HIPAA NOTICE OF PRIVACY PRACTICES
Effective Date: March 10, 2003
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.
This Notice is provided to you pursuant to the Health Insurance Portability and Accessibility Act of 1996 and its implementation regulations ("HIPAA"). It is designed to tell you how we may, under federal law, use or disclose your Health Information.
I. Your Rights.
- You have the right to request restrictions on the uses and disclosures of your Health Information. However, we are not required to comply with your request.
- You have the right to receive your Health Information through confidential means and in a manner that is reasonably convenient for you and us.
- You have the right to inspect and copy your Health Information.
- You have a right to request that we amend your Health Information that is incorrect or incomplete. We are not required to change your Health Information and will provide you with information about our denial and how you can disagree with the denial.
- You have a right to receive an accounting of disclosures of your Health Information made by us, except that we do not have to account for disclosures: authorized by you; made for treatment, payment, health care operations; provided to you; provided in response to an Authorization; made in order to notify and communicate with approved family members; and/or for certain government functions, to name a few.
- You have been provided with a paper copy of this Notice of Privacy Practices. If you would like to have a more detailed explanation of these rights or if you would like to exercise one or more of these rights, contact the Accounts Receivable Department at Pentec Health, Inc.
II. We May Use or Disclose Your Health Information for Purposes of Treatment, Payment or Healthcare Operations without Obtaining Your Prior Authorization and Here is One Example of Each:
We may provide your Health Information to other health care professionals - including doctors, nurses and technicians - for purposes of providing you with care.
Our billing department may access your information - and send relevant parts to insurance companies to allow us to be paid for the services we render to you.
We may access or send your information to our attorneys or accountants in the event we need the information in order to address one of our own business functions. Our attorneys and accountants are required to maintain confidentiality when they receive patient information.
III. We May Also Use or Disclose Your Health Information Under Certain Circumstances without Obtaining Your Prior Authorization. However, in general, we will attempt to ensure that you have been made aware of the use or disclosure of your Health Information prior to providing it to another person. Some instances where we may need to disclose information include but are not limited to:
To Notify and/or Communicate with Your Family. We will only communicate with family members that we are authorized to communicate with based on your completion of the Authorization to Disclose Health Information to Family and Friends form.
As Required By Law.
For Health Oversight Activities. We may use or disclose your Health Information to health oversight agencies during the course of audits, investigations, certification and other proceedings.
In Response to Civil Subpoenas or for Judicial Administrative Proceedings. We may use or disclose your Health Information, as directed, in the course of any civil administrative or judicial proceeding.
To Law Enforcement Personnel. We may use or disclose your Health Information to a law enforcement official to comply with a court order or grand jury subpoena and other law enforcement purposes.
For Purposes of Organ Donation. We may use or disclose your Health Information for purposes of communicating to organizations involved in procuring, banking or transplanting organs and tissues.
For Worker's Compensation. We may use or disclose your Health Information as necessary to comply with worker's compensation laws.
IV. For All Other Circumstances, We May Only Use or Disclose Your Health Information After You Have Signed an Authorization. If you authorize us to use or disclose your Health Information for another purpose, you may revoke your authorization in writing at any time.
V. You Should Be Advised that We May Also Use or Disclose Your Health Information for the Following Purposes:
Appointment Reminders. We may use your Health Information in order to contact you to provide appointment reminders or to give information about other treatments or health-related benefits and services that may be of interest to you.
Change of Ownership. In the event that our Business is sold or merged with another organization, your Health Information/record will become the property of the new owner.
VI. Our Duties.
We are required by law to maintain the privacy of your Health Information and to provide you with a copy of this Notice.
We are also required to abide by the terms of this Notice.
We reserve the right to amend this Notice at any time in the future and to make the new Notice provisions applicable to all your Health Information — even if it was created prior to the change in the Notice. If any such amendment is made that materially changes this Notice, we will send you another copy.
VII. Complaints to the Government.
You may make complaints to the Security of the Department of Health and Human Services ("DHHS") if you believe your rights have been violated.
We promise not to retaliate against you for any complaint you make to the government about our privacy practices.
VIII. Contact Information.
You may contact us about our privacy practices by calling our Privacy Officer at 610-494-8700.
You may contact the DHHS at:
The U.S. Department of Health and Human Services
200 Independence Avenue, S. W.
Washington, D.C. 20201
Toll Free: 1-877-696-6775