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THE ALLERGY & ASTHMA CENTER, P.C.

 

NOTICE OF PRIVACY PRACTICES

(Effective September 23, 2013)

 

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.  If you have any questions or need any additional information about this Notice of Privacy Practices (Notice”), please contact the Allergy & Asthma Center, P.C.’s Contact Person at (260) 432-5005.

 

A.            AAC’s DUTIES

 

The Allergy & Asthma Center, P.C. (“AAC”) is required by the final Standards for Privacy of Individually Identifiable Health Information (the “Privacy Standards”) to maintain the privacy of your protected health information.  In addition, AAC is required by law to provide you with adequate notice of AAC’s uses and disclosures of your protected health information, notice of your rights with respect to your protected health information, and notice of AAC’s legal duties with respect to your protected health information. This Notice is given to you to satisfy AAC’s legal obligations to provide adequate notice to you. AAC agrees to abide by the terms of its Notice then in effect.

 

AAC is required to give this Notice to you no later than its first delivery of services to you.  If the first service delivery to you is delivered electronically, AAC will provide electronic notice of its privacy practices automatically and contemporaneously in response to your first request for service.  In addition, AAC is required to make its Notice available to you at any time upon your request, and to post the Notice in a clear and conspicuous location in the waiting room of each of AAC’s offices. A copy of this Notice will be posted on AAC’s website.

 

For purposes of the Privacy Standards and this Notice, the term “protected health information” means “individually identifiable health information”.  The term “individually identifiable health information” means health information (whether oral or recorded in any form or medium), including demographic information collected from you, that identifies you, or could reasonably be used to identify you and which: is created or received by a health care provider, health plan, public health authority, employer, life insurer, school or university, or health care clearinghouse; and, relates to your past, present, or future physical or mental health or condition, the provision of health care to you, or the past, present, or future payment for the provision of health care to you.

 

B.            How AAC May Use or Disclose YOUR Protected Health Information

 

As a general rule, AAC may not use, disclose or request protected health information about you except as required or permitted by the Privacy Standards.  Furthermore, except in limited circumstances, AAC must use,  disclose or request only the minimum necessary protected health information to accomplish the purpose of the use, disclosure or request.

 

1.             Required Disclosures.  The following categories describe the instances in which AAC is required to disclose your protected health information:

 

             To You.  AAC is required to disclose protected health information about you to you when requested by you in certain circumstances. Pursuant to the Privacy Standards, you have the right to request access to your protected health information for inspection and copying purposes and to request an accounting of disclosures.  Each of those rights in discussed in more detail in the “Your Rights Regarding Protected Health Information About You” section of this Notice.

 

             To the Secretary. AAC is required to disclose protected health information to the Secretary of the Department of Health and Human Services when the information is required in order for the Secretary to investigate or determine whether AAC is in compliance with the Privacy Standards.

 

2.             Permitted Uses and Disclosures.  The following categories describe the instances in which AAC is permitted to use and disclose protected health information about you without obtaining your written authorization. For each category, AAC has attempted to explain what it means and has given examples.  Not every use or disclosure in a category will be listed.  However, all of the ways AAC may use and disclose information without authorization will fall within one of the following:

 

             Treatment.  AAC may use your protected health information to provide you with medical treatment or services.  AAC may disclose protected health information about you to doctors, nurses, or other health care professionals who are involved in taking care of you.  For example, if you have a medical condition that might affect the provision of allergy or asthma services to you, AAC may want to consult with another health care provider about that condition.  In addition, during your course of treatment with AAC, you might develop another medical condition, like high blood pressure, for which another doctor will provide care to you.  That doctor may need to know that you are receiving allergy and asthma services from AAC as those services might affect the treatment for your high blood pressure.  AAC may disclose information about your allergy and asthma services to the doctor treating you for your high blood pressure.

             Payment.  AAC may use or disclose your protected health information for purposes of receiving payment for treatment and services you receive.  For example, AAC may give your insurance company information about your treatment so the insurance company will pay AAC or reimburse you.  AAC may also tell your insurance company about treatment you are going to receive to determine whether your insurance company will pay for it.

 

             Health Care Operations.  AAC may use and disclose protected health information about you for operational purposes.  For example, your protected health information may be disclosed to AAC’s health care professionals to evaluate the performance of the health care professionals, to assess the quality of care and outcomes in your cases and similar cases, to learn how to improve AAC’s facilities and services, and, to determine how to continually improve the quality and effectiveness of the health care AAC provides.

 

             Incidental Uses and Disclosures.  AAC may use and disclose protected health information about you incident to a use or disclosure permitted or required by the Privacy Standards so long as AAC has complied with the minimum necessary and safeguards requirements imposed under the Privacy Standards.  For example, AAC’s nurses may discuss information about your care at the nursing station, and if someone overhears that discussion, the disclosure to that person will be permitted so long as the nurses discussed only the minimum necessary and AAC took appropriate steps to put safeguards in place.

 

             Appointment Reminders. AAC may use and disclose protected health information about you to contact you as a reminder that you have an appointment for treatment or medical care or to remind you to schedule an appointment. The appointment reminder may be via phone (including a voice message), mail (including a reminder postcard), email or otherwise.

 

             Treatment Alternatives.  AAC may use and disclose your protected health information to tell you about or to recommend possible treatment options or alternatives that may be of interest to you so long as AAC is not receiving financial remuneration in exchange for making the communication.

 

             Health-Related Benefits and Services.  AAC may use and disclose your protected health information to tell you about health-related benefits or services that may be of interest to you so long as AAC is not receiving financial remuneration in exchange for making the communication..

 

             Fundraising Activities.  AAC may use  protected health information about you to contact you in an effort to conduct fundraising activities.  With each fundraising communication, AAC must provide you with a clear and conspicuous opportunity to elect not to receive any further fundraising communications.

 

             Business Associates.  AAC contracts with others outside of AAC’s organization to perform or assist AAC in performing functions that involve the use and disclosure of protected health information.  For example, AAC may contract with a billing company to do billing for AAC.  The billing company will need protected health information in order to perform its job.  As such, AAC may disclose protected health information about you to business associates of AAC so that the business associates can perform the job AAC has asked them to do.  In order to protect your protected health information, AAC will require all of its business associates to make assurances to AAC they will each appropriately safeguard your protected health information. Further, business associates will be required to report to AAC any breaches with respect to your information about which they know or in the exercise of reasonable diligence should know.

 

             Individuals Involved in Your Care.  In certain circumstances, AAC may use or disclose protected health information about you to a family member, relative  or close personal friend who is involved in your medical care. In addition, AAC may disclose protected health information about you to notify or assist in the notification of a family member, relative  or close personal friend who is involved in your medical care of your condition, location and status. 

 

             Disaster Relief Efforts.  In certain circumstances, AAC may use or disclose protected health information about you to a public or private entity authorized by law to assist in disaster relief efforts for the purpose of coordinating with such entities. 

 

             Personal Representatives.  Except in limited circumstances, AAC must treat a personal representative of a decedent as the individual about who the protected health information relates.  As such, AAC may disclose protected health information to your personal representative.

 

             Adults and Emancipated Minors.  If a person has authority to act on behalf of an adult or an emancipated minor in making decisions related to health care, AAC must treat that person as a personal representative.  As such, except in limited circumstances, AAC may disclose protected health information to your personal representative as if the disclosure was being made to you.

 

             Unemancipated Minors.  If, under applicable law, a parent, guardian or other person acting in loco parentis has authority to obtain access to protected health information about an unemancipated minor, then AAC may disclose protected health information to the person acting in loco parentis as if the disclosure was being made to the unemancipated minor.

 

             Required by Law.  AAC will disclose protected health information about you when it is required to do so by federal, state or local law, rule or regulation.  For example, AAC may disclose information for the following purposes: for judicial and administrative proceedings pursuant to legal authority; to report information related to victims of abuse, neglect or domestic violence; and, to assist law enforcement officials in their law enforcement duties.

 

             Public Health/Health Oversight.  AAC may use or disclose protected health information about you for public health activities such as assisting public health authorities or other legal authorities to prevent or control disease, injury, or disability, or for other health oversight activities.

 

             Deceased Individuals.  AAC may disclose protected health Information to funeral directors, medical examiners and/or coroners to enable them to carry out their lawful duties.

 

             Organ/Tissue Donation.  AAC may use or disclose protected health information about you for cadaveric organ, eye or tissue donation purposes.

 

             Research.  AAC may use or disclose protected health information about you for research purposes.  For example, a research project may involve comparing the health and recover of patients who received one medication to those who received another medication.  All research projects are subject to a special approval process.  Before AAC will use or disclose protected health information about you, the project will be approved through the special approval process. 

 

             Health and Safety.  AAC. may use or disclose your protected health information to avert a serious threat to the health or safety of you or any other person pursuant to applicable law.

 

             Specialized Government Functions.  AAC may use and disclose your protected health information for military and veterans activities, for national security and intelligence activities, for protective services of the President and others, and to correctional institutions and other law enforcement custodial situations. 

 

             Workers’ Compensation.  AAC may use and disclose protected health information about you for workers’ compensation or similar programs to the extent authorized by and to the extent necessary to comply with laws regarding said programs.  

 

             Military and Veterans.  If you are a member of the armed forces, AAC may disclose your protected health information as required by military authorities. AAC may also use and disclose protected health information about you to the Department of Veterans Affairs to determine whether you are eligible for certain benefits. 

  

             Inmates.  If you are an inmate at a correctional facility or under the custody of a law enforcement official, AAC may disclose protected health information about you to the correctional facility or law enforcement official. 

 

             FDA Reporting.  In the event AAC is subject to the jurisdiction of the federal Food and Drug Administration with respect to a product or activity for which AAC has a duty to make reports of quality, safety or effectiveness, AAC may use and disclose protected health information about you to make any fulfill any requirements imposed by the FDA.

 

             Lawsuits. If you are involved in a lawsuit, AAC may disclose your protected health information in response to a court order.  AAC may also disclose protected health information about you in response to a subpoena, discovery request or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information.

 

3.             Uses and Disclosures For Which Authorization is Required.  The following categories describe the instances in which  AAC may only use and disclose protected health information about you after first obtaining your written authorization:

 

a.             All Instances Except as Required or Permitted.  Except as required or permitted by the Privacy Standards, AAC may not use or disclose protected health information about you without your written  authorization.  When AAC receives your authorization to use or disclose your protected health information, AAC must make its use and disclosure consistent with such authorization.  If you provide AAC authorization to use or disclose your protected health information, you may revoke that authorization, in writing, at any time.  If you revoke your authorization, AAC will no longer use or disclose your protected health information for the reasons covered by your authorization.  However, your revocation will not be applicable to disclosures that AAC already made prior to its receipt of your written revocation.

 

b.             Psychotherapy Notes.  AAC may not use and disclose psychotherapy notes without your authorization except: to carry out certain treatment, payment and health care operation activities; as required by law; for health oversight activities; to coroners and medical examiners; and, to prevent or lessen a serious and imminent threat to the health and safety of a person or the public. 

 

c.             Marketing. AAC may not use and disclose protected health information about you for marketing without your authorization. Marketing means a communication about a product or service that encourages the recipient of the communication to purchase or use the product or service.  Marketing does not include a face to face communication made by AAC to you and/or a promotional gift of nominal value provided by AAC.  Marketing also does not include refill reminders or other communications about drugs, communications to recommend alternative treatments for you and/or communications to describe health-related product or services, so long as AAC is not receiving any financial remuneration in exchange for making the communication.

 

d.             Sale of PHI. AAC may not use and disclose PHI about you if such use or disclosure is a sale of PHI, without your authorization.  Your authorization must state that you acknowledge that the disclosure will result in remuneration to AAC. 

 

C.            YOUR RIGHTS REGARDING PROTECTED HEALTH INFORMATION ABOUT YOU

 

You have the following rights regarding protected health information AAC maintains about you:

 

1.             Request Restrictions.  You have the right to request that AAC restrict or limit how it uses or discloses your protected health information f