient is exhibiting suicidal or homicidal ideations.
2. Notification purposes
We may use and disclose your protected health information to notify, or to assist in the notification of a family member, a personal representative, or another person responsible for your care, regarding your location, general condition or death. For example, if you need to be hospitalized, we may notify a family member of the hospital and your general condition. In addition, we may disclose your protected health information to a disaster relief entity, such as the Red Cross, so that it can notify a family member, personal representative, or another person involved in your care regarding your location, general condition or death.
3. Required by Law
We may use and disclose protected health information when required by federal, state or local law. For example, we may disclose protected health information to comply with mandatory reporting requirements involving births & death, child abuse, disease prevention and control, vaccine-related injuries, medical devise-related death and serious injuries, gunshot and other injuries by a deadly weapon or criminal act, driving impairments, and blood alcohol testing.
For school-age children, we will provide immunization (shot) records to the schools at their request, to update their records, which is required by state law.
4. Other Public Health activities
We may use and disclose protected health information for public health activities including:
*Public health reporting – communicable disease reports
*Child abuse & neglect reports (CYS-Children & Youth Services)
*FDA-related reports and disclosures, for example – adverse events
*Public health warnings to third parties at risk of a communicable disease/condition
*OSHA requirements for workplace surveillance and injury reports
5. Victims of Abuse, neglect or domestic violence
We may use and disclose protected health information for the purposes of reporting abuse, neglect or domestic violence in addition to child abuse.
6. Health oversight activities
We may use and disclose protected health information for purposes of health oversight activities authorized by law. These activities could include audits, inspections, investigations, licensure actions and legal proceeding. For example, we may comply with a Drug Enforcement Agency inspection of patient records.
7. Judicial and Administrative proceedings
We may use and disclose protected health information disclosures in judicial and administrative proceedings in response to a Court Order or subpoena, discovery request or other lawful process. For example, we may comply with a Court Order to testify in a case at which your medical condition is at issue.
8. Law Enforcement Purposes
We may use and disclose protected health information for certain law enforcement purposes including to:
*Comply with legal process like a search warrant
*Comply with a legal requirement such as mandatory report of gun shot wounds
*Respond to a request for information for identification/location purposes
*Respond to a request for information about a crime victim
*Report a death suspected to have resulted from criminal activity
*Provide information regarding a crime on the premises
*Report a crime in an emergency
9. Coroners and Medical Examiners
We may use and disclose protected health information for purposes of providing information to a coroner or medical examiner for the purpose of identifying a deceased patient, determining a cause of death, or facilitating their performance of other duties required by law.
10. Funeral Directors
We may use and disclose protected health information for purposes of providing information to funeral directors as necessary to carry out their duties.
11. Organ & Tissue Donation
For purposes of facilitating organ, eye & tissue donation and transplantation, we may use protected health information and disclose protected health information to entities engaged in the procurement, banking, or transplantation of cadaveric organs, eyes or tissue.
12. Threat to Public Safety
We may use and disclose protected health information for purposes involving a threat to public safety, including protection of a third party from harm and identification and apprehension of a criminal. For example, in certain circumstances, we are required by law to disclose information to protect someone from imminent serious harm.
13. Specialized government functions
We may use and disclose protected health information for purposes involving specialized government functions including:
*Military & veterans activities
*National security and intelligence
*Protective services for the President & others
*Medical suitability determinations for the Department of State
*Correctional institutions & other law enforcement custodial situations
14. Workers’ compensation and similar programs
We may use and disclose protected health information as authorized by and to the extent necessary to comply with laws relating to workers’ compensation or similar programs, established by law, that provide benefits for work-related injuries or illness without regard to fault. For example, this would include submitting a claim for payment to your employer’s workers’ compensation carrier if we treat you for a work related injury (adolescent/young adult patients).
15. Business Associates
Certain functions of the practice are performed by a business associate such as a billing company, an accounting firm, or a law firm. We may disclose protected health information to our business associates and allow them to create and receive protected health information on our behalf.
16. Creation of de-identified Information
We may use protected health information about you in the process of de-identifying the information. For example, we may use your protected health information in the process of removing those aspects which could identify you so that the information can be disclosed to a researcher without your authorization.
17. Incidental Disclosures
We may disclose protected health information as a by-product of an otherwise permitted use or disclosure. For example: other patients may overhear your name being paged in the waiting room, your chart may be seen on the exam room door or you may walk past our telephone triage room and overhear portions of a conversation.
C. Uses and disclosures with authorization
For all other purposes which do not fall under a category listed under sections III.A and III.B, we will obtain written authorization to use and disclose your protected health information. Your authorization can be revoked at any time except to the extent that we have relied on the authorization.
III. PATIENT PRIVACY RIGHTS
A. Further restriction on use or disclosure
You have a right to request that we further restrict use and disclosure of your protected health information to carry out treatment, payment, or health care operations, to someone who is involved in their care or the payment for your care, or for notification purposes. We are not required to agree to a request for a further restriction.
To request a further restriction, you must submit a written request to our privacy officer. The request must tell us: (a) what information you want restricted; (b) how you want the information restricted; and (c) to whom you want the restriction to apply.
B. Confidential communication
You have the right to request that we communicate your protected health information to you by a certain mean or at a certain location. For example, you might request that we only contact you by mail or at work. We are not required to agree to requests for confidential communications that are unreasonable.
To make a request for confidential communications, you must submit a written request to our privacy officer. The request must tell us how or where you want to be contacted. In addition, if another individual or entity is responsible for payment, the request must explain how payment will be handled.
C. Accounting of disclosures
You have a right to obtain, upon request, an “accounting” of certain disclosures of your protected health information by us (or a business associate for us). This right is limited to disclosures within six years of the request and other limitations. Also in limited circumstances we may charge you for providing the accounting. To request an accounting, you must submit a written request to our privacy officer. The request should designate the applicable time period.
D. Inspection and copying
You have a right to inspect and obtain a copy of your protected health information that we maintain in a designated records set. This right is subject to limitations and we may impose charges for the labor and supplies involved in providing copies.
To exercise your right of access, you must submit a written request to our privacy officer. The request must: (a) describe the health information to which access is requested, (b) state how you want to access the information, such as inspection, pick-up of copy, mailing of copy, (c) specify any requested form or format, such as paper copy or an electronic means, and (d) include the mailing address, if applicable.
E. Right to Amendment
You have a right to request that we amend protected health information that we maintain about you in a designated records set if the information is incorrect or incomplete. This right is subject to limitations. To request an amendment, you must submit a written request to our privacy officer. The request must specify each change that you want and provide a reason to support each requested change.
F. Paper copy of privacy notice
You have a right to receive a paper copy of our Notice of Privacy Practices. If you should require additional copies, please contact our Privacy Officer.
IV. CHANGES TO THIS NOTICE
We reserve the right to change this notice at any time. We further reserve the right to make any change effective for all protected health information that we maintain at the time of the change – including information that we created or received prior to the effective date of the change.
We will post a copy of our current notice in the waiting room for the practice. At any time, patients may review the current notice by contacting our privacy officer.
V. COMPLAINTS
If you believe that we have violated your privacy rights, you may submit a complaint to the practice via the privacy officer or to the Secretary of Health and Human Services. To file a complaint with the practice, submit the complaint in writing to our privacy officer. We will not retaliate against you for filing a complaint.
VI. LEGAL EFFECT OF THIS NOTICE
This notice is not intended to create contractual or other rights independent of those created in the Federal Privacy rule.