Notice of Privacy
Practices
RUTH HASKINS, MD, INC.
(916)
817-2649
Effective Date: JULY 1, 2008
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.
We understand the importance of privacy
and are committed to maintaining the confidentiality of your medical
information. We make a record of the
medical care we provide and may receive such records from others. We use these records to provide or enable
other health care providers to provide quality medical care, to obtain payment
for services provided to you as allowed by your health plan and to enable us to
meet our professional and legal obligations to operate this medical practice
properly. We are required by law to maintain the privacy of protected health
information and to provide individuals with notice of our legal duties and
privacy practices with respect to protected health information. This notice
describes how we may use and disclose your medical information. It also describes your rights and our legal
obligations with respect to your medical information. If you have any questions about this Notice,
please contact our Privacy Officer listed above.
TABLE OF CONTENTS
A. How this
Medical Practice May Use or Disclose Your Health Information
.
... p. 2
B. When This
Medical Practice May Not Use or Disclose Your Health Information
.
. p. 4
C. Your
Health Information Rights
.p. 5
D. Changes to
this Notice of Privacy Practices
.
.. p. 6
E. Complaints
.... p. 6
A. How This
Medical Practice May Use or Disclose Your Health Information
This
medical practice collects health information about you and stores it in a chart
and on a computer. This is your medical
record. The medical record is the
property of this medical practice, but the information in the medical record
belongs to you. The law permits us to
use or disclose your health information for the following purposes:
1. Treatment. We use medical information about you to
provide your medical care. We disclose
medical information to our employees and others who are involved in providing
the care you need. For example, we may
share your medical information with other physicians or other health care providers
who will provide services which we do not provide. Or we may share this information with a
pharmacist who needs it to dispense a prescription to you, or a laboratory that
performs a test. We may also disclose
medical information to members of your family or others who can help you when
you are sick or injured.
2. Payment. We use and disclose medical information
about you to obtain payment for the services we provide. For example, we give your health plan the
information it requires before it will pay us.
We may also disclose information to other health care providers to
assist them in obtaining payment for services they have provided to you.
3. Health Care Operations. We may use and disclose medical information
about you to operate this medical practice.
For example, we may use and disclose this information to review and
improve the quality of care we provide, or the competence and qualifications of
our professional staff. Or we may use
and disclose this information to get your health plan to authorize services or
referrals. We may also use and disclose
this information as necessary for medical reviews, legal services and audits,
including fraud and abuse detection and compliance programs and business planning
and management. We may also share your
medical information with our "business associates", such as our
billing service, that perform administrative services for us. We have a written contract with each of these
business associates that contains terms requiring them to protect the confidentiality
of your medical information. Although
federal law does not protect health information which is disclosed to someone
other than another healthcare provider, health plan or healthcare
clearinghouse, under
4. Appointment Reminders. We may use and disclose medical information
to contact and remind you about appointments.
If you are not home, we may leave this information on your answering
machine or in a message left with the person answering the phone. We will not leave personal messages regarding
lab results or clinical conditions on a voice mail answering machine without
your specific permission.
5. Sign in sheet. We may use and disclose medical information
about you by having you sign in when you arrive at our office. We will call out only your first name when we
are ready to see you (unless you specifically direct us to do otherwise).
6. Notification and communication with
family. We may disclose your health
information to notify or assist in notifying a family member, your personal
representative or another person responsible for your care about your location,
your general condition or in the event of your death. In the event of a disaster, we may disclose
information to a relief organization so that they may coordinate these
notification efforts. We may also
disclose information to someone who is involved with your care or helps pay for
your care. If you are able and available
to agree or object, we will give you the opportunity to object prior to making
these disclosures, although we may disclose this information in a disaster even
over your objection if we believe it is necessary to respond to the emergency
circumstances. If you are unable or
unavailable to agree or object, our health professionals will use their best
judgment in communication with your family and others.
7. Marketing. We will
not use or disclose your medical information for marketing purposes without
your written authorization, and we will disclose whether we receive any
payments for that marketing activity.
8. Required by law. As required by law, we will use and disclose
your health information, but we will limit our use or disclosure to the
relevant requirements of the law. When
the law requires us to report abuse, neglect or domestic violence, or respond
to judicial or administrative proceedings, or to law enforcement officials, we
will further comply with the requirement set forth below concerning those
activities.
9. Public health. We may, and are sometimes required by law to disclose your health
information to public health authorities for purposes related to: preventing or controlling disease, injury or
disability; reporting child, elder or dependent adult abuse or neglect;
reporting domestic violence; reporting to the Food and Drug Administration
problems with products and reactions to medications; and reporting disease or
infection exposure. GYNECOLOGISTS ARE MANDATED REPORTERS OF DOMESTIC ABUSE AND
OF SEXUAL ABUSE. IF YOU TELL ME, I MUST
REPORT IT. When we report suspected
elder or dependent adult abuse or domestic violence, we will inform you
promptly unless in our best professional judgment, we believe the notification
would place you at risk of serious harm or would require informing a personal
representative we believe is responsible for the abuse or harm.
10. Health oversight activities. We may, and are sometimes required by law to
disclose your health information to health oversight agencies during the course
of audits, investigations, inspections, licensure and other proceedings,
subject to the limitations imposed by federal and
11. Judicial and administrative
proceedings. We may, and are
sometimes required by law, to disclose your health information in the course of
any administrative or judicial proceeding to the extent expressly authorized by
a court or administrative order. We may
also disclose information about you in response to a subpoena, discovery
request or other lawful process if reasonable efforts have been made to notify
you of the request and you have not objected, or if your objections have been
resolved by a court or administrative order.
12. Law enforcement. We may, and are sometimes required by law, to
disclose your health information to a law enforcement official for purposes
such as identifying of locating a suspect, fugitive, material witness or
missing person, complying with a court order, warrant, grand jury subpoena and
other law enforcement purposes.
13. Coroners. We may, and are often required by law, to
disclose your health information to coroners in connection with their
investigations of deaths.
14. Organ
or tissue donation. We may disclose
your health information to organizations involved in procuring, banking or
transplanting organs and tissues. We do
not provide your contact information for the purpose of marketing for
procurement of umbilical cord blood donation.
15. Public
safety. We may, and are sometimes
required by law, to disclose your health information to appropriate persons in
order to prevent or lessen a serious and imminent threat to the health or
safety of a particular person or the general public.
16. Specialized
government functions. We may
disclose your health information for military or national security purposes or
to correctional institutions or law enforcement officers that have you in their
lawful custody.
17. Workers compensation. We may disclose your health information as
necessary to comply with workers compensation laws. For example, to the extent your care is
covered by workers' compensation, we will make periodic reports to your
employer about your condition. We are
also required by law to report cases of occupational injury or occupational
illness to the employer or workers' compensation insurer.
18. Change of Ownership. In the event that this medical practice is
sold or merged with another organization, your health information/record will
become the property of the new owner, although you will maintain the right to
request that copies of your health information be transferred to another
physician or medical group.
B. When This
Medical Practice May Not Use or Disclose Your Health Information
Except
as described in this Notice of Privacy Practices, this medical practice will
not use or disclose health information which identifies you without your
written authorization. If you do
authorize this medical practice to use or disclose your health information for
another purpose, you may revoke your authorization in writing at any time.
C. Your
Health Information Rights
1. Right to Request Special Privacy
Protections. You have the right to
request restrictions on certain uses and disclosures of your health information,
by a written request specifying what information you want to limit and what
limitations on our use or disclosure of that information you wish to have
imposed. We reserve the right to accept
or reject your request, and will notify you of our decision.
2. Right to Request Confidential
Communications. You have the right
to request that you receive your health information in a specific way or at a
specific location. For example, you may
ask that we send information to a particular e-mail account or to your work
address. We will comply with all
reasonable requests submitted in writing which specify how or where you wish to
receive these communications.
3. Right
to Inspect and Copy. You have the
right to inspect and copy your health information, with limited
exceptions. To access your medical
information, you must submit a written request detailing what information you
want access to and whether you want to inspect it or get a copy of it. We will charge a reasonable fee, as allowed
by
4. Right to Amend or Supplement. You have a right to request that we amend
your health information that you believe is incorrect or incomplete. You must make a request to amend in writing,
and include the reasons you believe the information is inaccurate or
incomplete. We are not required to
change your health information, and will provide you with information about
this medical practice's denial and how you can disagree with the denial. We may deny your request if we do not have
the information, if we did not create the information (unless the person or
entity that created the information is no longer available to make the
amendment), if you would not be permitted to inspect or copy the information at
issue, or if the information is accurate and complete as is. You also have the right to request that we
add to your record a statement of up to 250 words concerning any statement or
item you believe to be incomplete or incorrect.
5. Right to an Accounting of
Disclosures. You have a right to
receive an accounting of disclosures of your health information made by this
medical practice, except that this medical practice does not have to account
for the disclosures provided to you or pursuant to your written authorization,
or as described in paragraphs 1 (treatment), 2 (payment), 3 (health care
operations), 6 (notification and communication with family) and 16 (specialized
government functions) of Section A of this Notice of Privacy Practices or
disclosures for purposes of research or public health which exclude direct
patient identifiers, or which are incident to a use or disclosure otherwise
permitted or authorized by law, or the disclosures to a health oversight agency
or law enforcement official to the extent this medical practice has received
notice from that agency or official that providing this accounting would be
reasonably likely to impede their activities.
6. You have a right to a paper copy of
this Notice of Privacy Practices, even if you have previously requested its
receipt by e-mail.
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 our Privacy Officer
listed at the top of this Notice of Privacy Practices.
D. Changes to
this Notice of Privacy Practices
We
reserve the right to amend this Notice of Privacy Practices at any time in the
future. Until such amendment is made, we
are required by law to comply with this Notice.
After an amendment is made, the revised Notice of Privacy Protections
will apply to all protected health information that we maintain, regardless of
when it was created or received. We will
keep a copy of the current notice available in our reception area, available
for review on our website (www.ruthhaskinsmd.com)
and you may request a copy of an updated Privacy Policy Statement at any visit
to our office.
E. Complaints
Complaints about this Notice of Privacy Practices or how
this medical practice handles your health information should be directed to our
Privacy Officer listed at the top of this Notice of Privacy Practices.
If you are not satisfied with the manner in which this
office handles a complaint, you may submit a formal complaint to:
Department of Health and Human Services
Office of Civil Rights
Hubert H. Humphrey Bldg.
Room 509F,
You will not be penalized for filing a
complaint.