NOTICE OF PRIVACY PRACTICES FOR PEDIATRIC ASSOCIATES OF PLYMOUTH, INC.
Effective date: April 14, 2003
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW TO GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.
If you have any questions regarding this notice, you may contact our privacy officer at:
Address: Pediatric Associates of Plymouth, Inc., Attention: Privacy Officer, 3031 Walton Road
C101, Plymouth Meeting, Pa. 19462
Telephone: (610) 825-3500 Facsimile: (610) 825-8502
I. YOUR PROTECTED HEALTH INFORMATION
Pediatric Associates of Plymouth, Inc. is required by the federal privacy rule to maintain the privacy of 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 to you, or payment for 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 section describes how we may use and disclose your protected health information for treatment, payment, and health care operations purposes. The descriptions include examples. Not every possible use or disclosure for treatment, payment, and health care operations purposes will be listed.
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:
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:
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:
B. Uses and disclosures for other purposes
We may use and disclose your protected health information for other purposes. This section generally describes those 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 than 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, child abuse, disease prevention and control, vaccine-related injuries, medical device-related 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:
5. Victims of abuse, neglect or domestic violence
We may use and disclose protected health information for purposes of reporting 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.
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:
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:
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 about you in the process of de-identifying the information. For example, we may use your protected health information in the process of removing those aspects which could identify you so that information can be disclosed to a researcher without your authorization.
17. Incidental disclosures
We may disclose protected health information as by-product of an otherwise permitted use or disclosure. For example, other patients may overhear your name being paged in the waiting room.
C. Uses and disclosures with authorization
For all other purposes which do not fall under a category listed under sections III.A and III.B, we will obtain your 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 (i) to carry out treatment, payment, or health care operations, (ii) to someone who is involved in their care or the payment for your care, or (iii) for notification purposes. We are not required to agree to a request for a 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, that 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 accounting services, 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 charges 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, and (c) include the mailing address, if applicable.
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 limitations. 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. At any time, patients may review the current notice by contacting our privacy officer.
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 the 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 intended to create contractual or other rights independent of those created in the federal privacy rule.