HIPAA NOTICE OF
PRIVACY PRACTICES
Effective Date:
THIS NOTICE DESCRIBES
HOW HEALTH 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 Privacy Officer,
at (716) 835-2966.
OUR PLEDGE REGARDING HEALTH INFORMATION:
We understand that health information about you and your health care is personal. We are committed to protecting health information about you. We create a record of the care and services you receive from us. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by this health care practice, whether made by your personal doctor or others working in this office. This notice will tell you about the ways in which we may use and disclose health information about you. We also describe your rights to the health information we keep about you, and describe certain obligations we have regarding the use and disclosure of your health information.
We are required by law to:
· make sure that health information that
identifies you is kept private;
· give you this notice of our legal duties and
privacy practices with respect to health
information about you; and
· follow the terms of the notice that is currently
in effect.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU.
The following categories describe different ways that we use and
disclose health information. For each category of uses or disclosures we will
explain what we mean and try to give some examples. Not every use or disclosure
in a category will be listed. However, all of the ways we are permitted to use
and disclose information will fall within one of the categories.
For Treatment:
We may use health information about you to provide you with health
care treatment or services. We may disclose health information about you to
doctors, nurses, technicians, health students, or other personnel who are
involved in taking care of you. They may work at our offices, at the hospital
if you are hospitalized under our supervision, or at another doctor's office,
lab, pharmacy, or other health care provider to whom we may refer you for
consultation, to take x-rays, to perform lab tests, to have prescriptions
filled, or for other treatment purposes. For example,
a doctor treating you for a broken leg may need to know if you have diabetes
because diabetes may slow the healing process. In addition, the doctor may need
to tell the dietitian at the hospital if you have diabetes so that we can
arrange for appropriate meals. We may also disclose health information about
you to an entity assisting in a disaster relief effort so that your family can
be notified about your condition, status and location.
For Payment:
We may use and disclose health information about you so that the
treatment and
services you receive from us may be billed to and
payment collected from you, an insurance company, or a third party. For
example, we may need to give your health plan information about your office
visit so your health plan will pay us or reimburse you for the visit. We may
also tell your health plan about a treatment you are going to receive to obtain
prior approval or to determine whether your plan will cover the treatment.
For Health Care Operations:
We may use and disclose health information about you for
operations of our health care practice. These uses and disclosures are
necessary to run our practice and make sure that all of our patients receive
quality care. For example, we may use health information to review our
treatment and services and to evaluate the performance of our staff in caring
for you. We may also combine health information about many patients to decide
what additional services we should offer, what
services are not needed, whether certain new treatments are effective, or to
compare how we are doing with others and to see where we can make improvements.
We may remove information that identifies you from this set of health
information so others may use it to study health care delivery without learning
who our specific patients are.
Appointment Reminders:
We may use and disclose health information to contact you as a
reminder that you have an appointment. Please let us know if you do not wish to
have us contact you concerning your appointment, or if you wish to have us use
a different telephone number or address to contact you for this purpose.
Research:
Under certain circumstances, we may use and disclose health
information about you
for research purposes. For example, a research
project may involve comparing the health and recovery of all patients who
received one medication to those who received another, for the same condition.
All research projects, however, are subject to a special approval process. This
process evaluates a proposed research project and its use of health
information, trying to balance the research needs with patients' need for
privacy of their health information. Before we use or disclose health
information for research, the project will have been approved through this research
approval process; but we may disclose health information about you to people
preparing to conduct a research project.
For example, we may help potential researchers look for patients
with specific health needs, so long as the health information they review does
not leave our facility. We will almost always ask for your specific permission
if the researcher will have access to your name, address, or other information
that reveals who you are, or will be
involved in your care.
As Required By Law:
We will disclose health information about you when required to do
so by
federal, state, or local law.
To Avert a Serious Threat to Health or Safety:
We may use and disclose health information about you when
necessary to prevent a serious threat to your health and safety or the health
and safety of the public or another person. Any disclosure, however, would only
be to someone able to help prevent the threat.
Military and Veterans:
If you are a member of the armed forces or separated/discharged
from
military services, we may release health
information about you as required by military command, authorities or the
Department of Veterans Affairs as may be applicable. We may also release health
information about foreign military personnel to the appropriate foreign
military authorities.
Workers' Compensation:
We may release health information about you for workers'
compensation or similar programs. These programs provide benefits for
work-related injuries or illness.
Public Health Risks:
We may disclose health information about you for public health
activities.
These activities generally include the following:
· to prevent or control disease, injury or
disability
· to report births and deaths
· to report child abuse or neglect
· to report reactions to medications or problems
with products
· to notify people of recalls of products they may
be using
· to notify person or organization required to receive
information on FDA-regulated
products;
· to notify a person who may have been exposed to
a disease or may be at risk for
contracting or spreading a disease or condition
· to notify the appropriate government authority
if we believe a patient has been the
victim of abuse, neglect, or domestic violence. We
will only make this disclosure if
you agree or when required or authorized by law.
Health Oversight Activities:
We may disclose health information to a health oversight agency
for activities authorized by law. These oversight
activities include, for example, audits,
investigations, inspections, and
licensure. These activities are necessary for the government to monitor the
health care system, government programs, and compliance with civil rights laws.
Lawsuits and Disputes:
If you are involved in a lawsuit or a dispute, we may disclose
health information about you in response to a court or administrative order. We
may also disclose 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 requested.
Law Enforcement:
We may release health information if asked to do so by a law enforcement
official:
· in reporting certain injuries, as required by
law, gunshot wounds, burns, injuries to
perpetrators of crime
· in response to a court order, subpoena, warrant,
summons or similar process;
· to identify or locate a suspect, fugitive,
material witness, or missing person:
-
Name and address
-
Date of birth or place of birth;
-
Social security number;
-
Blood type or rh factor;
-
Type of injury;
-
Date and time of treatment and/or death, if applicable; and
-
A description of distinguishing physical characteristics.
· about the victim of a crime, if the victim
agrees to disclosure or under certain limited
circumstances, we are unable to
obtain the person's agreement;
· about a death we believe may be the result of
criminal conduct;
· about criminal conduct at our facility; and
· in emergency circumstances to report a crime;
the location of the crime or victims; or
the identity, description, or location of the
person who committed the crime.
Coroners, Health Examiners and Funeral Directors:
We may release health information to a coroner or health examiner.
This may be necessary, for example, to identify a deceased person or determine
the cause of death. We may also release health information about patients to
funeral directors as necessary to carry out their duties.
National Security and Intelligence Activities:
We may release health information about you to authorized federal
officials for intelligence, counterintelligence, and other national security
activities authorized by law.
Protective Services for the President and Others:
We may disclose health information about you to authorized federal
officials so they may provide protection to the President, other authorized
persons or foreign heads of state or conduct special investigations.
Inmates:
If you are an inmate of a correctional institution or under the
custody of a law
enforcement official, we may release health
information about you to the correctional institution or law enforcement
official. This release would be necessary (1) for the institution to provide
you with health care; (2) to protect your health and safety or the health and
safety of others; or (3) for the safety and security of the correctional
institution.
YOUR RIGHTS REGARDING HEALTH INFORMATION
ABOUT YOU
You have the following rights regarding health information we
maintain about you:
Right to Inspect and Copy:
You have the right to inspect and copy health information that may
be used to make decisions about your care. Usually, this includes health and
billing records. To inspect and copy health information that may be used to
make decisions about you, you
must submit your request in writing to Privacy
Officer, . If you request a copy of the information, we may charge a fee for
the costs of copying, mailing or other supplies and services associated with
your request. We may deny your request to inspect and copy in certain very
limited circumstances. If you are denied access to health information, you may
request that the denial be reviewed. Another licensed health care professional
chosen by our practice will review your request and the denial. The person
conducting the review will not be the person who denied your request. We will
comply with the outcome of the review.
Right to Amend:
If you feel that health information we have about you is incorrect
or incomplete, you may ask us to amend the information. You have the right to
request an amendment for as long as we keep the information. To request an
amendment, your request must be made in writing, submitted to Privacy Officer, and must be contained on one page of paper
legibly handwritten or typed in at least 10 point font size. In addition, you
must provide a
reason that supports your request for an amendment. We
may deny your request for an amendment if it is not in writing or does not
include a reason to support the request. In addition, we may deny your request
if you ask us to amend information that:
· was not created by us, unless the person or
entity that created the information is no
longer available to make the amendment;
· is not part of the health information kept by or
for our practice;
· is not part of the information which you would
be permitted to inspect and copy; or
· is accurate and complete.
Any amendment we make to your health information will be disclosed
to those with whom we disclose information as previously specified.
Right to an Accounting of Disclosures:
You have the right to request a list accounting for any
disclosures of your health information we have made, except for uses and
disclosures for treatment, payment, and health care operations, as previously
described. To request this list of disclosures, you must submit your request in
writing to Privacy Officer. Your request must state a time period which may not
be longer than six years and may not include dates before
any costs are incurred. We will mail you a list of
disclosures in paper form within 30 days of your request, or notify you if we
are unable to supply the list within that time period and by what date we can
supply the list; but this date will not exceed a total of 60 days from the date
you made the request.
Right to Request Restrictions:
You have the right to request a restriction or limitation on the
health information we use or disclose about you for treatment, payment, or
health care operations. You also have the right to request a limit on the
health information we disclose about you to someone who is involved in your
care or the payment for your care, such as a family member or friend. For
example, you could ask that we restrict a specified nurse from use of your
information, or that we not disclose information to your spouse about a surgery
you had.
We are not required to agree to your request for restrictions if
it is not feasible for us to ensure our compliance or believe it will
negatively impact the care we may provide you.
If we do agree, we will comply with your request unless the information
is needed to provide you emergency treatment. To request a restriction, you
must make your request in writing to Privacy Officer. In your request, you must tell us what
information you want to limit and to whom you want the limits to apply; for
example, use of any information by a specified nurse, or disclosure of
specified surgery to your spouse.
Right to Request Confidential Communications:
You have the right to request that we communicate with you about
health matters in a certain way or at a certain location. For example, you can
ask that we only contact you at work or by mail to a post office box. To
request confidential communications, you must make your request in writing to
Privacy Officer. We will not ask you the reason for your request. We will
accommodate all reasonable requests. Your request must specify how or where you
wish to be contacted.
Right to a Paper Copy of This Notice:
You have the right to obtain a paper copy of this notice at any
time. To obtain a copy, please request it from Privacy Officer. You may also obtain a copy of this notice
from our website, www.buffaloheartgroup.com. Even if you have received a notice
electronically, you still retain the right to receive a paper copy upon
request.
CHANGES TO THIS NOTICE:
We reserve the right to change this notice. We reserve the right
to make the revised or changed notice effective for health information we
already have about you as well as any information we receive in the future. We
will post a copy of the current notice in our facility. The notice will contain
on the first page, in the top right-hand corner, the effective date. In
addition, each time you register for treatment or health care services, we will
offer you a copy of the current notice in effect.
COMPLAINTS:
If you believe your privacy rights have been violated, you may
file a complaint with us or with the Secretary of the Department of Health and
Human Services. To file a complaint with us, contact Privacy Officer.
All complaints must be submitted in writing. You will not be
penalized for
filing a complaint.
OTHER USES OF HEALTH INFORMATION:
Other uses and disclosures of health information not covered by
this notice or the laws that apply to us will be made only with your written
permission. If you provide us permission to use or disclose health information
about you, you may revoke that permission, in writing, at any time. If you
revoke your permission, we will no longer use or disclose health information
about you for the reasons covered by your written authorization. You understand
that we are unable to take back any disclosures we have already made with your
permission, and that we are required to retain our records of the care that we
provided to you.
Acknowledgement of Receipt of this Notice
We will request that you sign a separate form or notice
acknowledging you have received a copy of this notice. If you choose, or are
not able to sign, a staff member will sign their name, date. This
acknowledgement will be filed with your records.