| The office is permitted by federal privacy laws to make uses
and disclosures of your health information for purposes of treatment,
payment, and health care operations. Protected health information is the
information we create and obtain in providing our services to you. Such
information may include documenting your symptoms, examination, and test
results, diagnoses, treatment, and applying for future care or treatment.
It also includes billing documents for those services.
Examples of Uses of Your Health Information for Treatment Purposes
are:
- A nurse obtains treatment information about you and records it in a
health record.
- During the course of your treatment, the physician determines she
will need to consult with another specialist in the area. She will
share the information with such specialist and obtain his/her input.
- Appointment reminder: we may use and disclose medical
information to contact you as a reminder that you have an appointment
for treatment or medical care.
- Follow-up care: we may use and disclose medical information
when contacting you or attempting to contact you by phone regarding
various test results, changes in appointment times, or other reasons
in an ongoing effort to coordinate your care.
- Treatment Care: we may use and disclose medical information to
research the availability of possible treatment options or
alternatives that may be of interest to you.
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Health-related Benefits: we may use and
disclose medical information to tell you about health-related benefits
or services that may be of interest to you.
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Uses and Disclosures of Protected Health
Information Based upon Your Written Authorization: Other uses and
disclosures of your protected health information will be made only
with your written authorization unless otherwise permitted or required
by law as described below. You may revoke this authorization at any
time, in writing, except to the extent that your physician or the
physician’s practice has taken an action in reliance on the use or
disclosure indicated in the authorization.
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Others Involved in your Health Care: unless you
object, we may disclose to a member of your family, a relative, a
close friend or any other person you identify, your protected health
information that directly relates to that person’s involvement in
your health care. If you are unable to agree or object to such a
disclosure, we may disclose such information as necessary if we
determine that it is in your best interest based on our professional
judgment. We may use or disclose protected health information to
notify or assist in notifying a family member, personal representative
or any other person that is responsible for your care of your
location, general condition or death. Finally, we may use or disclose
your protected health information to an authorized public or private
entity to assist in disaster relief efforts and to coordinate uses and
disclosures to family or other individuals involved in your health
care.
Example of Use of Your Health Information for Payment
Purposes:
We submit requests for payment to your health insurance company. The
health insurance company (or other business associate helping us obtain
payment) requests information from us regarding medical care given. We
will provide information to them about you and the care given.
Example of Use of Your Information for Health Care
Operations:
We obtain services from our insurers or other business associates such
as quality assessment, quality improvement, outcome evaluation, protocol
and clinical guideline development, training programs, credentialing,
medical review, legal services, and insurance. We will share information
about you with such insurers or other business associates as necessary to
obtain these services.
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Your Health Information Rights
The health and billing records we maintain are the physical property
of the office/hospital. The information in it, however, belongs to you.
You have a right to:
- Request a restriction on certain uses and disclosures of your health
information by delivering the request to our office/hospital -- we are
not required to grant the request, but we will comply with any request
granted;
- Obtain a paper copy of the current Notice of Privacy Practices for
Protected Health Information ("Notice") by making a request at our
office;
- Request that you be allowed to inspect and copy your health record
and billing record – you may exercise this right by delivering the
request to our office;
- Appeal a denial of access to your protected health information,
except in certain circumstances;
- Request that your health care record be amended to correct
incomplete or incorrect information by delivering a request to our
office. We may deny your request if you ask us to amend
information that:
- Was not created by us, unless the person or entity that created the
information is no longer available to make the amendment;
- Is not part of the health information kept by or for the office;
- Is not part of the information that you would be permitted to
inspect and copy; or,
- Is accurate and complete.
If your request is denied, you will be informed of the reason for the
denial and will have an opportunity to submit a statement of disagreement
to be maintained with your records;
- Request that communication of your health information be made by
alternative means or at an alternative location by delivering the
request in writing to our office;
- Obtain an accounting of disclosures of your health information as
required to be maintained by law by delivering a request to our office. An accounting will not include uses and disclosures of
information for treatment, payment, or operations; disclosures or uses
made to you or made at your request; uses or disclosures made pursuant
to an authorization signed by you; uses or disclosures made in a
facility directory or to family members or friends relevant to that
person's involvement in your care or in payment for such care; or, uses
or disclosures to notify family or others responsible for your care of
your location, condition, or your death.
- Revoke authorizations that you made previously to use or disclose
information by delivering a written revocation to our office,
except to the extent information or action has already been taken.
If you want to exercise any of the above rights, please contact Arva
Chiu, MD, in person or
in writing, during regular, business hours. She will inform you of the
steps that need to be taken to exercise your rights.
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To Request Information or File a
Complaint
If you have questions, would like additional information, or want to
report a problem regarding the handling of your information, you may
contact Arva Chiu, MD at 907-452-2637.
Additionally, if you believe your privacy rights have been violated,
you may file a written complaint at our office by delivering the written
complaint to Arva Chiu, MD. You may also file a
complaint by mailing it or e-mailing it to the Secretary of Health and
Human Services.
- We cannot, and will not, require you to waive the right to file a
complaint with the Secretary of Health and Human Services (HHS) as a
condition of receiving treatment from the office.
- We cannot, and will not, retaliate against you for filing a
complaint with the Secretary of Health and Human Services. Website
for the Office for Civil Rights is: www.hhs.gov/ocr/hipaa/
Other Disclosures and Uses
Communication with Family*
- Using our best judgment, we may disclose to a family member, other
relative, close personal friend, or any other person you identify,
health information relevant to that person's involvement in your care or
in payment for such care if you do not object or in an emergency.
Notification
- Unless you object, we may use or disclose your protected health
information to notify, or assist in notifying, a family member, personal
representative, or other person responsible for your care, about your
location, and about your general condition, or your death.
Research*
- We may disclose information to researchers when their research has
been approved by an institutional review board that has reviewed the
research proposal and established protocols to ensure the privacy of
your protected health information.
Disaster Relief*
- We may use and disclose your protected health information to assist
in disaster relief efforts.
Organ Procurement Organizations*
- Consistent with applicable law, we may disclose your protected
health information to organ procurement organizations or other entities
engaged in the procurement, banking, or transplantation of organs for
the purpose of tissue donation and transplant.
Food and Drug Administration (FDA)
- We may disclose to the FDA your protected health information
relating to adverse events with respect to food, supplements, products
and product defects, or post-marketing surveillance information to
enable product recalls, repairs, or replacements.
Workers Compensation*
- If you are seeking compensation through Workers Compensation, we may
disclose your protected health information to the extent necessary to
comply with laws relating to Workers Compensation.
Public Health*
- As authorized by law, we may disclose your protected health
information to public health or legal authorities charged with
preventing or controlling disease, injury, or disability; to report
reactions to medications or problems with products; to notify people of
recalls; to notify a person who may have been exposed to a disease or
who is at risk for contracting or spreading a disease or condition.
Abuse & Neglect*
- We may disclose your protected health information to public
authorities as allowed by law to report abuse or neglect.
Employers*
- We may release health information about you to your employer if we
provide health care services to you at the request of your employer, and
the health care services are provided either to conduct an evaluation
relating to medical surveillance of the workplace or to evaluate whether
you have a work-related illness or injury. In such circumstances, we
will give you written notice of such release of information to your
employer. Any other disclosures to your employer will be made only if
you execute a specific authorization for the release of that information
to your employer.
Correctional Institutions*
- If you are an inmate of a correctional institution, we may disclose
to the institution or its agents the protected health information
necessary for your health and the health and safety of other
individuals.
Law Enforcement*
- We may disclose your protected health information for law
enforcement purposes as required by law, such as when required by a
court order, or in cases involving felony prosecution, or to the extent
an individual is in the custody of law enforcement.
Health Oversight*
- Federal law allows us to release your protected health information
to appropriate health oversight agencies or for health oversight
activities.
Judicial/Administrative Proceedings*
- We may disclose your protected health information in the course of
any judicial or administrative proceeding as allowed or required by law,
with your authorization, or as directed by a proper court order.
Serious Threat
- To avert a serious threat to health or safety, we may disclose your
protected health information consistent with applicable law to prevent
or lessen a serious, imminent threat to the health or safety of a person
or the public.
For Specialized Governmental Functions
- We may disclose your protected health information for specialized
government functions as authorized by law such as to Armed Forces
personnel, for national security purposes, or to public assistance
program personnel.
Coroners, Medical Examiners, and Funeral Directors
- We may release health information to a coroner or medical examiner.
This may be necessary, for example, to identify a deceased person or
determine the cause of death. We may also release health information
about patients of Covered Entities to funeral directors as necessary for
them to carry out their duties.
Other Uses
- Other uses and disclosures, besides those identified in this Notice,
will be made only as otherwise required by law or with your written
authorization and you may revoke the authorization as previously
provided in this Notice under "Your Health Information Rights."
Website
- If we maintain a website that provides information about our entity,
this Notice will be on the website.
Effective Date: April 14, 2003
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