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This Practice is committed to maintaining the privacy of
your protected health information ("PHI"), which includes
information about your health condition and the care and treatment
you receive from the Practice. The creation of a record detailing
the care and services you receive helps this office to provide you
with quality health care. This Notice details how your PHI may be
used and disclosed to third parties. This Notice also details your
rights regarding your PHI. The privacy of PHI in patient files will
be protected when the files are taken to and from the Practice by
placing the files in a box or brief case and kept within the custody
of a doctor or employee of the Practice authorized to remove the
files from the Practice's office. It may be necessary to take
patient files to a facility where a patient is confined or to a
patient's home where the patient is to be examined or treated.
The Practice may use and/or disclose your PHI for the
purposes of:
(a) Treatment - In order to provide you with the health
care you require, 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 health
condition and needs. For example, a physician treating you for a
condition or disease may need to know the results of your latest
physician examination by this office.
(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 payors, pursuant to
their billing and payment requirements. For example, the Practice
may need to provide 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 treatment you are going to receive so
that it can determine whether or not it will cover the treatment
(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.
1. The Practice may use and/or disclose your PHI, without a written
Consent from you, in the following additional instances:
(a) De-identified Information - Information that does not
identify you and, even without your name, cannot be used to identify
(b) Business Associate - To a business associate if the
Practice obtains satisfactory written assurance, in accordance with
applicable law, that the business associate will appropriately
safeguard your PHI. A business associate is an entity that assists
the Practice in undertaking some essential function, such as a
billing company that assists the office in submitting claims for
payment to insurance companies or other payers.
(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) Emergency Situations -
(i) for the purpose of obtaining or rendering emergency treatment
to you provided that the Practice attempts to obtain your Consent as
soon as possible; or
(ii) to a public or private entity authorized by law or by its
charter to assist in disaster relief efforts, for the purpose of
coordinating your care with such entities in an emergency situation.
(e) Communication Barriers - If, due to substantial
communication barriers or inability to communicate, the Practice has
been unable to obtain your Consent and the Practice determines, in
the exercise of its professional judgment, that your Consent to
receive treatment is clearly inferred from the circumstances.
(f) Public Health Activities - Such activities include,
for example, information collected by a public health authority, as
authorized by law, to prevent or control disease and that does not
identify you and, even without your name, cannot be used to identify
(g) 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
(h) Health Oversight Activities - Such activities, which
must be required by law, involve government agencies and may
include, for example, criminal investigations, disciplinary actions,
or general oversight activities relating to the community's health
care system.
(i) Judicial and Administrative Proceeding - For example, the
Practice may be required to disclose your PHI in response to a court
order or a lawfully issued subpoena.
(j) Law Enforcement Purposes - In certain instances, your
PHI may have to be disclosed to a law enforcement official. For
example, your PHI may be the subject of a grand jury subpoena. Or,
the Practice may disclose your PHI if the Practice believes that
your death was the result of criminal conduct.
(k) 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.
(l) 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.
(m) 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 and that does not identify you and, even without your
name, cannot be used to identify you.
(n) 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.
(o) 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.