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ADVANCED NURSING, INC. NOTICE OF
PRIVACY PRACTICES
As required by the Privacy
Regulations Promulgated Pursuant to
the Health Insurance
Portability and Accountability Act of 1996
(HIPAA)
EFFECTIVE DATE APRIL 14, 2003
THIS NOTICE DESCRIBES HOW
HEALTH
INFORMATION ABOUT YOU MAY
BE USED AND
DISCLOSED, AND HOW YOU
CAN GET ACCESS
TO YOUR IDENTIFIABLE
HEALTH
INFORMATION.
PLEASE REVIEW THIS NOTICE
CAREFULLY.
A. OUR
COMMITMENT TO YOUR PRIVACY
Our organization
is dedicated to maintaining the privacy of your identifiable 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 privacy practices concerning your identifiable health
information. By law, we must follow the terms of the notice of privacy
practices that we have in effect at the time.
To
summarize, this notice provides you with the following important
information.
How we may use
and disclose your identifiable health information
Your privacy
rights in your identifiable health information
Our obligations
concerning the use and disclosure of your identifiable health information.
The terms of
this notice apply to all records containing your identifiable health
information that are created or retained by our practice. We reserve the
right to revise or amend our notice of privacy practices. Any revision or
amendment to this notice will be effective for all of your records our
practice has created or maintained in the past, and for any of your records
we may create or maintain in the future. Our organization will post a copy
of our current notice in our offices in a prominent location, and you may
request a copy of our most current notice during any office visit.
B. IF YOU
HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT:
Privacy Officer
at (601) 684-8181.
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
identifiable health information.
1. Treatment.
Our organization may use your identifiable health information to treat you.
For example, we may ask you to undergo laboratory tests (such as blood or
urine tests), and we may use the results to help us reach a diagnosis. Many
of the people who work for our organization may use or disclose your
identifiable health information in order to treat you or to assist others
in your treatment. Additionally we may disclose your identifiable health
information to others who may assist in your care, such as your physician,
therapists, spouse, children or parents.
2. Payment.
Our organization may use and disclose your identifiable 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 identifiable health information to obtain payment from third
parties that may responsible for such costs, such as family members. Also,
we may use your identifiable health information to bill you directly for
service s and items.
3. Health Care
Operations.
Our organization may use and disclose your identifiable health information
to operate our business. As examples of the ways in which we may use and
disclose your information for our operations, our organization 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 our
practice.
OPTIONAL:
4. Appointment
Reminders.
Our organization
may use and disclose your identifiable health information to contact you and
remind you of visits/deliveries.
OPTIONAL:
5. Health-
Related Benefits and Services.
Our organization
may use and disclose your identifiable health information to inform you of
health-related benefits or services that be of interest to you.
OPTIONAL:
6. Release of
Information to Family/Friends.
Our organization may release your identifiable health information to a
friend or family member who is helping you pay for your health care, or who
assists in taking care of you.
7. Disclosures
Required By Law.
Our organization
will use and disclose your identifiable health information when we are
required to do so by federal, state, or local law.
D. USE AND
DISCLOSURE OF YOUR IDENTIFIABLE HEALTH
INFORMATION IN
CERTAIN SPECIAL CIRCUMSTANCES
The following
categories describe unique scenarios in which we may use or disclose your
identifiable health information.
1. Public Health
Risks.
Our organization may disclose your identifiable health information to public
health authorities that are authorized by law to collect 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 a potential exposure to a communicable disease
Notifying a
person regarding a potential risk for spreading or contracting a
disease or condition
Reporting
reactions to drugs or problems with products or devices
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 organization
may your identifiable 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
other similar Proceedings.
Our organization
may use and disclose your identifiable 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 identifiable health information in
response to discovery request, subpoena, or other lawful process by another
party involved in the dispute, but only if w have made an effort to inform
you of the request or to obtain an order protecting the information the
party has requested.
4. Law
Enforcement.
We may release identifiable 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 might have 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, identify or location of the perpetrator)
5. Serious
Threats to Health or Safety.
Our organization may use and disclose your identifiable 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 treat.
6. Military.
Our organization may disclose your identifiable health information if you
are a member of U.S. or foreign military forces (including veterans) and if
required by the appropriate military command authorities.
7. National
Security.
Our Organization may disclose your identifiable health information to
federal officials for intelligence and national security activities
authorized by law. We also may disclose your identifiable health information
to federal officials in order to protect the President, other officials, or
foreign heads of state, or to conduct investigations.
8. Inmates.
Our organization may disclose your identifiable 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.
9. Workers'
Compensation.
Our organization may release your identifiable health information for
workers' compensation and similar programs.
E. YOUR
RIGHTS REGARDING YOUR IDENTIFIABLE HEALTH
INFORMATION
You may have the
following rights regarding the identifiable health information that we
maintain about you:
1. Confidential
Communications.
You have the
right to request that our organization 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 our Privacy Officer at (601) 684-8181 specifying the
requested method of contact, or the location where you wish to be contacted.
Our organization will accommodate reasonable requests. You
do not 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
identifiable health information for treatment, payment, or health care
operations. Additionally, you have the right to request that we limit our
disclosure of your identifiable health information to individuals involved
in your care or the payment for your care, such as family members and
friends. We are not required to agree to your request;
however, if we do agree, we are bound by our agreement except when otherwise
required by law, in emergencies, or when the information is necessary to
treat you. In order to request a restriction in our use or disclosure of
your identifiable health information, you make your request in writing to
our Privacy Officer at (601) 684-8181. Your request must be describe in a
clear and concise fashion: (a) the information you wish restricted; (b)
weather you are requesting to 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 obtain and inspect a copy of the identifiable 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 our Privacy Officer at (601) 684-8181 in
order to inspect and/or obtain a copy of your identifiable health
information. Our organization may charge a fee for the costs of copying,
mailing, labor, and supplies associated with your request. Our practice may
deny your request to inspect and/or copy in certain limited circumstances;
however, you may request a review of our denial. Reviews will be conducted
by another licensed health care professional chosen by us.
4. Amendment.
You may ask us to amend your health information if you believe it is
incorrect or incomplete, and you may request an amendment for as long as the
information is kept by or for our organization. To request an amendment,
your request must be made in writing and submitted to our Privacy Officer at
(601) 684-8181. You must provide us with a reason that supports your
requests for amendment. Our organization will deny your request if you fail
to submit your request (and the reason supporting your request) in writing.
Also, we may deny your request if you ask us to amend information that is:
(a) accurate and complete; (b) not part of the health information kept by or
for the organization; (c) not part of the identifiable health information
which you would be permitted to inspect and copy; or (d) not created by our
organization, unless the individual or entity that created the information
is not available to amend the information.
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 disclosures our
organization has made of your identifiable health information. In order to
obtain an accounting of disclosures, you must submit your request in writing
to our Privacy Officer at (601) 684-8181. All requests for an "accounting of
disclosures" must state a time period which may be not longer than six years
and may not include dates 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 organization will
notify you of the costs involved with additional requests, and you may
withdraw your requests before you incur any costs.
6. Right to a
Paper Copy of This Notice.
You 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 our Privacy Officer at (601) 684-8181.
7. Right to File
a Complaint.
If you believe
your privacy rights have been violated, you may file a complaint with our
organization or with the Secretary of the Department of Health and Human
Services. To file a complaint with our organization, contact our Privacy
Officer at (601) 684-8181. All complaints must be submitted in writing.
You will not be penalized for filing a complaint.
8. Right to
Provide an Authorization for Other uses and Disclosures.
Our organization
will obtain your written authorization for uses and disclosures that are not
identified by this notice or permitted by applicable law. Any
authorization you provide to us regarding the use and disclosure of your
identifiable health information may be revoked any time in writing.
After you
revoke your
authorization, we will no longer use or disclose your identifiable health
information
for the reasons
described in the authorization. Please note: We are required to retain
records of your care.
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