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EFFECTIVE DATE APRIL 14, 2003
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.
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU:
The following categories describe different ways that we use and
disclose medical information. For each category of uses or disclosures,
we will elaborate on the meaning and provide more specific examples,
if you request. Not every use or disclosure in a category will be
listed. However, all of the ways we are permitted to use and disclose
information will fall within one of the categories.
For Payment: We may use and disclose medical information about you
so that the treatment and services you receive at the practice may
be billed to and payment may be collected from you, an insurance
company or a third party. For example: we may disclose your record
to an insurance company, so that we can get paid for treating you.
For Treatment: We may use medical information about you to provide
you with medical treatment or services. We may disclose medical
information about you to doctors, nurses, technicians, medical students,
or other personnel who are involved in taking care of you at the
practice or the hospital. Such disclosures may be available in an
electronic format such as InfoSolutions of BlueCross BlueShield
of Alabama. For example, we may disclose medical information about
you to people outside the practice who may be involved in your medical
care, such as family members, clergy or other persons that are part
of your care. Additionally, our research staff in conjunction with
your physician may review your medical information for potential
opportunities for inclusion in clinical trials.
For Health Care Operations: We may use and disclose medical information
about you for health care operations. These uses and disclosures
are necessary to run the practice and ensure that all of our patients
receive quality care. We may also disclose information to doctors,
nurses, technicians, medical students, and other practice personnel
for review and learning purposes. For example, we may review your
record to assist our quality improvement efforts and we may submit
your PHI to MDdatacor who will in return provide certain healthcare
information services back to Cardiology Associates. Additionally,
we may leave messages on your answering machine; leave messages
at your place of employment, send appointment reminder postcards,
call to remind you of an appointment, mail practice information
or patient satisfaction surveys.
WHO WILL FOLLOW THIS NOTICE:
This notice describes our practice’s policies and procedures
and that of any health care professional authorized to enter information
into your medical chart, any member of a volunteer group which we
allow to help you, as well as all employees, staff and other practice
personnel.
POLICY REGARDING THE PROTECTION OF PERSONAL INFORMATION:
We create a record of the care and services you receive at the practice.
We need this record in order to provide you with quality care and
to comply with certain legal requirements. This notice applies to
all of the records of your care generated by the practice, whether
made by practice personnel or by your personal doctor. The law requires
us to: make sure that medical information that identifies you is
kept private; give you this notice of our legal duties and privacy
practices with respect to medical information about you; and to
follow the terms of the notice that are currently in effect. Other
ways we may use or disclose your protected healthcare information
include: appointment reminders; as required by law; for health-related
benefits and services; to individuals involved in your care or payment
for your care; research; to avert a serious threat to health or
safety; and for treatment alternatives. Other uses and disclosures
of your personal information could include disclosure to, or for:
coroners, medical examiners and funeral directors; health oversight
activities; law enforcement; lawsuits and disputes; military and
veterans; national security and intelligence activities; organ and
tissue donation; protective services for the President and others;
public health risks; and worker’s compensation.
NOTICE OF INDIVIDUAL RIGHTS
You have the following rights regarding medical
information we maintain about you:
Right to an Accounting of Disclosures: You have the right to request
an “accounting of disclosures.” This is a list of the
disclosures we made of medical information about you. To request
this list or accounting of disclosures, you must submit your request
in writing to the Privacy Officer.
Right to Amend: If you feel that medical information we have about
you is incorrect or incomplete, you may ask us to amend the information.
You have the right to request an amendment for as long as the information
is kept by, or for, the practice. To request an amendment, your
request must be made in writing and submitted to the Privacy Officer
and you must provide a reason that supports your request. We may
deny your request for an amendment.
Right to Inspect and Copy: You have the right to inspect and copy
medical information that may be used to make decisions about your
care. We may deny your request to inspect and copy in certain very
limited circumstances.
Right to a Paper Copy of this Notice: You have the right to a paper
copy of this notice. You may ask us to give you a copy of this notice
at any time.
Right to Request Confidential Communications: You have the right
to request that we communicate with you about medical matters in
a certain way or at a certain location. You must make your request
in writing and you must specify how or where you wish to be contacted.
Right to Request Restrictions: You have the right to request a restriction
or limitation on the medical information we use or disclose about
you for treatment, payment or health care operations. You also have
the right to request a limit on the medical information we disclose
about you to someone who is involved in your care or the payment
for your care, like a family member or friend. We are not required
to agree to your request. If we do agree, we will comply with your
request unless the information is needed to provide you emergency
treatment. To request restrictions, you must make your request in
writing to the Privacy Officer.
CHANGES TO THIS NOTICE:
We reserve the right to change this notice. We will post
a copy of the current notice in the practice’s waiting room.
COMPLAINTS:
If you believe your privacy rights have been violated, you may file
a complaint with the practice or with the Secretary of the Department
of Health and Human Services. To file a complaint with Cardiology
Associates, you may contact Alleen Barnett, Director of Operations,
Privacy Officer, at (251)460-0078 or 3715 Dauphin St, Suite 4400,
Mobile, Al 36608. All complaints must be submitted in writing. You
will not be penalized for filing a complaint.
OTHER USES OF MEDICAL INFORMATION:
Other uses and disclosures of medical information not covered by
this notice or the laws that apply to use will be made only with
your written authorization. If you provide us permission to use
or disclose medical information about you, you may revoke that permission,
in writing, at any time.
If you have any questions about this notice
or would like to receive a more detailed explanation, please contact
our Privacy Officer.
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