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(a) Treatment
- In order to provide, coordinate and manage your health care,
the Practice will provide your PHI to those health care professionals,
whether on the Practice's staff or not, directly involved in your
care so that they may understand your medical condition and needs
and possibly provide advice or treatment ( a specialist or laboratory).
For example, a physician treating you for a condition such as
arthritis may need to know what medications have been prescribed
for you by the physicians in this Practice.
(b)
Payment - In order to get paid for services provided to you,
the Practice will provide your PHI, directly or through a billing
service, to appropriate third party payers, pursuant to their
billing and payment requirements. For example, the Practice may
need to provide your health insurance carrier or, if you are over
62, the Medicare program with information about health care services
that you received from the Practice so that the Practice can be
properly reimbursed. The Practice may also need to tell your insurance
plan about the need to hospitalize you so that the insurance plan
can determine whether or not it will pay for the expense.
(c)
Health Care Operations - In order for the Practice to operate
in accordance with applicable law and insurance requirements and
in order for the Practice to continue to provide quality and efficient
care, it may be necessary for the Practice to compile, use, and/or
disclose your PHI. For example, the Practice may use your PHI
in order to evaluate the performance of the Practice's personnel
in providing care to you.
Authorization
Not Required
1. The Practice may use and/or disclose your PHI, without a written
Authorization from you, in the following instances:
(a) De-identified
Information - Your PHI is altered so that it does not identify
you and, even without your name, cannot be used to identify you.
(b) Business Associate - To a business associate, which
is someone who the Practice contracts with to provide a service
necessary for your treatment, payment for your treatment and health
care operations billing service or transcription service). The
Practice will obtain satisfactory written assurance, in accordance
with applicable law, that the business associate will appropriately
safeguard your PHI.
(c) Personal Representative - To a person who, under applicable
law, has the authority to represent you in making decisions related
to your health care.
(d) Public Health Activities - Such activities include,
for example, information collected by a public health authority,
as authorized by law, to prevent or control disease, injury or
disability. This includes reports of child abuse or neglect.
(e) Federal Drug Administration - If required by the Food
and Drug Administration to report adverse events, product defects
or problems or biological product deviations, or to track products,
or to enable product recalls, repairs or replacements, or to conduct
post marketing surveillance.
(f) Abuse, Neglect or Domestic Violence - To a government
authority if the Practice is required by law to make such disclosure.
If the Practice is authorized by law to make such a disclosure,
it will do so if it believes that the disclosure is necessary
to prevent serious harm or if the Practice believes that you have
been the victim of abuse, neglect or domestic violence. Any such
disclosure will be made in accordance with the requirements of
law, which may also involve notice to you of the disclosure.
(g) Health Oversight Activities - Such activities, which
must be required by law, involve government agencies involved
in oversight activities that relate to the health care system,
government benefit programs, government regulatory programs and
civil rights law. Those activities include, for example, criminal
investigations, audits, disciplinary actions, or general oversight
activities relating to the community's health care system.
(h) Judicial and Administrative Proceedings - For example,
the Practice may be required to disclose your PHI in response
to a court order or a lawfully issued subpoena.
(i) Law Enforcement Purposes - In certain instances, your
PHI may have to be disclosed to a law enforcement official for
law enforcement purposes. Law enforcement purposes include: (1)
complying with a legal process (L subpoena) or as required by
law; (2) information for identification and location purposes
( suspect or missing person); (3) information regarding a person
who is or is suspected to be a crime victim; (4) in situations
where the death of an individual may have resulted from criminal
conduct; (5) in the event of a crime occurring on the premises
of the Practice; and (6) a medical emergency (not on the Practice's
premises) has occurred, and it appears that a crime has occurred.
(j) Coroner or Medical Examiner - The Practice may disclose
your PHI to a coroner or medical examiner for the purpose of identifying
you or determining your cause of death, or to a funeral director
as permitted by law and as necessary to carry out its duties.
(k) Organ. Eye or Tissue Donation - If you are an organ
donor, the Practice may disclose your PHI to the entity to whom
you have agreed to donate your organs.
(I) Research - If the Practice is involved in research
activities, your PHI may be used, but such use is subject to numerous
governmental requirements intended to protect the privacy of your
PHI such as approval of the research by an institutional review
board and the requirement that protocols must be followed.
(m) Avert a Threat to Health or Safety - The Practice may
disclose your PHI if it believes that such disclosure is necessary
to prevent or lessen a serious and imminent threat to the health
or safety of a person or the public and the disclosure is to an
individual who is reasonably able to prevent or lessen the threat.
(n) Specialized Government Functions - When the appropriate
conditions apply, the Practice may use PHI of individuals who
are Armed Forces personnel: (1) for activities deemed necessary
by appropriate military command authorities; (2) for the purpose
of a determination by the Department of Veteran Affairs of eligibility
for benefits; or (3) to a foreign military authority if you are
a member of that foreign military service. The Practice may also
disclose your PHI to authorized federal officials for conducting
national security and intelligence activities including the provision
of protective services to the President or others legally authorized.
(o) Inmates - The Practice may disclose your PHI to a correctional
institution or a law enforcement official if you are an inmate
of that correctional facility and your PHI is necessary to provide
care and treatment to you or is necessary for the health and safety
of other individuals or inmates.
(p) Workers' Compensation - If you are involved in a Workers'
Compensation claim, the Practice may be required to disclose your
PHI to an individual or entity that is part of the Workers' Compensation
system.
(q) Required by Law - If otherwise required by law, but
such use or disclosure will be made in compliance with the law
and limited to the requirements of the law.
Authorization
Uses and/or disclosures, other than those described above, will
be made only with your written Authorization.
Sign-In-Sheet
The Practice may use a sign-in-sheet at the registration desk. The
Practice may also call your name in the waiting room when your physician
is ready to see you.
Appointment
Reminder
The Practice may, from time to time, contact you to provide appointment
reminders.
Treatment
Alternatives/Benefits
The Practice may, from time to time, contact you about treatment
alternatives, or other health benefits or services that may be of
interest to you.
Marketing
The practice may only use and/or disclose your PHI for marketing
activities if we obtain from you a prior written Authorization.
"Marketing" activities include communications to you that
encourage you to purchase or use a product or service, and the communication
is not made for your care or treatment. However, marketing does
not include, for example, sending you a newsletter about this Practice.
Marketing also includes the receipt by the Practice of remuneration,
directly or indirectly, from a third party whose product or service
is being marketed. The Practice will inform you if it engages in
marketing and will obtain your prior Authorization.
Fund Raising
The Practice may use and/or disclose your demographic information
and the dates that you received treatment from your physician, as
necessary, in order to contact you for fund raising activities supported
by the Practice. If you do not want to receive these materials,
please contact the Practice's Privacy Officer to request that these
fund-raising materials not be sent to you.
On-Call-Coverage
In order to provide on-call coverage for you, it is necessary that
the Practice establish relationships with other physicians who will
take your call if a physician from the Practice is not available.
Those on-call physicians will provide the Practice with whatever
PHI that they create and will, by agreement, keep your PHI confidential.
Family/Friends
The Practice may disclose to your family member, other relative,
a close personal friend, or any other person identified by you,
your PHI directly relevant to such person's involvement with your
care or the payment for your care. The Practice may also use or
disclose your PHI to notify or assist in the notification (including
identifying or locating) a family member, a personal representative,
or another person responsible for your care, of your location, general
condition or death. However, in both cases, the following conditions
will apply:
(a)
If you are present at or prior to the use or disclosure of your
PHIL, the Practice may use or disclose your PHI if you agree,
or if the Practice provides you with opportunity to object and
you do not object, or if the Practice can reasonably infer from
the circumstances, based on the exercise of its professional judgment,
that you do not object to the use or disclosure.
(b) If you are not present, the Practice will, in the exercise
of professional judgment, determine whether the use or disclosure
is in your best interests and, if so, disclose only the PHI that
is directly relevant to the person's involvement with your care.
Facility
Directory [see Regs § 164.510(a)]
Your Rights
1. You have the right to:
(a)
Revoke any Authorization, in writing, at any time. To request
a revocation, you must submit a written request to the Practice's
Privacy Officer.
(b) Request restrictions on certain use and/or disclosure
of your PHI as provided by law. However, the Practice is not obligated
to agree to any requested restrictions. To request restrictions,
you must submit a written request to the Practice's Privacy Officer.
In your written request, you must inform the Practice of what
information you want to limit, whether you want to limit the Practice's
use or disclosure, or both, and to whom you want the limits to
apply. If the Practice agrees to your request, the Practice will
comply with your request unless the information is needed in order
to provide you with emergency treatment.
(c) Receive confidential communications or PHI by alternative
means or at alternative locations. You must make your request
in writing to the Practice's Privacy Officer. The Practice will
accommodate all reasonable requests.
(d) Inspect and copy your PHI as provided by law. To inspect
and copy your PHI, you must submit a written request to the Practice's
Privacy Officer. The Practice can charge you a fee for the cost
of copying, mailing or other supplies associated with your request.
In certain situations that are defined by law, the Practice may
deny your request, but you will have the right to have the denial
reviewed as set forth more fully in the written denial notice.
(e) Amend your PHI as provided by law. To request an amendment,
you must submit a written request to the Practice's Privacy Officer.
You must provide a reason that supports your request. The Practice
may deny your request if it is not in writing, if you do not provide
a reason in support of your request, if the information to be
amended was not created by the Practice (unless the individual
or entity that created the information is no longer available),
if the information is not part of your PHI maintained by the Practice,
if the information is not part of the information you would be
permitted to inspect and copy, and/or if the information is not
accurate and complete. If you disagree with the Practice's denial,
you will have the right to submit a written statement of disagreement.
(f) Receive an accounting of disclosures of your PHI as
provided by law. To request in accounting, you must submit a written
request to the Practice's Privacy Officer. The request must state
a time period which may not be longer than six (6) years and may
not include dates before April 14, 2003. The request should indicate
in what form you want the list (such as a paper or electronic
copy). The first list you request within a twelve (12) month period
will be free, but the Practice may charge you for the cost of
providing additional lists. The Practice will notify you of the
costs involved and you can decide to withdraw or modify your request
before any costs are incurred.
(g) Receive a paper copy of this Privacy Notice from the
Practice upon request to the Practice's Privacy Officer.
(h) Complain to the Practice or to the Secretary of Health
and Human Services if you believe your privacy rights have been
violated. To file a complaint with the Practice, you must contact
the Practice's Privacy Officer. All complaints must be in writing.
(i) To obtain more information on, or have your questions
about your rights answered, you may contact the Practice's Privacy
Officer, Linda Bauer, at (585) 383-8830.
or via email at info@geneseesurgical.com
Practice's
Requirements
1. The Practice:
(a) Is
required by law to maintain the privacy of your PHI and to provide
you with this Privacy Notice of the Practice's legal duties and
privacy practices with respect to your PHI.
(b) Is required to abide by the terms of this Privacy Notice.
(c) Reserves the right to change the terms of this Privacy
Notice and to make the new Privacy Notice provisions effective
for all of your PHI that it maintains.
(d) Will not retaliate against you for filing a complaint.
(e) Must make a good faith effort to obtain from you an
acknowledgement of receipt of this Notice.
Effective
Date
This Notice is in effect as of April 14, 2003
DT2/19/03F
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