Allergy and Asthma Specialists, PC
HIPAA NOTICE OF PRIVACY PRACTICES
Effective Date (April 14, 2003)
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:
Allergy and Asthma Specialists, PC
ATTN: Marijo Washburn
470 Sentry Pkwy East, Suite 200
Blue Bell, PA 19422
Telephone: 610-825-5800, Ext 125
Fax: 610-397-0702
This notice describes the privacy practices at our
offices.
I. YOUR PROTECTED HEALTH INFORMATION
A & AS is required by the federal privacy rule to maintain
the privacy of your health information that is protected
by the rule, and to provide you with notice of our legal
duties and privacy practices with respect to your
protected health care information. We are required to
abide by the terms of the notice currently in effect.
Generally speaking, your protected health information is
any information that relates to your past, present or
future physical or mental health or condition, the
provision of health care provided to you, and individually
identifies you or reasonably can be used to identify you.
Your medical and billing records at our practice are
examples of information that usually will be regarded as
your protected health information.
II. USES AND DISCLOSURES OF YOUR PROTECTED HEALTH
INFORMATION
A. Treatment, payment and health care operations.
This secion describes how we may use and disclose your
protected health information for treatment, payment and
health care operations purposes. The desciptions include
examples. Not every possible use or disclosure for
treatment, payment and health care operations purposes
will be listed.
1. Treatment
We may use and disclose your protected health
information for our treatment purposes as well as the
treatment purposes of other health care providers.
Treatment includes the provision, coordination or
management of health care services to you by one or more
health care providers. Some examples of treatment uses
and disclosures include:
During an office visit, practice physicians and other
staff involved in your care may review your medical record
and share and discuss your medical information with each
other.
We may share and discuss your medical information with an
outside physician to whom we have referred you for care.
We may share and discuss your medical information with an
outside physician with whom we are consulting regarding
you.
We may share and discuss your medical information with an
outside laboratory, radiology center, or other health care
facility where we have referred you for testing.
We may share and discuss your medical information with an
outside home health agency, durable medical equipment
agency or other health care provider to whom we have
referred you for health care services and products.
We may share and discuss your medical infomation with a
hospital or other health care facility where we are
admitting or treating you or referring you for admission
or treatment.
We may share and discuss your medical information with
another health care povide who seeks this information for
the purpose of treating you. One example of this type of
health care provider is a school nurse.
We may use a patient sign-in sheet in the waiting area
which is accessible to all patients.
We may page patients in the waiting room when it is time
for them to go to an examining room.
We may contact you by telephone, and leave a message on
your voice mail identifying ourselves as staff from
Allergy and Asthma Specialists, PC, to provide appointment
reminders, lab test and x-ray results, prescription and
extract refills, or account financial information.
We may contact you by mail, using a return address as
Allergy and Asthma Specialists, PC on the outside of the
mailing to provide newsletters, appointment reminders,
marketing information, lab test and x-ray results, extract
information, or account financial information.
2. Payment
We may use and disclose your protected health information
for our payment purposes as well as the payment purposes
of other health care providers and health plans. Payment
uses and disclosures include activities conducted to
obtain payment for the care provided to you or so that you
can obtain reimbursement for that care, for example, from
your health insurer. Some examples of payment uses and
disclosures include:
Sharing information with your health insurer to determine
whether you are eligible for coverage or whether proposed
treatment is a covered service.
Submission of a claim form to your health insurer.
Providing supplemental information to your health insurer
so that your health insurer can obtain reimbursement from
another health plan under a coordination of benefits
clause in your subscriber agreement.
Sharing your demographic information (for example, your
address) with other health care providers who seek this
information to obtain payment for health care services
provided to you.
Mailing you bills in envelopes with our practice name and
return address.
Allowing your health insurer access to your medical record
for a medical necessity or quality review audit.
Providing information to a collection agency or our
attorney for purposes of securing payment of a delinquent
account.
3. Health care operations
We may use and disclose your protected health information
for our health care operation purposes as well as certain
health care operation purposes of other health care
providers and health plans. Some examples of health care
operation purposes include:
Quality assessment and improvement activities.
Population based activities relating to improving health
or reducing health care costs.
Reviewing the competence, qualifications, or performance
of health care professionals.
Conducting training programs for interns and residents,
medical students and other students.
Accreditation, certification, licensing and credentialing
activities.
Health care fraud and abuse detection and compliance
programs.
Conducting other medical review, legal services, and
auditing functions.
Business planning and development activities, such as
conducting cost management and planning related analyses.
Sharing information regarding patients with entities that
are interested in purchasing our practice and turning over
patient records to entities that have purchased our
practice.
Other business management and general administrative
activities, such as compliance with the federal privacy
rule and resolution of patient grievances.
4. Research
Our practice may use and disclose your PMI for research
purposes in certain limited circumstances. We will obtain
your written authorization to use your PMI for research
purposes except when: (a) our use or disclosure was
approved by an Institutional Review Board or a Privacy
Board; (b) we obtain the oral or written agreement of a
researcher that (i) the information being sought is
necessary for the research study; (ii) the use or
disclosure of your PMI is being used only for the research
and (iii) the researcher will not remove any of your PMI
from our practice; or (c) the PMI sought by the researcher
only relates to decedents and the researcher agrees either
orally or in wiriting that the use or disclosure is
necessary for the research and, if we request it, to
provide us with proof of death prior to access to the PMI
of the decedents.
B. Uses and disclosures for other purposes.
We may use and disclose your protected health information
for other purposes. This section generally describes thoses purposes by category. Each category includes one
or more examples. Not every use or disclosure in a
category will be listed. Some examples fall into more
that one category - not just the category under which they
are listed.
1. Individuals involved in care or payment for care
We may disclose your protected health information to
someone involved in your care or payment for your care,
such as a spouse, a family member, or close friend. For
example, if you have surgery, we may discuss your physical
limitations with a family member assisting in your post-
operative care.
2. Notification purposes
We may use and disclose your protected health information
to notify, or to assist in the notification of, a family
member, a personal representative, or another person
responsible for your care, regarding your location,
general condition, or death. For example, if you are
hospitalized, we may notify a family member of the
hospital and your general condition. In addition, we may
disclose your protected health information to a disaster
relief entity, such as the Red Cross, so that it can
notify a family member, a personal representative, or
another person involved in your care regarding your
location, general condition or death.
3. Required by law
We may use and disclose protected health information when
required by federal, state, or local law. For example, we
may disclose protected health information to comply with
mandatory reporting requirements involving births and
deaths and serious injuries, gunshot and other injuries
by a deadly weapon or criminal act, driving impairments
and blood alcohol testing.
4. Other public health activities
We may use and disclose protected health information for
public health activities, including:
Public health reporting, for example, communicable disease
reports.
Child abuse and neglect reports
FDA-related reports and disclosures, for example, adverse
event reports.
Public health warnings to third parties at risk of a
communicable disease or condition
OSHA requirements for workplace surveillance and injury
reports.
5. Victims of abuse, neglect or domestic violence
We may use and disclose protected health information for
purposes of reporting of abuse, neglect or domestic
violence in addition to child abuse, for example, reports
of elder abuse to the Department of Aging or abuse of a
nursing home patient to the Department of Public Welfare.
6. Health oversight activities
We may use and disclose protected health information for
purposes of health oversight activities authorized by
law. These activities could include audits, inspections,
investigations, licensure actions, and legal proceedings.
For example, we may comply with a Drug Enforcement Agency
inspection of patient records.
7. Judicial and administrative proceedings
We may use and disclose protected health information
disclosures in judicial and administrative proceedings in
response to a court order or subpoena, discovery request
or other lawful process. For example, we may comply with
a court order to testify in a case at which your medical
condition is at issue.
8. Law enforcement purposes
We may use and disclose protected health information for
certain law enforcement purposes including to:
-Comply with legal process, for example, a search warrant.
-Comply with a legal requirement, for example, mandatory
reporting of gun shot wounds.
-Respond to a request for information for
identification/location purposes.
-Respond to a request for information about a crime victim.
-Report a death suspected to have resulted from criminal
activity.
-Provide information regarding a crime on the premises.
-Report a crime in an emergency.
9. Coroners and medical examiners
We may use and disclose protected health information for
purposes of providing information to a coroner or medical
examiner for the purpose of identifying a deceased
patient, determining a cause of death, or facilitating
their performance of other duties required by law.
10. Funeral directors
We may use and disclose protected health information for
purposes of providing information to funeral directors as
necessary to carry out their duties.
11. Organ and tissue donation
For purposes of facilitating organ, eye and tissue
donation and transplantation, we may use protected health
information and disclose protected health information to
entities engaged in the procurement, banking or
transplantation of cadaveric organs, eyes, or tissue.
12. Threat to public safety
We may use and disclose protected health information for
purposes involving a threat to public safety, including
protection of a third party from harm and identification
and apprehension of a criminal. For example, in certain
circumstances, we are required by law to disclose
information to protect someone from imminent serious harm.
13. Specialized government functions
We may use and disclose protected health information for
purposes involving specialized government functions
including:
-Military and veteran activities
-National security and intelligence
-Protective services for the President and others.
-Medical suitability determinations for the Department of
State
-Correctional institutions and other law enforcement
custodial situations.
14. Workers' compensation and similar programs
We may use and disclose protected health information as
authorized by and to the extent necessary to comply with
laws relating to workers' compensation or similar
programs, established by law, that provide benefits for
work-related injuries or illness without regard to fault.
For example, this would include submitting a claim for
payment to your employer's workers' compensation carrier
if we treat you for a work injury.
15. Business associates
Certain functions of the practice are performed by a
business associate such as a billing company, an
accountant firm, or a law firm. We may disclose protected
health information to our business associates and allow
them to create and receive protected health information on
our behalf. For example, we may share with our billing
company information regarding your care and payment for
your care so that the company can file health insurance
claims and bill you or another responsible party.
16. Creation of de-identified information
We may use protected health information as by-product or
an otherwise permitted use or disclosure. For example,
other patients may overhear your name being paged in the
waiting room.
(Other possible categories: facility directory and
research)
C. Uses and disclosures with authorization
For all other purposes which do not fall under a category
listed under sections II. A and II. B, we will obtain our
written authorization to use or disclose your protected
health information. Your authorization can be revoked at
any time except to the extent that we have relied on the
authorization.
III. PATIENT PRIVACY RIGHTS
A. Further restriction on use or disclosure
You have a right to request that we further restrict use
and disclosure of your protected health information to
carry out treatment, payment or health care operations, to
someone who is involved in their care or the payment for
your care, or for notification purposes. We are not
required to agree to a request for further restriction.
To request a further restriction, you must submit a
written request to our privacy officer. The request must
tell us: (a)what information you want restricted; (b)how
you want the information restricted; and (c)to whom you
want the restriction to apply.
B. Confidential communication
You have a right to request that we communicate your
protected health information to you by a certain means or
at a certain location. For example, you might request
that we only contact you by mail or at work. We are not
required to agree to requests for confidential
communications that are unreasonable.
To make a request for confidential communications, you
must submit a written request to our privacy officer.
The request must tell us how or where you want to be
contacted. In addition, if another individual or entity
is responsible for payment, the request must explain how
payment will be handled.
C. Accounting of disclosures
You have a right to obtain, upon request, an "accounting"
of certain disclosures of your protected health
information by us (or a business associate for us). This
right is limited to disclosures within six years of the
request and other limitations. Also in limited
circumstances we may charge you for providing the
accounting. To request an accounting, you must submit a
written request to our privacy officer. The request
should designate the applicable time period.
D. Inspection and copying
You have a right to inspect and obtain a copy of your
protected health information that we maintain in a
designated records set. This right is subject to
limitations and we may impose charge for the labor and
supplies involved in providing copies.
To exercise your right of access, you must submit a
written request to our privacy officer. The request
must: (a) describe the health information to which access
is requested, (b)state how you want to access the
information, such as inspection, pick-up of copy, mailing
of copy, (c)specify any requested form or format, such as
paper copy or an electronic means, and (d)include the
mailing address, if applicable. We have thirty days to
provide this information upon receipt of a written request.
E. Right to amendment
You have a right to request that we amend protected health
information that we maintain about you in a designated
records set if the information is incorrect or
incomplete. This right is subject to limitation. To
request an amendment, you must submit a written request to
our privacy officer. The request must specify each change
that you want and provide a reason to support each
requested change.
F. Paper copy of privacy notice
You have a right to receive, upon request, a paper copy of
our Notice of Privacy Practices. To obtain a paper copy,
contact our privacy officer.
IV. CHANGES TO THIS NOTICE
We reserve the right to change this notice at any time.
We further reserve the right to make any change effective
for all protected health information that we maintain at
the time of the change - including information that we
created or received prior to the effective date of the
change.
We will post a copy of our current notice in the waiting
room for the practice. Patients also may access the
current notice at our web site at www.86cough.com.
V. COMPLAINTS
If you believe that we have violated your privacy rights,
you may submit a complaint to the practice or the
Secretary of Health and Human Services. To file a
complaint with the practice, submit a complaint in writing
to our privacy officer. We will not retaliate against you
for filing a complaint.
VI. LEGAL EFFECT OF THIS NOTICE.
This notice is not intened to create contractual or other
rights independent of those created in the federal privacy
rule.
© 2006 Allergy & Asthma Specialists, P.C.
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