Notice of Privacy Practices - Online Store
Effective Date of this Notice: April 14, 2003
NOTICE OF PRIVACY PRACTICES
As Required by the Privacy Regulations Created as a Result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
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 HEALTH INFORMATION.
PLEASE REVIEW THIS NOTICE CAREFULLY.
A. OUR COMMITMENT TO YOUR PRIVACY
Our practice is dedicated to maintaining the privacy of you protected health information (your 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 the privacy practices that we maintain in our practice concerning your health information. By federal and state law, we must follow the terms of the notice of privacy practices that we have in effect at the time.
We realize that these laws are complicated, but we must provide you with the following important information:
- How we may use and disclose your health information
- Your privacy rights in your health information
- Our obligations concerning the use and disclosure of your health information
The terms of this notice apply to all records containing your health information that are created or retained by our practices. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all of your records that our practice has created or maintained in the past, and for any of your records that we may create or maintain in the future. Our practices will post a copy of our current Notice in our offices in a visible location at all times, and you may request a copy of our most current Notice at any time.
B. IF YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT:
Privacy Officer at 205-591-2169
C. WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION IN THE FOLLOWING WAYS
The following categories describe the different ways in which we may use and disclose your health information.
1. Treatment
Our practices may use your health information to treat you. For example, we may ask you to have laboratory tests (such as blood, tissue or urine tests), and we may use the results to help us reach a diagnosis. We might use your health information in order to write a prescription for you, or we might disclose your health information to a pharmacy when we order a prescription for you. Many of the people who work for our practice - including, but not limited to, our doctors and nurses - may use or disclose your health information in order to treat you or assist others in your treatment. Additionally, we may also disclose your health information to other health care providers for purposes related to your treatment.
2. Payment
Our practice may use and disclose your 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 also may use and disclose your health information to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your health information to bill you directly for services and items. We may disclose your health information to other health care providers and covered entities to assist in their billing and collection efforts.
3. Health Care Operations
Our practice may use and disclose your health information to operate our business. As examples of the ways in which we may use and disclose your information for our operations, our practice 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 practice. We may disclose your health information to other covered entities to assist in their health care operations.
4. Business Associates
Our practice may disclose your health information to our business associates that assist us in our delivery of health care and related services, such as billing companies, lawyers, accountants and others. Before we disclose your health information to our business associates, we will have a written contract to ensure that they also protect the confidentiality of your health information.
5. Appointment Reminders
Our practice may use and disclose your health information to contact you and remind you of an appointment.
6. Treatment Options
Our practice may use and disclose your health information to inform you of potential treatment options or alternatives.
7. Health-Related Benefits and Services
Our practice may use and disclose your health information to inform you of health-related benefits or services that may be of interest to you.
8. Release of Information to Family/Friends
If you do not object, our practice may release your health information to a friend or family member that is involved in your care, or who assists in taking care of you. If you are unable to agree or object because of a medical emergency or other circumstance, we will discuss your preferences with you as soon as practicable thereafter. We may notify a family member or other person responsible for your care about your general condition.
9. Disclosures Required By Law
Our practice may use and disclose your health information when we are required to do so by federal, state or local law. We may also disclose your health information to the Secretary of Health and Human Services or his designee to determine our compliance with federal privacy laws.
D. USE AND DISCLOSURE OF YOUR HEALTH INFORMATION IN CERTAIN SPECIAL CIRCUMSTANCES
The following categories describe special scenarios in which we may use or disclose your health information:
1. Public Health Risks
Our practice may disclose your health information to the public health authorities that are authorized by law to collection information for the purpose of:
- Maintaining vital records, such as births and deaths
- Reporting child abuse or neglect
- Preventing or controlling disease, injury or disability
- Notifying a person regarding potential exposure to a communicable disease
- Notifying a person regarding a potential risk for spreading and contracting a disease or condition
- Reporting reactions to drugs or problems with products or devices
- Notifying individuals if a product or device they may be using has been recalled
- Notifying appropriate government agency(ies) and authority(ies) regarding the potential abuse or neglect of an adult patient (including domestic violence); however, we will only disclose this information if the patient agrees or we are required or authorized by law to disclose this information
- Notify your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance
2. Health Oversight Activities
Our practice may disclose your 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.
3. Lawsuits and Similar Proceedings
Our practices may use and disclose your health information in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding. We also may disclose your health information in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if you have been informed of the request or an order protecting the information the party has requested as been obtained.
4. Law Enforcement
We may release your 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 has 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 an emergency, to report a crime (including the location or victim(s) of the crime, or the description, identity or location of the perpetrator)
5. Deceased Patients
Our practice may release health information to a medical examiner or coroner to identify a deceased individual or to identify the cause of death. If necessary, we also may release information in order for funeral directors to perform their jobs.
6. Organ and Tissue Donation
Our practice may release your health information to organizations that handle organ, eye or tissue procurement or transplantation, including organ donation banks, as necessary to facilitate organ or tissue donation and transplantation if you are an organ donor.
7. Serious Threats to Health or Safety
Our practices may use and disclose your health information when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.
8. Military
Our practices may disclose your health information if you are a member of U.S. or foreign military forces (including veterans) and if required by the appopriate authorities.
9. National Security
Our practice may disclose your health information to federal officials for intelligence and national security activities authorized by law. We also may disclose your health information to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.
10. Inmates
Our practice may disclose your health information to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. Disclosure for these purposes would be necessary: (a) for the institution to provide health care services to you, (b) for the safety and security of the institution, and/or (c) to protect your health and safety or the health and safety of other individuals.
11. Victims of Abuse, Neglect or Domestic Violence
We may release your health information in some instances if we reasonably believe you are a victim of abuse, neglect or domestic violence.
12. Workers' compensation
Our practice may release your health information for workers' compensation and similar programs that provide benefits for work-related injuries as authorized by and to the extent necessary to comply with such laws.
13. Research
Under some circumstances, we may use and disclose your health information without your authorization if we obtain approval through a special process to ensure that research without your authorization poses minimal risk to your privacy. We may also release your health information without your authorization to people who are preparing a future research project, so long as any information identifying you does not leave our offices. In the unfortunate event of your death, we may share your health information with people who are conducting research using the information of deceased persons, as long as they agree not to remove from our offices any information that identifies you.
14. Personal Representatives
We may disclose your health information to yoru personal representatives that are appointed by you or authorized by applicable law. Parents and guardians will generally be personal representatives of minors unless the minors are permitted by applicable law to act on their own behalf with respect to health care services.
E. POTENTIAL IMPACT OF STATE LAW
In some situations, the federal privacy laws do not preempt (or take precedence over) state privacy laws that give you greater privacy protections. As a result, the privacy laws of a particular state might impose a privacy standard under which we will be required to operate. For example, Alabama law may provide greater privacy protections to health information related to HIV and AIDS.
F. YOUR AUTHORIZATION IS NEEDED FOR OTHER USES AND DISCLOSURES
We will not use or disclose your health information for any other purpose unless you give us written authorization to do so. If you give us written authorization to use or disclose your health information for a purpose that is not described in this notice, then you may revoke it in writing at any time. Your revocation will be effective for all your health information that we maintain, unless we have taken action in reliance on your authorization.
G. YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
You have the following rights regarding the health information that we maintain about you:
1. Confidential Communications
You have the right to request that our practice 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 Privacy Officer @ 840 Montclair Rd., #327, Birmingham, AL 35213 specifying the requested method of contact, or the location where you wish to be contacted. Our practice will accommodate reasonable requests. You do not need to give a reason for your request.
2. Requesting Restrictions
You have the right to request a restriction in our use or disclosure of your health information. We are not required to agree to your request. In order to request a restriction in our use or disclosure of your health information, you must make a request in writing to Privacy Officer @ 840 Montclair Rd., #327, Birmingham, AL 35213. Your request must describe in a clear and concise fashion:
(a) the information you wish restriction;
(b) whether you are requesting the limit our practice's use, disclosure or both; and
(c) to whom you want the limits to apply.
3. Inspection and Copies
You have the right to inspect and obtain a copy of the 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 Privacy Officer @ 840 Montclair Rd., #327, Birmingham, AL 35213 in order to inspect and/or obtain a copy of your health information. Our practice may charge a fee for the costs of copying, mailing, and supplies associated with your request. Our practice may deny your request to inspect and/or copy in certain limited circumstances.
4. Amendment
You may ask us to amend your health information if you believe it is incorrect or incomplete. To request an amendment, your request must be made in writing and submitted to Privacy Officer @ 840 Montclair Rd., #327, Birmingham, AL 35213. You must provide us with a reason that supports your request for amendment. We may deny your request to amend in certain circumstances.
5. 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 non-routine disclosures our practice has made of your health information for non-treatment, non-payment or non-operations purposes. In order to obtain an accounting of disclosures, you must submit your request in writing to Privacy Officer @ 840 Montclair Rd., #327, Birmingham, AL 35213. All requests for an "accounting of disclosures" must state a time period, which may not be longer than six (6) years from the date of the request and may not include disclosures before April 14, 2003. The first list you request within a 12-month period is free of charge, but our practice may charge you for additional lists within the same 12-month period. Our practice will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs.
6. Right to a Paper Copy of this Notice
Your are entitled to receive a paper copy of our notice of privacy practices. You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this notice, contact the Privacy Officer @ 205-591-2169.
7. Right to File a Complaint
If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services. To file a complaint with our practice, contact Privacy Officer @ 840 Montclair Rd., #327, Birmingham, AL 35213. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
Again, if you have any questions regarding this notice or our health information privacy practices, please contact the Privacy Officer @ 205-591-2169.
