NOTICE OF PRIVACY PRACTICES FOR
CENTRAL MASS ALLERGY & ASTHMA CARE
Mandated by the Health Insurance Portability and Accountability Act (HIPAA)
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
If you have any questions about this notice, please contact Joan Hawkins at (508) 757-1589 or by mail at 100 MLK Jr. Blvd. 2nd floor Worcester, MA 01608.
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 are 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. It will tell you about the ways in which we may use and disclose health information about you and describes your rights and our obligations regarding the use and disclosure of that information. Any other use of protected health information requires your specific, signed consent.
We are required to have your written, signed consent showing you have been provided with this policy. We may use and disclose your protected health information for the following purposes without an authorization:
We may use health information about you to provide you with medical treatment or services. We may disclose health information about you to doctors, nurses, technicians, office staff or other personnel who are involved in taking care of you and your health.
For example, your doctor may be treating you for asthma and may need to know if you have other health problems that could complicate your treatment. The doctor may use your medical history to decide what treatment is best for you. The doctor may also tell another doctor about your condition so that doctor can help determine the most appropriate care for you.
Different personnel in our office may share information 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, scheduling lab work and ordering X-rays. Family members and other healthcare providers may be part of your medical care outside this office and may require information about you that we have.
We may use and disclose health information about you so that the treatment and services you receive at this office may be billed to and payment may be collected from you, an insurance company or a third party. For example, we may need to give your health plan information about a service you received here so your health plan will pay us or reimburse you for the service. We may also tell your health plan about a treatment you are going to receive to obtain prior approval, or to determine whether your plan will cover the treatment.
We may use and disclose health information about you in order to run the office and make sure that you and our other patients receive quality care. For example, we may use your health information to evaluate the performance of our staff in caring for you. We may also use health information about all or many of our patients to help us decide what additional services we should offer, how we can become more efficient, or whether certain new treatments are effective. In addition, we may deny your request if you ask us to amend information that:
a) We did not create, unless the person or entity that created the information is no longer available to make the amendment.
b) Is not part of the health information that we keep.
c) You would not be permitted to inspect and copy.
d) Is inaccurate and incomplete.
You have the right to request an "accounting of disclosures." This is a list of the disclosures we made of medical information about you for purposes other than treatment, payment and healthcare operations. To obtain this list, you must submit your request in writing to our privacy officer, Joan Hawkins. It must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper or electronically). We may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before incurring any costs.
You have the right to request a “restriction or limitation” on the health information we use or disclose about you for treatment, payment or healthcare operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for it, like a family member or friend. For example, you could ask that we not use or disclose information about a lab test you had.
If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
To request restrictions, you may submit a written request of restrictions on use/disclosure of medical information (or call if you need assistance with this request) to Joan Hawkins. The request must be signed and dated.
RIGHT TO REQUEST CONFIDENTIAL COMMUNICATIONS
You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. You may indicate this on your registration form.
To request confidential communications, you may also submit a written request at any time to Joan Hawkins, our Privacy Officer. We will not ask you the reason for your request unless we have difficulty implementing the request successfully. Your request must specify how or where you wish to be contacted. We will accommodate all reasonable requests during our normal business hours.
***This office confirms your appointments by telephone and uses reminder post cards mailed to your home address when it is time to schedule an appointment. You must inform us if you wish not to be contacted by either of these methods. We will leave a message on your answering machine only asking you to contact us if we need to discuss patient care or results. No treatment or personal information will be left on answering machine at any time.***
YOU HAVE A RIGHT TO A PAPER COPY OF THIS COMMUNICATION
You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive it electronically, you are still entitled to a paper copy. To obtain such a copy, contact our designated privacy official, Joan Hawkins or any of our staff members.
We reserve the right to change this notice, and to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post a summary of the current notice in the office with its effective date in the top right hand corner. You are entitled to a copy of the notice currently in effect.
If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services. To file a complaint with our office, contact Joan Hawkins, Practice Manager at (508) 757-1589. You will not be penalized for filing a complaint.
We are required by law to provide this written information to our patients. A signature must be obtained from the patient (or patient’s legal guardian if the patient is under 18 years of age) and filed in the patient chart showing compliance of this regulation. Your signature denotes receipt of this document.
Copy date April 2003