Payment:? Our practice may use and disclose PHI so that we can bill and collect payment for the treatment and services provided to you.? For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment.? We may also use and disclose your PHI to obtain payment from third parties that may be responsible for such costs, such as family members.? We may use and disclose PHI for billing, claims management, and collection activities.? We may disclose PHI to insurance companies providing you with additional coverage.? We may also disclose PHI to another health care provider or to a company or health plan that is required to comply with the Privacy Rule for the payment activities of that health care provider, company, or health plan.? For example, we may allow a health insurance company to review PHI for the insurance company?s activities to determine the insurance benefits to be paid for your care.
Health Care Operations:? Our practice may use and disclose your PHI to operate our business.? Health care operations include doing things that allow us to improve the quality of care we provide and to reduce health care costs.? For example, we may use PHI about you to develop ways to assist our physicians and staff in deciding how we can improve the medical treatment we provide to others.? We may also disclose PHI for the health care operations of an ?organized heath care arrangement (OHCA).?? An example of an OHCA is the joint care provided by a hospital and the doctors who see patients at the hospital.? We may also contact you to remind you of appointments.
Individuals Involved in Your Care or Payment for Your Care:? Our practice may release your PHI to a friend or family member that is involved in your care, or who assists in taking care of you.? For example, a parent or guardian may ask that a babysitter take their child to the doctor for a post operative check-up.? In this example, the babysitter may have access to this child?s medical information.? We may also use professional judgment and our experience with common practice to make reasonable decisions about your best interests in allowing a person to act on your behalf to pick up filled prescriptions, medical supplies, or other things that contain PHI about you.
Public Health Activities:? Our practice may use or disclose PHI to public health authorities that are authorized by law to collect information for the purpose of:
Lawsuits and Similar Proceedings:? Our practice may use or disclose your PHI when required by a court or administrative order.? We may also disclose your PHI in response to a discovery request subpoena, or other required legal process when efforts have been made to advise you of the request or to obtain an order protecting the information requested.
Law Enforcement:? Our practice may release PHI if asked to do so by a law enforcement official:
Organ and Tissue Donation:? Our practice may release your PHI to organizations that help procure, locate, and transplant organs in order to facilitate an organ, eye, or tissue donation and transplantation.
Research:? Our practice may use and disclose PHI about you for research purposes under certain limited circumstances.? We must obtain a written authorization to use and disclose PHI about you for research purposes except in situations where a research project meets specific, detailed criteria established by the Privacy Rule to ensure the privacy of PHI.
Serious Threats to Health or Safety:? Our practice may use and disclose your PHI when necessary to reduce or prevent a serious threat to your health and safety, or the health and safety of another individual or the public.? Under these circumstances, we will only make disclosures to a person or organization that is able to help prevent the threat.
Specialized Government Functions:? Under certain circumstances we may disclose PHI:
Right to Request Restrictions:? You have the right to request additional restrictions on the PHI that we may use for treatment, payment, and health care operations.? Additionally, you have the right to request that we restrict our disclosure of your PHI to only certain individuals involved in your care or the payment for your care, such as family members and friends.? We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you.? In order to request a restriction in our use or disclosure of your PHI, please complete a ?Request for Limitations and Restrictions of PHI Form.?? You can obtain this form at Salem Surgical.?
Right to Inspect and Copy:? You have the right to inspect and obtain a copy of the PHI that may be used to make decisions about you, including medical and billing records.? We may deny your request to inspect and copy PHI only in limited circumstances; however, you may request a review of our denial.? Another licensed health care professional chosen by us will conduct reviews.? To inspect and copy your PHI, please contact our office and complete a ?Request to Inspect and Copy PHI? form.? If you request a copy of PHI about you, we may charge you a reasonable fee for the copying, postage, labor, and supplies used in meeting your request.? You will not be charged a search fee for the records.
Right to Amend:? You have the right to request that we amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our practice.? To request an amendment, please obtain a ?Request for Correction of PHI? form from our office and complete it.? We may deny your request if you ask us to amend information that is, in our opinion,: (a) accurate and complete; (b) not part of the ?designated records set? kept by or for the practice; (c) not part of the PHI which you would be permitted to inspect and copy; or (d) not created by our practice, unless the individual or entity that created the information is not available to amend the information.
Right to Receive an Accounting of Disclosures:? You have the right to request an ?accounting? of disclosures that we have made of PHI about you.? This is a list of disclosures made by us during a specified period of up to six years other than disclosures made:? for treatment, payment, and health care operations; for use in or related to a facility directory; to family members or friends involved in your care; to you directly; pursuant to an authorization of you or your personal representative; for certain notification purposes; and disclosures made before April 14, 2003.? If you wish to make such a request, please contact our office and complete a ?Request for an Accounting of Certain Disclosures? form.? The first list you request in a 12-month period will be free, but we may charge for our reasonable costs of providing additional lists in the same 12-month period.? Our practice will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs.
Right to Provide an Authorization for Other Uses and Disclosures:? Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law.? Any authorization you provide to us regarding the use and disclosure of your PHI may be revoked at any time in writing.? After you revoke your authorization, we will no longer use or disclose your PHI for the reasons described in the authorization.?
Right to a Paper Copy of this Notice:? You are entitled to receive a paper copy of our notice of privacy practices.? You may ask us to give you a copy of this notice at any time.? To obtain a copy of this notice, please contact our office.
Right to File a Complaint:? If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services.? To file a complaint with our office please contact: