STAT Medical, Inc. Notice of Privacy Practices

Effective January 1st 2003

 

this notice describes how your health information may be used and disclosed and how you can gain access to this information  - please review it carefully

 

Our organization is dedicated to maintaining the privacy of your identifiable health information.  In conducting our business, we will create records regarding you and the treatment and services we provide to you.  We are required by law to maintain the confidentiality of health information that identifies you.  We also are required by law to provide you with this notice of our legal duties and privacy practices concerning your identifiable health information.  By law, we must follow the terms of the notice of privacy practices that we have in effect at the time.

 

This notice provides you with the following:

 

The terms of this notice apply to all records containing your identifiable health information that are created or retained by our organization.  We reserve the right to revise or amend out Notice of Privacy Practices.  Any revision or amendment to this notice will be effective for all of your records our organization has created or maintained in the past, and for any of your records that we may create or maintain in the future.  Our organization will post a copy of our current notice in our offices in a prominent location, and you may request a copy of our most current notice during any office visit.

 

We May Disclose Your Health Information In the Following Ways

 

The following categories describe the different ways in which we may use and disclose your identifiable health information.

 

TREATMENT – Our organization may use your identifiable health information to treat you.  For example, we may ask you to undergo laboratory tests (such as blood or urine tests) and we may use the results to help us reach a diagnosis.  Many of the people who work for our organization may use of disclose your identifiable health information in order to treat you or to assist others in your treatment.  Additionally, we may disclose your identifiable health information to others who may assist in your care, such as your physician, therapists, spouse, children, parents, and authorized caregivers.

 

PAYMENT – Our organization may use and disclose your identifiable health information in order to bill and collect payment for the services and items you may receive from us.  For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment.  We may also use and disclose your identifiable health information to obtain payment from third parties that may responsible for such costs, such as family members.  Also we may use your identifiable health information to bill you directly for services and items.

 

Health Care Operations – Our organization may use and disclose your identifiable health care information to operate our business.  As examples of the ways in which we may use and disclose your information for our operations, our organization may use your health information to evaluate the quality of care you received from us, or to conduct cost-management and business planning activities for our practice.

 

Release of Information to Family/Friends – Our organization may release your identifiable health information to a friend or family member that is helping you pay for your health care, or who assists in taking care of you.

 

Disclosures Required By Law – Our organization will use and disclose your identifiable health information when we are required to do so by federal, state, or local law.

 

Disclosures Under Special Circumstances – Under unique circumstances we may disclose your identifiable health information such as:

 

Public Health Risks – We may disclose your identifiable health information to public authorities that are authorized by law to collect information for the purpose of:

·         Maintaining vital records, such as births and deaths

·         Reporting abuse or neglect

·         Preventing or controlling disease, injury or disability

·         Notifying a person regarding potential exposure to communicable disease

·         Reporting reactions to drugs or problems with products or devices

·         Notifying individuals if a product or device they may be using has been recalled

 

Health Oversight Activities – Our organization may disclose your identifiable health information to a health oversight agency for activities authorized by law.  Oversight activities can include for example, investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.

 

Lawsuits and Similar Proceedings – Our organization may disclose your identifiable health care information in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding.  We also may disclose your information in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.

 

Law Enforcement – We may release identifiable health information if asked to do so by a law enforcement official:

·         Regarding a crime victim in certain situations, if we are unable to obtain the person’s agreement\

·         Concerning a death we believe might have resulted from criminal conduct

·         Regarding criminal conduct at our offices

·         In response to a warrant, summons, court order, subpoena, or similar legal process

·         To identify/locate a suspect, material witness, fugitive or missing person

·         In a emergency, to report a crime

Serious Threats to Health or Safety – We may use and disclose your identifiable health information when necessary to reduce or prevent a serious threat to your health or safety or another individual or the public.  Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.

 

Your Rights Regarding Your Identifiable Health Information

 

 You have the following rights regarding the identifiable health information we maintain about you:

 

Confidential Communications – You have the right to request that our organization communicate with you about your health and related issues in a particular manner or at a certain location.  For instance, you may ask that we contact you at home, rather than work.  In order to request a type of confidential communication, you must make a written request to STAT Medical, Inc. specifying the requested method of contact, or the location where you wish to be contacted.  Our organization will accommodate reasonable requests.  You do not have to give a reason for your request.

 

Requesting Restrictions – You have the right to request a restriction in our use or disclosure of you identifiable health information for treatment, payment, or health care operations.  Additionally, you have the right to request that we limit our disclosure of your identifiable health information to individuals involved in your care or the payment for your care, such as family members and friends.  We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you.  In order to request a restriction in our use or disclosure of your identifiable health information you must make your request in writing to STAT Medical, Inc.  Your request must describe in a clear and concise fashion: (1)the information you wish restricted, (2)whether you a requesting to limit our organization’s use, disclosure, or both and (3) whom you want the limits to apply.

 

Inspection and Copies – You have the right to inspect and obtain a copy of the identifiable health information that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes.  You must submit your request in writing to STAT Medical, Inc. in order to inspect and/or obtain a copy of your identifiable health information.  Our organization may charge a fee for the costs of copying , mailing, labor and supplies associated with your request.  Our practice may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial.  Another licensed health care professional chosen by us will conduct reviews.

 

Amendments – You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as your information is kept by or for our organization.  To request an amendment, your request must be made in writing and submitted to our office.  You must provide us with a reason that supports your request for amendment.  Our organization will deny your request if you fail to submit your request in writing.  Also we may deny your request if you ask us to amend information that is already accurate and complete, not part of the health information that is kept by our organization, not part of the health information that you are permitted to inspect and copy, or not created by our organization unless the individual or entity that created the information is not available to amend the information.

 

Accounting of Disclosures – All of our patients have the right to request an “accounting of disclosures.”  An Accounting of Disclosures  is a list of certain disclosures our organization has made of your identifiable health information.  In order to obtain an accounting of disclosures, you must submit your request in writing to STAT Medical, Inc.  All requests for an “accounting of disclosures” must state the time period, which may not be longer than six years and may not include dates before April 14, 2003.  The first list you request within a 12-month period is free of charge, but our office may charge you for additional lists within the same 12-month period.  Our organization will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any charges.

 

Right to File a Complaint – If you believe your privacy rights have been violated, you may file a complaint with our organization or with the Secretary of the Department of Health and Human Services.  To file a complaint with our organization contact CJ Domingo, Office Manager (808) 848-4663 all complaints must be in writing.  You will not be penalized for filing a complaint.

 

Right to Provide an Authorization if Other Uses and Disclosures – Our organization will obtain your written authorizations for uses and disclosures that are not identified by this notice or permitted by applicable law.  Any authorizations you provide to us regarding the use and disclosure of your identifiable health information may be revoked at any time in writing.  After you revoke your authorization, we will no longer use or disclose your identifiable health information for the reasons described in the authorization.  Please note, we are required to retain records of your care.

 

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