NOTICE OF PRIVACY PRACTICES (Effective February 28th, 2014)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.
Midwest Regional Health Services, LLC, and its employees are dedicated to maintaining the privacy of your personal health information, as required by applicable federal and state laws. These laws require us to provide you with this Notice of Privacy Practices, and to inform you of your rights and our obligations concerning Protected Health Information, or PHI, which is information that identifies you and that relates to your physical or mental health condition. We are required to follow the privacy practices described below while this Notice. We may change our privacy practices at any time. The revised privacy practices will be set forth in a revised Notice and will be effective for all health information that we maintain at that time. Upon your request, we will provide you with a copy of the most recent Notice. A current copy of our Notice of Privacy Practices will be posted in our office in a visible location at all times.
A. Permitted Uses and Disclosures of PHI. We may use or disclose your PHI for the following reasons:
1. Treatment. Each time you visit our office a record of your visit is made. This record contains your symptoms, examinations and test results, diagnosis, treatment and a plan for future care or treatment. We may use and disclose your PHI to a physician or other health care provider providing treatment to you. For example, we may disclose medical information about you to physicians, nurses, technicians or personnel who are involved with the administration of your care.
2.Payment. We may use and disclose your PHI to bill and collect payment for the services we provide to you. For example, we may send a bill to you or to a third party payor for the rendering of services by us. The bill may contain information that identifies you, your diagnosis and procedures and supplies used. We may need to disclose this information to insurance companies to establish insurance eligibility benefits for you. We may also provide your PHI to our business associates, such as billing companies, claims processing companies and others that process our health care claims.
3. Health Care Operations. We may use and disclose your PHI in connection with our health care operations. Health care operations include quality assessment activities, reviewing the competence or qualifications of health care professionals, evaluating provider performance, and other business operations. For example, we may use your PHI to evaluate the performance of the health care services you received. We may also provide your PHI to accountants, attorneys, consultants and others to make sure we comply with the laws that govern us.
4. Incidental Uses and Disclosures. There may be incidental uses or disclosures of your PHI as a result of otherwise allowed uses and disclosures. Such uses and disclosures may occur because they cannot reasonably be prevented. For example, when your name is called in the waiting room, we cannot reasonably prevent others from overhearing your name. We may use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your physician.
5. Emergency Treatment. We may disclose your PHI if you require emergency treatment or are unable to communicate with us.
6. Family and Friends. We may disclose your PHI to a family member, friend or any other person who you identify as being involved with your care or payment for care, unless you object. Such communication may include providing your location and general condition.
7. Required by Law; Legal Proceedings. We may disclose your PHI for law enforcement purposes and as required by state or federal law. For example, the law may require us to report instances of abuse, neglect or domestic violence; to report certain injuries such as gunshot wounds; or to disclose PHI to assist law enforcement in locating a suspect, fugitive, material witness or missing person. We will inform you or your representative if we disclose your PHI because we believe you are a victim of abuse, neglect or domestic violence, unless we determine that informing you or your representative would place you at risk. In addition, we must provide PHI to comply with an order in a legal or administrative proceeding. Finally, we may be required to provide PHI in response to a subpoena discovery request or other lawful process, but only if efforts have been made, by us or the requesting party, to contact you about the request or to obtain an order to protect the requested PHI.
8. Serious Threat to Health or Safety. We may disclose your PHI if we believe it is necessary to avoid a serious threat to the health and safety of you or the public.
9. Public Health. We may disclose your PHI to public health or other authorities charged with preventing or controlling disease, injury or disability, or charged with collecting public health data.
10. Health Oversight Activities. We may disclose your PHI to a health oversight agency for activities authorized by law, such as audits; civil, administrative or criminal investigations or proceedings; inspections; licensure or disciplinary actions; or other activities necessary for oversight of the health care system, government programs and compliance with civil rights laws.
11. Research. We may disclose your PHI to researchers when their research has been approved by a privacy board or an institutional review board that has reviewed protocols in place to ensure the privacy of your PHI.
12. Workers’ Compensation. We may disclose your PHI to comply with laws relating to workers’ compensation or other similar programs.
13. Military/National Security. If you are active military or a veteran, we may disclose your PHI as required by military command authorities. We may also be required to disclose PHI to authorized federal officials for the conduct of intelligence or other national security activities.
14. Coroners, Medical Examiners, Funeral Directors and Organ Donation. We may disclose your PHI to coroners or medical examiners for identification purposes or determining the cause of death, and to funeral directors as necessary to carry out their duties. If you are an organ donor, or have not indicated that you do not wish to be a donor, we may disclose your PHI to organ procurement organizations to facilitate organ, eye or tissue donation and transplantation.
15. Disaster Relief. Unless you object, we may disclose your PHI to a governmental agency or private entity (such as FEMA or Red Cross) assisting with disaster relief efforts.
16. Direct Contact with You. We may use your PHI to contact you by phone, mail or email to remind you that you have an appointment, or to inform you about treatment alternatives or other health-related benefits and services that may be of interest to you. We may leave a brief message with minimal information at the phone number you have provided.
17. Correctional Institutions. If you are an inmate or in legal custody, we may disclose the correctional institution or law enforcement official having legal custody of you, certain health information if necessary for health and safety purposes.
B.Disclosures Requiring Written Authorization.
1.Not Otherwise Permitted. In any other situation not described in Section A above, we may not disclose your PHI without your written authorization.
2.Psychotherapy Notes. We must receive your written authorization to disclose psychotherapy notes, except for certain treatment, payment or health care operations activities.
3.Marketing and Sale of PHI. We must receive your written authorization for any disclosure of PHI for marketing purposes or for any disclosure which is a sale of PHI.
1.Right to Receive a Paper Copy of This Notice. You have the right to receive a paper copy of this Notice upon request.
2.Right to Access PHI. You have the right to inspect and copy your PHI for as long as we maintain your medical record. You must make a written request for access to the Privacy/Compliance Officer at the address listed at the end of this Notice. If we maintain your health information electronically, we will provide you with a copy of your medical record in the electronic form and format that you request, if we can readily product such format. If we cannot readily produce the format you requested, we will produce your electronic health information in at least one readable electronic format as agreed to between you and us. We may charge you a reasonable fee for the processing of your request (including, without limitation, labor, supplies and postage) and the copying of your medical record pursuant to Nebraska law. In certain circumstances we may deny your request to access your PHI, and you may request that we reconsider our denial. Depending on the reason for the denial, another licensed health care professional chosen by us may review your request and the denial.
3.Right to Request Restrictions. You have the right to request a restriction on the use or disclosure of your PHI for the purpose of treatment, payment or health care operations, except for in the case of an emergency. You also have the right to request a restriction on the information we disclose to a family member or friend who is involved with your care or the payment of your care. However, we are not legally required to agree to such a restriction.
4.Right to Restrict Disclosure for Services Paid by You in Full. You have the right to restrict the disclosure of your PHI to a health plan if the PHI pertains to health care services for which you paid in full directly to us.
5.Right to Request Amendment. You have the right to request that we amend your PHI if you believe it is incorrect or incomplete, for as long as we maintain your medical record. We may deny your request to amend if (a) we did not create the PHI, (b) is not information that we maintain, (c) is not information that you are permitted to inspect or copy (such as psychotherapy notes), or (d) we determine that the PHI is accurate and complete.
6.Right to an Accounting of Disclosures. You have the right to request an accounting of disclosures of PHI made by us (other than those made for treatment, payment or health care operations purposes) during the 6 years prior to the date of your request. You must make a written request for an accounting, specifying the time period for the accounting, to the Privacy/Compliance Officer at the address listed at the end of this Notice.
7.Right to Confidential Communications. You have the right to request that we communicate with you about your PHI by certain means or at certain locations. For example, you may specify that we call you only at your home phone number, and not at your work number. You must make a written request, specifying how and where we may contact you, to the Privacy/Compliance Officer at the address listed at the end of this Notice.
8.Right to Notice of Breach. You have the right to be notified if we or one of our business associates become aware of a breach of your unsecured PHI.
D.Acknowledgment of Receipt of Notice. We will ask you to sign an acknowledgment that you received this Notice.E.Questions and Complaints. If you would like more information about our privacy practices or have questions or concerns, please contact us. If you are concerned that we may have violated your privacy rights, or you disagree with a decision we made regarding the use, disclosure, or access to you PHI, you may complain to us by contacting the Privacy/Compliance Officer at the address and phone number at the end of this Notice. You also may submit a written complaint to the U.S. Department of Health and Human Services. We will provide you with the address to file such a complaint upon request.
We support your right to the privacy of your PHI. We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services. Please direct any of your questions or complaints to:
Midwest Regional Health Services
2727 S. 144th Street, Suite 280
Omaha, NE 68144