DIABETES & GLANDULAR DISEASE CLINIC
DIABETES & GLANDULAR DISEASE RESEARCH ASSOCIATES
DIABETES & GLANDULAR DISEASE CPU
DIABETES & GLANDULAR DISEASE WESTSIDE OFFICE
Notice of Privacy Practices
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.
Original Effective Date: April 14, 2003
Last Revised: __________________
Privacy Officer: Richard A. Pyburn
Privacy Contact Officer: Yvonne Hansel
This practice uses and discloses protected health information about you for treatment, to obtain payment for treatment, for administrative purposes, and to evaluate the quality of care that you receive. This notice describes our privacy practices. You can request a copy of this notice at any time. For more information about this notice or our privacy practices and policies or if you have any questions about this notice, please contact Yvonne Hansel of our office at 614-8612 at
5107 Medical Drive, San Antonio, Texas, 78229.
I. OUR COMMITMENT TO PROTECTING HEALTH INFORMATION ABOUT YOU
In this Notice, we describe the ways that we may use and disclose health information about our patients. The HIPAA Privacy Rule requires that we protect the privacy of health information that identifies a patient, or where there is a reasonable basis to believe the information can be used to identify a patient. This information is called “protected health information” or “PHI.” This Notice describes your rights as our patient and our obligations regarding the use and disclosure of PHI. We are required by law to:
· Maintain the privacy of PHI about you;
· Give you this Notice of our legal duties and privacy practices with respect to PHI; and
· Comply with the terms of our Notice of Privacy Practices that are currently in effect.
As permitted by the HIPAA Privacy Rule, we reserve the right to make changes to this Notice and to make such changes effective for all PHI we may already have about you. If and when this Notice is changed, we will post a copy in our office in a prominent location. We will also provide you with a copy of the revised Notice upon your request to our Privacy Contact Officer.
You will be asked to sign a form to show that you received this Notice. Even if you do not sign this form, we will still provide you with treatment.
WHO WILL FOLLOW THIS NOTICE
This notice describes information about privacy practices followed by our employees, staff and other office personnel. The practices described in this notice will also be followed by healthcare providers you consult with by telephone (when your regular healthcare provider from our office is not available) who provide “call coverage” for your healthcare provider.
YOUR HEALTH INFORMATION
This notice applies to the information and records we have about your health, health status, and the healthcare and services you receive at this office.
We are required by law to give you this notice. A federal regulation, known as “HIPAA Privacy Rule,” requires that we provide detailed notice in writing of our privacy practices. It will tell you about the ways in which we may use and disclose protected health information about you and describes your rights and our obligations regarding the use and disclosure of that information.
II. HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
USES AND DISCLOSURES FOR TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS
The following categories describe the different ways we may use and disclose PHI for treatment, payment, or health care operations without your consent or authorization. The examples included in each category do not list every type of use or disclosure that may fall within that category.
For Treatment.
We may use and disclose PHI about you to provide, coordinate, or manage your health care and related services. We are permitted to use and disclose your medical health information about you to those involved in your medical treatment such as doctors, nurses, certified diabetic educators, technicians, office administration or staff, or other personnel who are all involved in taking care of you and your health. We may consult with other health care providers regarding your treatment and coordinate and manage your health care with others. For example, the physicians in this practice are all endocrinologists (specialists). When we provide medical treatment for your particular condition and may need to know if you have other health problems that could complicate your treatment, we may request that your primary care physician or other physicians, share your medical information with us so that we can determine the best appropriate care for you. Also, we may provide your primary care physician or other physicians with medical information about your particular condition so that he or she can appropriately treat your other medical conditions, if any. We may also need to disclose your medical information to other physicians that our endocrinologists refer you out to in order to appropriately treat your other medical conditions. In emergencies, we may use and disclose PHI to provide the treatment you need.
Different personnel in our office may also disclose PHI about you and disclose information to people who do not work in our office in order to coordinate your care, such as phoning in prescriptions to your pharmacy, obtaining referrals from your primary care physician, obtaining referrals from your insurance company, scheduling appointments, scheduling lab work, ordering X-rays, scans, or any other diagnostic tests or health care services ordered by your physician for your medical treatment.
For Payment.
We are permitted to use and disclose demographic and medical health information about you so that the consultation, treatment and services you receive at this office may be billed to, collected from, and payment received from you, your insurance company or a third party payer. For example, we will complete a claim form to obtain payment from your health plan (insurance). We will need to give your health plan both demographic and medical information, a description of the medical services you received here in our office so your health plan will approve payment to us for those services or reimburse you.
Before providing treatment or services, we may share details with your health plan concerning the services you are scheduled to receive for prior approval. For example, we may ask for payment approval from your health plan before we provide care or services (pre-authorization). We may use and disclose PHI to find out if your health plan will cover the cost of care and services we provide. We may use and disclose PHI to confirm you are receiving the appropriate amount of care to obtain payment for services. We may use and disclose PHI for billing, claims management, and collection activities. We may disclose PHI to insurance companies providing you with additional coverage. We may disclose limited PHI to consumer reporting agencies relating to collection of payments owed to us.
We may also disclose PHI to another health care provider or to a company or health plan required to comply with the HIPAA Privacy Rule for the payment activities of that health care provider, company, or health plan. For example, we may allow a health insurance company to review PHI for the insurance company’s activities to determine the insurance benefits to be paid for your care.
For Health Care Operations.
We may use and disclose PHI in performing business activities that are called health care operations, which are activities that support this practice. Health care operations include doing things that allow us to improve the quality of care we provide and to reduce health care costs.
We may use and disclose PHI about you in the following health care operations:
· Reviewing and improving the quality, efficiency, and cost of care that we provide to our patients. For example, we may use PHI about you to develop ways to assist our physicians and staff in deciding how we can improve the medical treatment we provide to you and others.
· Improving health care and lowering costs for groups of people who have similar health problems and helping to manage and coordinate the care for these groups of people. We may use PHI to identify groups of people with similar health problems to give them information, for instance, about treatment alternatives and educational classes.
· Reviewing and evaluating the skills, qualifications, and performance of health care providers taking care of you and our other patients.
· Providing training programs for students, trainees, health care providers, or non-health care professionals (for example, billing personnel) to help them practice or improve their skills.
· Cooperating with outside organizations that assess the quality of the care that we provide.
· Cooperating with outside organizations that evaluate, certify, or license health care providers or staff in a particular field or specialty. For example, we may use or disclose PHI so that one of our nurses may become certified as having expertise in a specific field of nursing.
· Cooperating with various people who review our activities. For example, PHI may be seen by doctors reviewing the services provided to you, and by accountants, lawyers, and others who assist us in complying with the law and managing our business.
· Assisting us in making plans for our practice’s future operations.
· Resolving grievances within our practice.
· Reviewing our activities and using or disclosing PHI in the event that we combine with another practice.
· Business planning and development, such as cost-management analyses.
· Business management and general administrative activities of our practice, including managing our activities related to complying with the HIPAA Privacy Rule and other legal requirements.
· Creating “de-identified” information that is not identifiable to any individual, and disclosing PHI to a business associate for the purpose of creating de-identified information, regardless of whether we will use the de-identified information.
· Creating a “limited data set” of information that does not contain information directly identifying a patient. Our ability to disclose this information to others under limited conditions is discussed later in this Notice.
· We may engage the services of a professional to aid this practice in its compliance programs. This person will review billing and medical files to ensure we maintain our compliance programs with regulations and the law.
· We may ask one of our other endocrinologists in this practice to review your chart and medical records to evaluate our own performance internally so that we may ensure that only the best health care is provided to you by this practice.
· If your physician has a question regarding your health care and needs another medical opinion he or she may ask for an executive meeting (compromised of physicians only) and present your medical case for their professional medical review or opinions.
· We may also use or disclose PHI for the health care operations of this clinic, which includes “research studies” that we participate in to identify eligible candidates for these studies. The Diabetes & Glandular Disease Research Associates, an affiliate of the Diabetes & Glandular Disease Clinic, offers research opportunities and new treatments, which potentially may be more effective in the treatment of your medical condition. This helps us to become more efficient in caring for your medical condition and to provide you better service.
Appointment Reminders.
We may contact you as a reminder by telephone, mail or both that you have an appointment for an office visit, labs, treatment or other medical services at this office.
Treatment Alternatives.
We may tell you about or recommend possible treatment options or alternatives that may be of interest to you.
Health-Related Benefits and Services.
We may tell you about health-related benefits, products or services that may be of interest to you. For example, the physicians or nurses in this practice may suggest certain research studies that involve your medical condition for treatment that may be more beneficial to you.
Disclosures That Can Be Made Without Your AUTHORIZATION OR opportunity to agree or object
There are special situations in which we are permitted by law to disclose or use your medical information without your written authorization or an opportunity to object. In other situations we will ask for your written authorization before using or disclosing any identifiable health information about you. If you choose to sign an authorization to disclose information, you can later revoke that authorization, in writing, to stop future uses and disclosures. However, any revocation will not apply to disclosures or uses already made or taken in reliance on that authorization.
Individuals Involved in Your Care or Payment for Your Care such as Family and Friends
We may use and disclose PHI about you in some situations where you have the opportunity to agree or object to certain uses and disclosures of PHI about you. If you do not object, we may make these types of uses and disclosures of PHI.
· We may disclose PHI about you to your family member or close friend, or any other person identified by you if we obtain either your verbal or written agreement to do so or if we give you an opportunity to object to such a disclosure and you do not raise an objection.
· We may also disclose PHI to your family or friends if we can infer from the circumstances, based on our professional judgment that you would not object. For, example we may assume you agree to our disclosure of your PHI to your spouse when you bring your spouse with you into the exam room during treatment or while treatment is discussed.
· We may disclose PHI about you to any other person identified by you if that information is directly relevant to the person’s involvement in your care or payment for your care.
· If you are not present or you are unable to consent or object, we may exercise professional judgment in determining whether the use or disclosure of PHI is in your best interest. In that situation, we will disclose only medical information relevant to the person’s involvement in your care. For example, if you are brought into this office and are unable to communicate normally with your physician for some reason, we may find it is in your best interest to give your prescription and other medical supplies to the relative or friend who brought you in for treatment.
· We may also use and disclose PHI to notify such persons of your location, general condition, or death. We also may coordinate with disaster relief agencies to make this type of notification.
· We may also use professional judgment and our experience with common practice to make reasonable decisions about your best interests in allowing a person to act on your behalf to pick up filled prescriptions, medical supplies, X-rays, or other things that contain PHI about you.
· In case of a medical emergency, we may inform the person who accompanied you that you suffered a medical emergency and provide updates on your progress and prognosis.
OTHER USES AND DISCLOSURES WE CAN MAKE WITHOUT YOUR WRITTEN AUTHORIZATION OR OPPORTUNITY TO AGREE OR OBJECT
We may use and disclose PHI about you in the following circumstances without your authorization or opportunity to agree or object, provided that we comply with certain conditions that may apply.
Required By Law
We may use and disclose PHI as required by federal, state, or local law to the extent that the use or disclosure complies with the law and is limited to the requirements of the law (subject to all applicable legal requirements).
Public Health Activities
Public health activities are mandated by federal, state, or local government for the collection of information about disease, vital statistics (like births and death), or injury by a public health authority. We may use and disclose PHI to public health authorities or other authorized persons to carry out certain activities related to public health, including the following activities:
To Avert a Serious Threat to Health or Safety
We may use and disclose PHI about you in limited circumstances when necessary to prevent a threat to the health or safety of a person or to the public. This disclosure can only be made to a person who is able to help prevent the threat.
Abuse, Neglect, or Domestic Violence
We may also disclose PHI to a public agency authorized to receive reports of child abuse or neglect. Texas law requires physicians to report child abuse or neglect. Regulations also permit the disclosure of PHI to report abuse or neglect of elders or the disabled. We may disclose PHI in certain cases to proper government authorities if we reasonably believe that a patient has been a victim of domestic violence, abuse, or neglect.
Health Oversight Activities
We may disclose your PHI to a health oversight agency for those activities authorized by law. Examples of these activities are audits, investigations, licensure and disciplinary activities, inspections and other activities conducted by health oversight agencies which are all government activities undertaken to monitor the health care delivery system, government health care programs and compliance with other laws, such as civil rights laws.
Lawsuits and Other Legal Proceedings
We may disclose your PHI in the course of judicial or administrative proceedings in response to an order of the court or an administrative tribunal order. We may also disclose PHI in response to subpoenas, discovery requests, or other required legal process when efforts have been made to advise you of the request or to obtain an order protecting the information requested. Certain requirements must be met before the information is disclosed.
Law Enforcement
Under limited circumstances, we may disclose PHI to law enforcement officials for the following purposes where the disclosure is:
· About a suspected crime victim if, under certain limited circumstances, we are unable to
obtain a person’s agreement because of incapacity or emergency;
· To alert law enforcement of a death that we suspect was the result of criminal conduct;
· Required by law;
· In response to a court order, warrant, subpoena, summons, administrative agency request,
or other authorized process;
· To identify or locate a suspect, fugitive, material witness, or missing person;
· About a crime or suspected crime that has occurred on these premises; or
· In response to a medical emergency not occurring at the office, if necessary to report a
crime, including the nature of the crime, the location of the crime or the victim, and the
identity of the person who committed the crime.
Coroners or Medical Examiners, and Funeral Directors
We may disclose your PHI to a coroner or medical examiner to identify a deceased person and determine the cause of death. In addition, we may disclose your PHI to a funeral director, as authorized by law, where such a disclosure is necessary for the director to carry out his duties.
Organ and Tissue Donation
If you are an organ or tissue donor, we may use or disclose your PHI as necessary to organizations that handle organ procurement for the purpose of facilitating organ, eye, or tissue transplantation or to an organ donation bank.
Research
We may use and disclose your PHI about you to researchers, other than the Diabetes and Glandular Disease Research Associates, under limited circumstances. Those circumstances where a research project meets specific detailed criteria for privacy protections (established by HIPAA Privacy Rule) and has been given the approval of an Institutional Review Board or Privacy Board will be deemed satisfactory to ensure the privacy of PHI. We will also request written authorization (your permission) to release your name and other PHI to the researcher.
Military, National Security and Intelligence Activities, Protection of the President or
Specialized Government Functions
Under certain conditions, we may disclose PHI:
· For certain military and veteran activities, including determination of eligibility for veterans benefits and where deemed necessary by military command authorities;
· For specialized governmental functions such as separation or discharge from military service, requests as necessary by appropriate military command authorities;
· For national security and intelligence activities;
· To help provide protective services for the President of the United States, other authorized government officials, or foreign heads of state.
Inmates
Under certain conditions, we may disclose PHI:
· For the health or safety of inmates and others at correctional institutions or other law enforcement custodial situations or for general safety and health related to correctional facilities;
· To the correctional institution or law enforcement official if you are an inmate or under the custody of law enforcement to provide you with medical care, to protect your health or the health and safety of others, or for the safety and security of the institution.
Workers’ Compensation
We may disclose PHI as authorized by the Texas workers’ compensation law or other similar programs that provide benefits for work-related injuries or illness.
Information Not Personally Identifiable
We may use or disclose PHI about you in a way that does not personally identify you or reveal who you are.
Disclosures Required by HIPAA Privacy Rule
We are required to disclose PHI to the Secretary of the United States Department of Health and Human Services when requested by the Secretary to review our compliance with the HIPAA Privacy Rule. We are also required in certain cases to disclose PHI to you upon your request to access PHI or for an accounting of certain disclosures of PHI about you (these requests are described in Section III of this Notice).
Incidental Disclosures
We may use or disclose PHI incident to a use or disclosure permitted by the HIPAA Privacy Rule so long as we have reasonably safeguarded against such incidental uses and disclosures and have limited them to the minimum necessary information.
Limited Data Set Disclosures
We may use or disclose a limited data set (PHI that has certain identifying information removed) for the purposes of research, public health, or health care operations. This information may only be disclosed for research, public health, and health care operations purposes. The entity receiving the information must sign an agreement to protect the information.
OTHER USES AND DISCLOSURES WE CAN MAKE WITHOUT YOUR WRITTEN AUTHORIZATION OR OPPORTUNITY TO AGREE OR OBJECT
We will not use or disclose your medical information for any purpose other than those identified in the previous sections without your specific, written Authorization. We must obtain your Authorization separate from any Consent we may have obtained from you. If you give us Authorization to use or disclose medical information about you, you may revoke that Authorization, in writing, at any time. If you revoke your Authorization, we will no longer use or disclose information about you for the reasons covered by your written Authorization, but we cannot take back any uses or disclosures already made with your permission.
If we have HIV or substance abuse information about you, we cannot release that information without a special signed, written authorization (different than the Authorization and Consent mentioned above) from you. In order to disclose these types of records for purposes of treatment, payment or healthcare operations, we will have to have both your signed Consent and a special written Authorization that complies with the law governing HIV or substance abuse records.
III. YOUR RIGHTS UNDER FEDERAL PRIVACY REGULATIONS REGARDING PROTECTED HELATH INFORMATION ABOUT YOU
The United States Department of Health and Human Services created regulations intended to protect patient privacy as required by the Health Insurance Portability and Accountability Act (HIPAA). Those regulations create several privileges that patients may exercise. We will not retaliate against a patient that exercises their HIPAA rights. Under federal law, you have the following rights regarding PHI about you:
Right to Request Restrictions
You have the right to request additional restrictions or limits on the PHI that we may use or disclose for treatment, payment, and health care operations. You may also request additional restrictions or limits on our disclosure of PHI to certain individuals involved in your care such as your family members, other relatives, or close personal friends that may or may not be involved in your care that otherwise are permitted by the Privacy Rule. We are not required to agree to your request. If we do agree to your request, we are required to comply with our agreement except in certain cases, including where the information is needed to treat you in the case of an emergency. To request restrictions or limits, you must make your request in writing. In your request, please include (1) the information that you want to restrict; (2) how you want to restrict the information (for example, restricting use to this office, only restricting disclosure to persons outside this office, or restricting both); and (3) to whom you want those restrictions to apply. Please send the request to the address and person listed below.
Right to Request Confidential Communications by Alternative Means
You have the right to request that you receive communications regarding PHI in a certain manner or at a certain location. You also have the right to request that we send communications regarding PHI by alternative means or to an alternative location. For example, you may request that we contact you at home, rather than at work for appointment reminders. You must make your request in writing to the person listed below. You must specify how you would like to be contacted and you must specify in your correspondence exactly how you want us to communicate with you and if you are directing us to send it to a particular place we need the contact/address information (for example, by regular mail to your post office box and not your home). We are required to accommodate only reasonable requests.
Right to Inspect and Copy Protected Health Information
You may inspect and/or copy health information that is within the designated record set, which is information that is used to make decisions about your care. Texas law requires that requests for copies be made in writing and we ask that requests for inspection of your health information also be made in writing. Please send your request to the person listed below.
We can refuse to provide some of the information you ask to inspect or ask to be copied if the information:
· Includes psychotherapy notes;
· Includes the identity of a person who provided information if it was obtained under a promise of confidentiality;
· Is subject to the Clinical Laboratory Improvements Amendments of 1988.
· Has been compiled in anticipation of litigation.
We can refuse to provide access to or copies of some information for other reasons, provided that we provide a review of our decision on your request. Another licensed health care provider who was not involved in the prior decision to deny access will make any such review.
Texas law requires that we are ready to provide copies or a narrative within 15 days of your request. We will inform you of when the records are ready or if we believe access should be limited. If we deny access, we will inform you in writing.
HIPAA permits us to charge a reasonable cost based fee. The Texas State Board of Medical Examiners (TSBME) has set limits on fees for copies of medical records that under some circumstances may be lower than the charges permitted by HIPAA. In any event, the lower of the fee permitted by HIPAA or the fee permitted by the TSBME will be charged.
Right to Amend Your Medical Information
You have the right to request that we amend your medical information in the designated record set about you as long as such information is kept by or for our office. This includes your medical and billing records but does not include psychotherapy notes or information gathered or prepared for a civil, criminal, or administrative proceeding. We may also refuse to allow an amendment if the information:
· Wasn’t created by this practice or the physicians here in this practice;
· Is not part of the Designated Record Set;
· Is not available for inspection because of an appropriate denial;
· If the information is accurate and complete.
Any such request must be made in writing to the person listed below. We will respond within 60 days of your request. Even if we refuse to allow an amendment you are permitted to include a patient statement about the information at issue in your medical record. If we refuse to allow an amendment we will inform you in writing. If we approve the amendment, we will inform you in writing, allow the amendment to be made and tell others that we now have the amended information.
Accounting of Certain Disclosures
The HIPAA privacy regulations permit you to request, and us to provide, an accounting of certain disclosures that we have made of PHI about you. This is a list of disclosures made by us during a specified period of up to 6 years, other than disclosures made: for treatment, payment, and health care operations; for use in or related to a facility directory; to family members or friends involved in your care; to you directly; pursuant to an authorization of you or your personal representative; for certain notification purposes (including national security, intelligence, correctional, and law enforcement purposes); as incidental disclosures that occur as a result of otherwise permitted disclosures; as part of a limited data set of information that does not directly identify you; and before April 14, 2003. If you wish to make such a request, please contact the person listed below. The first list that you request in a 12-month period will be free, but we may charge you for our reasonable costs of providing additional lists in the same 12-month period. We will tell you about these costs, and you may choose to cancel your request at any time before costs are incurred.
Right to a Paper Copy of this Notice
You have a right to receive a paper copy of this Notice at any time. You are entitled to a paper copy of this Notice even if you have previously agreed to receive this Notice electronically. To obtain a paper
copy of this Notice, please contact the Contact Person listed below.
IV. COMPLAINTS
If you are concerned that your privacy rights have been violated, you may contact the person listed below. You may also send a written complaint to the United States Department of Health and Human Services. We will not retaliate against you for filing a complaint with the government or us. The contact information for the United States Department of Health and Human Services is:
U.S. Department of Health and Human Services
HIPAA Complaint
7500 Security Blvd., C5-24-04
Baltimore, MD 21244
V. OUR PROMISE TO YOU
We are required by law and regulation to protect the privacy of your medical information, to provide you with this notice of our privacy practices with respect to protected health information (PHI), and to abide by the terms of the notice of privacy practices in effect.
VI. QUESTIONS AND CONTACT PERSON FOR REQUESTS
If you have any questions or want to make a request pursuant to the rights described above, please contact:
Yvonne Hansel
5107 Medical Drive
San Antonio, Texas 78229
Phone: (210) 614-8612, Fax: (210) 692-8852, e-mail: yhansel@dgdclinic.com
This notice is effective as of the following date: _____April 14, 2003_____________.
Acknowledgement of Review of
Notice of Privacy Practices
I have reviewed this office’s Notice of Privacy Practices, which explains how my medical information will be used and disclosed. I understand that I am entitled to receive a copy of this document.
_________________________________________
__________________
Signature of Patient or Personal
Representative Account #
_________________________________________
Date
_________________________________________
Name of Patient or Personal Representative
_________________________________________
Description of Personal Representative’s Authority
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