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Columbia Neurosurgical
Associates, P.A.
Notice of Privacy Practices
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 about this Notice please contact
the Privacy Officer for Columbia Neurosurgical Associates, P.A.
This Notice of Privacy
Practices describes how we may use and disclose your protected health
information to carry out treatment, payment or health care operations and
for other purposes that are permitted or required by law. It also describes
your rights to access and control your protected health information.
“Protected health information” is information about you, including
demographic information, that may identify you and that relates to your
past, present or future physical or mental health or condition and related
health care services.
We are required to abide
by the terms of this Notice of Privacy Practices. We may change the terms of
our notice, at any time. The new notice will be effective for all protected
health information that we maintain at that time. Upon your request, we will
provide you with any revised Notice of Privacy Practices by [accessing our
web site
www.columbianeurosurgical.com, calling the office and requesting that a
revised copy be sent to you in the mail or asking for one at the time of
your next appointment.
1. Uses and
Disclosures of Protected Health Information
Uses and Disclosures
of Protected Health Information:
Your protected health information may be used and disclosed by your
physician, our office staff and others outside of our office that are
involved in your care and treatment for the purpose of providing health care
services to you. Your protected health information may also be used and
disclosed to pay your health care bills and to support the operation of the
physician’s practice.
Following are examples
of the types of uses and disclosures of your protected health care
information that the physician’s office is permitted to make. These examples
are not meant to be exhaustive, but to describe the types of uses and
disclosures that may be made by our office.
Treatment:
We will use and disclose your protected health information to provide,
coordinate, or manage your health care and any related services. This
includes the coordination or management of your health care with a third
party that has already obtained your permission to have access to your
protected health information. For example, we would disclose your protected
health information, as necessary, to a home health agency that provides care
to you. We will also disclose protected health information to other
physicians who may be treating you when we have the necessary permission
from you to disclose your protected health information. For example, your
protected health information may be provided to a physician to whom you have
been referred to ensure that the physician has the necessary information to
diagnose or treat you.
In addition, we may
disclose your protected health information from time-to-time to another
physician or health care provider (e.g., a specialist or laboratory) who, at
the request of your physician, becomes involved in your care by providing
assistance with your health care diagnosis or treatment to your physician.
Payment:
Your protected health information will be used, as needed, to obtain payment
for your health care services. This may include certain activities that your
health insurance plan may undertake before it approves or pays for the
health care services we recommend for you such as; making a determination of
eligibility or coverage for insurance benefits, reviewing services provided
to you for medical necessity, and undertaking utilization review activities.
For example, obtaining approval for a hospital stay may require that your
relevant protected health information be disclosed to the health plan to
obtain approval for the hospital admission.
Healthcare
Operations: We may use or
disclose, as-needed, your protected health information in order to support
the business activities of your physician’s practice. These activities
include, but are not limited to, quality assessment activities, employee
review activities, training of medical students, licensing, marketing and
fundraising activities, and conducting or arranging for other business
activities.
For example, we may
disclose your protected health information to medical school students that
see patients at our office. In addition, we may use a sign-in sheet at the
registration desk where you will be asked to sign your name and indicate
your physician. We may also call you by name in the waiting room when your
physician is ready to see you. We may use or disclose your protected health
information, as necessary, to contact you to remind you of your appointment
and, if you are unavailable, we may leave the information with another
member of your household or on your voice mail.
We will share your
protected health information with third party “business associates” that
perform various activities (e.g., billing, transcription services) for the
practice. Whenever an arrangement between our office and a business
associate involves the use or disclosure of your protected health
information, we will have a written contract that contains terms that will
protect the privacy of your protected health information.
We may use or disclose
your protected health information, as necessary, to provide you with
information about treatment alternatives or other health-related benefits
and services that may be of interest to you. We may also use and disclose
your protected health information for other marketing activities. For
example, your name and address may be used to send you a newsletter about
our practice and the services we offer. We may also send you information
about products or services that we believe may be beneficial to you. You may
contact our Privacy Contact to request that these materials not be sent to
you.
We may use or disclose
your demographic information and the dates that you received treatment from
your physician, as necessary, in order to contact you for fundraising
activities supported by our office. If you do not want to receive these
materials, please contact our Privacy Contact and request that these
fundraising materials not be sent to you.
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.
Other Permitted and
Required Uses and Disclosures That May Be Made With Your Authorization or
Opportunity to Object
We may use and disclose your protected health information in the following
instances. You have the opportunity to agree or object to the use or
disclosure of all or part of your protected health information. If you are
not present or able to agree or object to the use or disclosure of the
protected health information, then your physician may, using professional
judgment, determine whether the disclosure is in your best interest. In this
case, only the protected health information that is relevant to your health
care will be disclosed.
Others Involved in
Your Healthcare: 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.
Other Permitted and
Required Uses and Disclosures That May Be Made Without Your Authorization or
Opportunity to Object
We may use or disclose your protected health information in the following
situations without your authorization. These situations include:
Required By Law: We may use or disclose your protected health information to the extent
that the use or disclosure is required by law. The use or disclosure will be
made in compliance with the law and will be limited to the relevant
requirements of the law. You will be notified, as required by law, of any
such uses or disclosures.
Public Health: We may disclose your protected health information for public health
activities and purposes to a public health authority that is permitted by
law to collect or receive the information. The disclosure will be made for
the purpose of controlling disease, injury or disability. We may also
disclose your protected health information, if directed by the public health
authority, to a foreign government agency that is collaborating with the
public health authority.
Communicable
Diseases: We may disclose your
protected health information, if authorized by law, to a person who may have
been exposed to a communicable disease or may otherwise be at risk of
contracting or spreading the disease or condition.
Health Oversight:
We may disclose protected health information to a health oversight agency
for activities authorized by law, such as audits, investigations, and
inspections. Oversight agencies seeking this information include government
agencies that oversee the health care system, government benefit programs,
other government regulatory programs and civil rights laws.
Abuse or Neglect:
We may disclose your protected health information to a public health
authority that is authorized by law to receive reports of child abuse or
neglect. In addition, we may disclose your protected health information if
we believe that you have been a victim of abuse, neglect or domestic
violence to the governmental entity or agency authorized to receive such
information. In this case, the disclosure will be made consistent with the
requirements of applicable federal and state laws.
Food and Drug
Administration: We may
disclose your protected health information to a person or company required
by the Food and Drug Administration to report adverse events, product
defects or problems, biologic product deviations, track products; to enable
product recalls; to make repairs or replacements, or to conduct post
marketing surveillance, as required.
Legal Proceedings:
We may disclose protected health information in the course of any judicial
or administrative proceeding, in response to an order of a court or
administrative tribunal (to the extent such disclosure is expressly
authorized), in certain conditions in response to a subpoena, discovery
request or other lawful process.
Law Enforcement: We may also disclose protected health information, so long as
applicable legal requirements are met, for law enforcement purposes. These
law enforcement purposes include (1) legal processes and otherwise required
by law, (2) limited information requests for identification and location
purposes, (3) pertaining to victims of a crime, (4) suspicion that death has
occurred as a result of criminal conduct, (5) in the event that a crime
occurs on the premises of the practice, and (6) medical emergency (not on
the Practice’s premises) and it is likely that a crime has occurred.
Coroners, Funeral
Directors, and Organ Donation:
We may disclose protected health information to a coroner or medical
examiner for identification purposes, determining cause of death or for the
coroner or medical examiner to perform other duties authorized by law. We
may also disclose protected health information to a funeral director, as
authorized by law, in order to permit the funeral director to carry out
their duties. We may disclose such information in reasonable anticipation of
death. Protected health information may be used and disclosed for cadaveric
organ, eye or tissue donation purposes.
Research:
We may disclose your protected health 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.
Criminal Activity:
Consistent with applicable federal and state laws, we may disclose your
protected health information, if we believe that the use or disclosure is
necessary to prevent or lessen a serious and imminent threat to the health
or safety of a person or the public. We may also disclose protected health
information if it is necessary for law enforcement authorities to identify
or apprehend an individual.
Military Activity
and National Security: When
the appropriate conditions apply, we may use or disclose protected health
information 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 Veterans Affairs of your
eligibility for benefits, or (3) to foreign military authority if you are a
member of that foreign military services. We may also disclose your
protected health information to authorized federal officials for conducting
national security and intelligence activities, including for the provision
of protective services to the President or others legally authorized.
Workers’
Compensation: Your protected
health information may be disclosed by us as authorized to comply with
workers’ compensation laws and other similar legally-established programs.
Inmates:
We may use or disclose your protected health information if you are an
inmate of a correctional facility and your physician created or received
your protected health information in the course of providing care to you.
Required Uses and
Disclosures: Under the law, we
must make disclosures to you and when required by the Secretary of the
Department of Health and Human Services to investigate or determine our
compliance with the requirements of Section 164.500 et. seq.
2. Your Rights
Following is a statement of your rights with respect to your protected
health information and a brief description of how you may exercise these
rights.
You have the right
to inspect and copy your protected health information.
This means you may inspect and obtain a copy of protected health information
about you that is contained in a designated record set for as long as we
maintain the protected health information. A “designated record set”
contains medical and billing records and any other records that your
physician and the practice uses for making decisions about you.
Under federal law,
however, you may not inspect or copy the following records; psychotherapy
notes; information compiled in reasonable anticipation of, or use in, a
civil, criminal, or administrative action or proceeding, and protected
health information that is subject to law that prohibits access to protected
health information. Depending on the circumstances, a decision to deny
access may be reviewable. In some circumstances, you may have a right to
have this decision reviewed. Please contact our Privacy Contact if you have
questions about access to your medical record.
You have the right
to request a restriction of your protected health information.
This means you may ask us not to use or disclose any part of your protected
health information for the purposes of treatment, payment or healthcare
operations. You may also request that any part of your protected health
information not be disclosed to family members or friends who may be
involved in your care or for notification purposes as described in this
Notice of Privacy Practices. Your request must state the specific
restriction requested and to whom you want the restriction to apply.
Your physician is not
required to agree to a restriction that you may request. If physician
believes it is in your best interest to permit use and disclosure of your
protected health information, your protected health information will not be
restricted. If your physician does agree to the requested restriction, we
may not use or disclose your protected health information in violation of
that restriction unless it is needed to provide emergency treatment. With
this in mind, please discuss any restriction you wish to request with your
physician. You may request a restriction by submitting your request in
writing to our Privacy Contact. The acceptance or denial of your request
will be documented in writing to you.
You have the right
to request to receive confidential communications from us by alternative
means or at an alternative location.
We will accommodate reasonable requests. We may also condition this
accommodation by asking you for information as to how payment will be
handled or specification of an alternative address or other method of
contact. We will not request an explanation from you as to the basis for the
request. Please make this request in writing to our Privacy Contact.
You may have the
right to have your physician amend your protected health information.
This means you may request an amendment of protected health information
about you in a designated record set for as long as we maintain this
information. In certain cases, we may deny your request for an amendment. If
we deny your request for amendment, you have the right to file a statement
of disagreement with us and we may prepare a rebuttal to your statement and
will provide you with a copy of any such rebuttal. Please contact our
Privacy Contact to determine if you have questions about amending your
medical record.
You have the right
to receive an accounting of certain disclosures we have made, if any, of
your protected health information.
This right applies to disclosures for purposes other than treatment, payment
or healthcare operations as described in this Notice of Privacy Practices.
It excludes disclosures we may have made to you, to family members or
friends involved in your care, as a result of an authorization signed by you
or for notification purposes. You have the right to receive specific
information regarding these disclosures that occurred after April 14, 2003.
You may request them for the previous six years or a shorter timeframe. The
right to receive this information is subject to certain exceptions,
restrictions and limitations.
You have the right
to obtain a paper copy of this notice from us,
upon request, even if you have agreed to accept this notice electronically.
3. Complaints
You may complain to us or to the Secretary of Health and Human Services if
you believe your privacy rights have been violated by us. You may file a
complaint with us by notifying our privacy contact of your complaint. We
will not retaliate against you for filing a complaint.
You may contact our
Privacy Officer at (803)462-0423 for further information about the complaint
process.
This notice was
published and becomes effective on April 14, 2003.
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