SOUTHERN INDIANA COMMUNITY HEALTH CARE, INC.
d/b/a Comprehensive Health Care, Crawford County Family Health Care, Valley Health
Patoka Family Health Care Center
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.
This notice of Privacy Practices describes how our office may use and disclose your protected health information to carry treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control of your protected health information. "Protected Health Information" is information about you, including demographic information that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.
We are required by law to maintain the privacy of your protected health information and to provide you with notice of our legal duties and privacy practices with respect to protected health information.
We are required to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice at any time. The new notice will be effective for all protected health information that we maintain at that time. Upon your request, we will provide you the any revised Notice of Privacy Practices. You can obtain the revised notice by calling the office and requesting that a revised copy be sent to you the mail or asking for one at the time of your next appointment.
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
You will be asked by your physician's office staff to sign a consent form. Once you have consented to the use and disclosure of your protected health information, your protected health information may be used and disclosed by your physician, nurse practitioner, our office staff and others outside of our office that are involved in your care and treatment for the purposes of providing health care services to you. Your protected health information may also be used and disclosed to pay your health care bills and to support the operation of the physician's practice.
Following are examples of the types of uses and disclosure of your protected health care information that the physician's office is permitted to make. These examples are to provide you the best description of the types of uses and disclosures that may be made by our office.
Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party that has already obtained your permission to have access to your protected health information. For example, we would disclose your protected health information, as necessary, to a home health agency that provides care to you. We will also disclose protected health information to other physicians who may be treating you when we have the necessary permission from you to disclose your protected health information. For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the Physician has the necessary information to diagnose or treat you.
In addition, we may disclose your protected health information from time-to-time to another physician, other health care provider, or medical agency (hospital, specialist, laboratory, or durable medical equipment) who, at the request of your physician/provider, becomes involved in your care by providing assistance with your health care diagnosis or treatment to your physician.
Payment: Your health information may be used to seek payment from your health plan, from other sources of coverage such as an automobile insurer, or from credit card companies that you may use to pay for services. For example, your health plan may request and receive information on dates of service, the services provided, and the medical condition being treated.
Healthcare Operations: We may use and disclose your health information in connection with our day-to-day health care operations. Healthcare operations include quality assessment and improvement activities, reviewing the competence of qualifications of health care professionals, evaluating practitioner and provider performance, conducting training programs, certification, licensing or credentialing activities.
For example, we may disclose your protected health information to medical school students that see patients at our office. In addition, we may use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your physician. We may also call you by name in the waiting room when your physician/nurse practitioner or other medical staff is ready to see you. We may also use or disclose your protected health information, as necessary, to contact you to remind you of your appointment. This contact may include, but is not limited to, sending you a written letter, leaving voice mail messages, postcards, or messages with other members of your household. You may request that we not use any or all of these methods to contact you.
We will share your protected health information with third party "Business Associates" that perform various activities (billing, transcription services, collection agencies) for the practice. Whenever an arrangement between our office and a business associate that involves the use or disclosure of your protected health information, we will have a written contract with the business associate that contains terms that will protect the privacy of your protected health information.
We may use or disclose your protected health information, as necessary, to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you. We may also use and disclose your protected health information for other marketing activities. For example, your name and address may be used to send you a newsletter about our practice and the service we offer. We may also send you information about products or services that we believe may be beneficial to you. You may contact our Privacy Officer to request that these materials not be sent to you.
USES AND DISCLOSURE OF PROTECTED HEALTH INFORMATION BASED
UPON YOUR WRITTEN AUTHORIZATION
Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law as described below. You may revoke this authorization, at any time, in writing, except to the extent that your physician/nurse practitioner or the physician's practice has taken an action in reliance on the use or disclosure indicated in the authorization.
OTHER PERMITTED AND REQUIRED USES AND DISCLOSURES THAT MAY BE MADE WITH YOUR CONSENT AUTHORIZATION OR OPPORTUNITY TO OBJECT
We may use and disclose your protected health information in the following instances. You have the opportunity to agree or object to the use or disclosure of all or part of your protected health information. If you are not present or able to agree or object to the use or disclosure of the protected health information, then your physician may, using professional judgment determine whether the disclosure is in your best interest. In this case, only the protected health information that is relevant to your health care will be disclosed.
We may use or disclose your protected health care information in all emergency treatment situations. If this happens, your physician or his/her representative shall try to obtain your consent as soon as reasonably practicable after the delivery of treatment (your physician or another provider in the practice is required by law to treat you and the physician/provider has reasonably attempted to obtain your consent but is unable due to unforeseen reasons, he or she may still use or disclose your protected health information to treat you.
Unless you object, we may disclose (to a member of your family, a relative, a close friend or any other person you identify) your protected health information that directly relates to that person's involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death. Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.
OTHER PERMITTED AND REQUIRED USES AND DISCLOSURES THAT MAY BE MADE WITHOUT YOUR CONSENT, AUTHORIZATION OR OPPORTUNITY TO OBJECT
Required By Law : We may use or disclose your protected health information to the extent that is required by law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, if required by law, of any such uses or disclosures.
Public Health: We may disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury or disability. We may also disclose your protected health information, if directed by the public health authority; to a foreign government age cy that is collaborating with the public health authority.
Communicable Diseases: We may disclose your protected health information if authorized by law, to a person who may have been exposed to a communicable d ease or may otherwise be at risk of contracting or spreading the disease or condition.
Health Oversight: We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee health care systems, government benefit programs, other government regulatory programs and civil rights laws.
Abuse or Neglect: We may disclose your protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your protected health information if we believe that you have been a victim of abuse, neglect or domestic violence to the governmental entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.
Food and Drug Administration: We may disclose protected health information to a person or company required by, the Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations, track products; to enable product recalls; to make repairs or replacements, or to conduct post marketing surveillance, as required.
Legal Proceedings: We may disclose protected health information in the course of any judicial or administrative proceedings, in response to an order of a court administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, or other lawful process.
Law Enforcement: We may also disclose protected health information, so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include (1) legal processes and otherwise required by law, (2) limited information requests for identification and location purposes, (3) pertaining to victims of a crime, (4) suspicion that death has occurred as a result of criminal conduct, (5) in the event that a crime occurs on the premises of the practice, and (6) medical emergency (not on the Practice's premises) and it is likely that a crime has occurred.
Coroners Funeral Directors and Organ Donations: We may disclose protected health information to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law. We may also disclose protected health information to a funeral director, as authorized by law, in order to permit the funeral director to carry out their duties. We may disclose such information in reasonable anticipation of death. Protected health information may be used and disclosed for cadaver organ, eye or tissue donation purposes.
Research: We may disclose your protected health information to researchers when an institutional review board has approved the research, and protocols have been established to ensure the privacy of your protected health information.
Criminal Activity: Consistent with applicable federal and state laws, we may disclose your protected health information, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.
Military Activity and National Security: When the appropriate conditions apply, we may use or disclose protected health information of individuals who are Armed Forces personnel (1) for activities deemed necessary by appropriate military command authorities; (2) for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits, or (3) to foreign military authority if you are a member of that foreign military services. We may also disclose your protected health information to authorized federal officials for conducting national security and intelligence activities, including for the provision of protective services to the President of others legally authorized.
Workers' Compensation: We may disclose your protected health information as authorized to comply with workers' compensation laws and other similar legally established programs.
Inmates: We may use or disclose your protected health information if you are an inmate of a correctional facility and your physician created or received your protected health information in the course of providing care to you.
Required Uses and Disclosures: Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human and Services to investigate or determine our compliance with the requirements of Section 164.500 et. Seq.
YOUR RIGHTS
You have the Right to inspect and copy your protected health information: This means you may inspect and obtain a copy of protected health information about you that is contained in a designated record set for as long as we maintain the protected health information. A "designated record set" contains medical and billing records and any other records that you're physician/nurse practitioner and the practice uses for making decisions about you. If you request a copy of the designated record set, we may charge fee for the costs of copying, mailing, or other associated supplies.
Under federal law, however, you may not inspect or copy the following records; psychotherapy notes, information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information. Depending on the circumstances, a decision to deny access may be reviewed. In some circumstances, you may have a right to have this decision reviewed. Please contact our Privacy Officer if you ha e questions about access to your medical record.
You have the right to request a restriction of your protected health information: This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in our care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specfic restriction requested and to whom you want the restriction to apply.
Your physician/nurse practitioner is not required to agree to a restriction that you may request. If physician/nurse practitioner believes it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted. If your physician/nurse practitioner does agree to the requested restriction, we may not use or disclose your protected health information in violation of that restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request with your provider. You may request a restriction by asking our receptionist, clerk, medical assistant, or Privacy Officer for the appropriate form for you to complete and sign.
You have the right to request to receive confidential communications from us by alternative means or at an alternative location: We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method on contact. We will not request an explanation from you as to the basis for the request. Please make this request in writing to our Privacy Officer.
You may have the right to have your physician/nurse practitioner amend your protected health information: This means you may request an amendment of protected health information about you in a designated record set for as long as we maintain this information. You will be required to make this request in writing. We have forms available in our office for this purpose. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact our Privacy Officer to determine if you have questions about amending your medical record.
You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information: This right applies to receiving a list of occurrences in which our Business Associates disclosed your health information for purposes other than treatment, payment, or healthcare operations and certain other activities, for the last 6 years, but not before April 14, 2003. If you request this accounting more than once in a 12-month period, we may charge you a reasonable, cost -based fee for responding to these additional requests.
COMPLAINTS/CONTACT PERSONS
If you would like to submit a comment or complaint about our privacy practices, you can do so by sending a letter outlining your concerns to our Privacy Officer, or to:
Janie Millspaugh, Manager (SICHC)
Comprehensive Health Care
Valley Health
P.O. Box 270
Paoli, IN 47454
Or
Diana Scott, Manager (SICHC)
Crawford County Family Health Care
Patoka Family Health Care Center
5604 East White Oak Lane
Marengo, IN 47140
If you believe that your privacy rights have been violated, you should call the matter to Our attention by sending a letter describing the cause of your concern to the dresses listed, or you may contact the Secretary of Health and Human Services.
You will not be penalized or otherwise retaliated against for filing a complaint.
PRIVACY OFFICER
Tracy Cook
Southern Indiana Community Health Care
P.O. Box 270
Paoli, IN 47454
(812) 723-3944
This notice was published and becomes effective on June 21, 2010.