Notice of Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Practice

 

For

 

Doctors On Call Service (DOCS)

 

 

This Notice describes how health information about you (as a patient of this practice) may be used and disclosed and how you can get access to your individually identifiable healthcare information.  Effective Date April 14, 2003.  Please review this carefully.

 

The terms of this Notice apply to all records containing your protected health information (PHI) that are created or retained by DOCS. DOCS reserves the right to revise or amend this Notice.  DOCS will post a copy of our current Notice on our website at www.doctorsoncallservice.com, and you may request a copy of the most current Notice at any time.

 

 

DOCS' Commitment To Your Privacy:

 

We are now required by law to maintain the confidentiality of health information that identifies you.  HIPAA provides for the privacy of protected health information (PHI).  The HIPAA Privacy Rule formalizes the policies and procedures that DOCS already utilizes to protect our patient's privacy and confidentiality.  Confidentiality has always been of utmost importance to all of us at DOCS .

 

At DOCS only the privacy officer, the office manager, or physicians may release or disclose PHI.

 

 

How Your PHI May Be Used And Disclosed:

 

DOCS will use and release PHI for purposes of patient care and treatment, for the purpose of assisting you with health insurance reimbursement for services rendered, and for the operation of the practice itself.

 

Treatment:

DOCS may use your PHI to treat you.  For example, the physician may use your PHI in order to write a prescription for you, or disclose your PHI to a specialist physician in consult for purposes related to your treatment.  DOCS may disclose your PHI to a pharmacy when ordering a prescription for you.

 

Payment:

Because you pay for services rendered at the time of the visit, DOCS may disclose your PHI to assist you in receiving your reimbursement from your health insurance company.  We may also disclose PHI to obtain payment from third parties who may be responsible for your visit costs, such as family members.

 

Healthcare Operations:

DOCS may use and disclose your PHI for business operation.  In other words, we may use your PHI to evaluate the quality of care you received from us, or to conduct cost-management and business planning activities for our practice.

 

Release Of PHI To Family/Friends & Others Involved In Your Care:

DOCS may release your PHI to a parent or guardian.  Unless you object, we may release your PHI to a parent/guardian or friend who is involved in your care. An example of this maybe a babysitter or nanny who is acting as the responsible guardian in the absence of the parent, and the medical information is directly relevant to that person's involvement with your care.

 

Additional Disclosures In Accordance With Federal & State Laws:

For any purpose as required by law; for public health activities, such as reporting of communicable diseases; abuse or neglect in accordance with federal and state law; to law enforcement officials as required by law; to a government oversight agency conducting investigations if required by law; for workers' compensation; if ordered by subpoena, discovery, or qualified protective order; organ donation if you are a donor or possible recipient; and if necessary to avert a serious threat to health or safety.

 

 

Your HIPAA Privacy Rights:

 

The Right To Receive DOCS Notice Of Privacy:

DOCS will give a copy of the Notice to the patient at the time of the healthcare visit.

 

The Right To Access Your Personal Health Information (PHI):

You have a right to obtain a copy and inspect specific items of your PHI.  We reserve the right to deny your request to certain PHI, as permitted or required by law.  All of DOCS patients will receive their designated medical record at the end of their patient visit.  The designated records include the patient encounter form (chart) and the original HCFA 1500 insurance claim form.  If a second copy of your medical record is needed a written request may be sent to: Doctors On Call Service - Privacy Officer PO Box 2637 Windermere, FL 34786-2637 phone: 407-399-3627.  A release of information form will be sent to you, and once we receive your signed authorization form, a second copy of the medical record will be faxed or mailed to you at no cost.  If additional requests for copies are made the patient may incur a charge, however, the patient will be informed of the cost at the time of the request.

 

The Right To Restrict Disclosure To Others:

You may ask us to restrict certain uses and disclosures of your PHI.  We are not required to agree to your request, but if we do, we will honor it.  In order to request a restriction in our use or disclosure of your PHI, you must submit your request in writing to: Doctors On Call Service - Privacy Officer PO Box 2637 Windermere, FL 34786-2637 phone: 407-399-3627.

 

The Right To Alternate Means Of Communicating Or Receiving PHI:

You may ask that DOCS contact you at a different location or by a different method.  In other words, you may ask that your PHI be mailed to your work address rather than your home address.  This request must be submitted in writing to: Doctors On Call Service - Privacy Officer PO Box 2637 Windermere, FL 34786-2637 phone: 407-399-3627.  We will agree to any reasonable request for alternate means of communication.

 

The Right To Request Amendments To Your PHI:

If you believe that DOCS has information that is either inaccurate or incomplete, you may request that we amend this information. You must provide DOCS with a written request with a reason that supports your request for amendment.  This request may be sent to: Doctors On Call Service - Privacy Officer, PO Box 2637, Windermere, FL 34786-2637.  DOCS reserves the right to deny your request if asked to amend information that is, in our opinion: accurate and complete; not part of the PHI retained by the practice; not part of the PHI which you would be permitted to view; or, PHI not created by this practice.

 

The Right To An Accounting Of PHI Disclosures:

You may request a list of certain non-routine disclosures our practice has made of your PHI for purposes not related to treatment, payment, or practice operations during the last 6 months.  Submit your request in writing to DOCS, including the time period, which may not be longer than six months from the date of disclosure, and may not include dates prior to April 15, 2003.  Your first request within a 12-month period of time is free of charge, but our practice may charge for additional lists within the same 12-month period.  DOCS will notify you of any costs involved.

 

The Right To File A Complaint:

If you believe your privacy rights have been violated, you may file a complaint with DOCS or with the Secretary of the Department of Health and Human Services in Washington, D.C.  To file a complaint with DOCS submit the complaint in writing to: Doctors On Call Service - Privacy Officer, PO Box 2637, Windermere, FL 34786-2637 phone: 407-399-3627.  Except as outlined in this Notice, we will not use or disclose your personal health information for any purposes unless you have signed a form authorizing the use or disclosure.  You have the right to revoke your authorization in writing at any time.  Contact DOCS to request a revocation authorization form.  If you have questions regarding this Notice of our health information privacy policies contact: Doctors On Call Service - Privacy Officer, PO Box 2637, Windermere, FL 34786-2637 phone: 407-399-3627.

 

 

Except as outlined in this Notice, we will not use or disclose your personal health information for any purposes unless you have signed a form authorizing the use or disclosure.  You have the right to revoke your authorization in writing at any time.

 

Contact DOCS to request a revocation authorization form.  If you have questions regarding this Notice of our health information privacy policies contact: Doctors On Call Service - Privacy Officer, PO Box 2637, Windermere, FL 34786-2637 phone: 407-399-3627