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Advanced Art of Cosmetic Surgery Thomas M. DeWire, Sr., MD, FACS Specializing in Cosmetic Plastic Surgery |
Notice of HIPAA Privacy Practices |
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As
Required by the Federal Privacy Regulations Created as a Result of the
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
1.
Purpose We understand that medical information about you and your health is personal and we are committed to protecting that information. We create a record of the care and services you receive at the Medical Practice in order to provide you with quality care and to comply with certain legal requirements. This Notice of Privacy
Practices describes how we may use and disclose medical information about
you, including demographic information, that may identify you and your
related health care services to carry out your treatment, obtain payment
for our services, to perform the daily health care operations of this
practice and for other purposes that are permitted or required by law.
This notice also describes your rights to access and control your
medical information. We
are required to abide by the terms of this Notice of Privacy Practices. 2. Written Acknowledgement You
will be asked to sign a written statement acknowledging that you have
received a copy of this notice.
The acknowledgement only serves to create a record that you have
received a copy of the notice. 3.
Changes to this Notice We may change
the terms of our Notice, at any time.
The new Notice will be effective for all medical information that
we maintain at that time. Upon
your request, we will provide you with any revised Notice of Privacy
Practices. To request a
revised copy, you may call our office and request that a revised copy be
sent to you in the mail or you may ask for one at the time of your next
appointment. The current
Notice of Privacy Practices will be also posted on our Web site,
www.advanced-art.com 4.
How We May Use and
Disclose Medical Information about You The following categories
describe the different ways that the Medical Practice may use and disclose
your medical information and a few examples of what we mean.
These examples are not meant to describe every circumstance, but to
give you an idea of the types of uses and disclosures that may be made by
our office. Other uses and
disclosures of your medical information that are not listed or described
below will be made only with your written authorization.
You may revoke this authorization, at any time, in writing, but it
will not apply to any actions we have already taken. ü
For your treatment:
Your medical information may be used and disclosed by us for
the purpose of providing medical treatment to you or for another health
care provider providing medical treatment to you.
For example, a nurse obtains treatment information about you and
documents it in your medical record and the physician has access to that
information. If you require
an x-ray to be taken, the x-ray technician also has access to your medical
information. In addition,
your medical information may be provided to a physician to whom you have
been referred or are otherwise seeing to ensure that the physician has the
necessary information to diagnose or treat you. ü
To obtain payment for
our services: Your
medical information may be used and disclosed by us to obtain payment for
your health care bills or to assist another health care provider in
obtaining payment for their health care bills.
For example, we may submit requests for payment to your health
insurance company for the medical services that you received. We may also disclose your medical information as required by
your health insurance plan before it approves or pays for the health care
services we recommend for you. ü
For our health care
operations: Your medical information may be used and disclosed by us
to support our daily operations. These
health care operation activities include, but are not limited to, quality
assessment activities, employee review activities, training of medical
students, licensing, fundraising activities, and conducting or arranging
for other business activities. For
example, we may disclose your medical information to medical school
students that see patients at our office.
We may also use the medical information we have to determine where
we can make improvements in the services and care we offer. ü
For the health care
operations of other health care providers:
We may also use your medical information to assist another
health care provider treating you with its quality improvement activities,
evaluation of the health care professionals or for fraud and abuse
detection or compliance. For example, we may disclose your medical information to
another physician to assist in its efforts to make sure it is complying
with all rules related to operating a medical practice. ü
For appointment
reminders: We may use or
disclose your medical information to contact you to remind you of your
appointment, by mail or by telephone.
Our message will include the name of our practice or the name of
our physician as well as the date and time for your appointment or a
reminder that an appointment needs to be scheduled. ü
To provide you with
treatment alternatives: We
may use or disclose your medical information to provide you with
information about treatment alternatives or other health-related benefits
and services that may be of interest to you.
For example, we may contact several home health agencies or
physical therapy providers to discuss the services they provide when we
have a patient who needs these services. ü
To our business
associates: We will share your medical 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 medical information, we will have a
written agreement that contains terms that will protect the privacy of
your medical information. For example, the Medical Practice may hire a billing company
to submit claims to your health care insurer.
Your medical information will be disclosed to this billing company,
but a written agreement between our office and the billing company will
prohibit the billing company from using your medical information in any
way other than what we allow. ü
For fundraising
activities: We may use or disclose your demographic information and
the dates that you received treatment from us in order to contact you for
fundraising activities supported by our office.
If you do not want to receive these materials, please contact the
Privacy Officer and request that these fundraising materials not be sent
to you. ü
Others involved in
your health care: Unless
you object, we may disclose to a member of your family, a relative, a
close friend or any other person you identify, your medical 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 your medical information to notify a family
member or any other person that is responsible for your care of your
location and general health condition.
Finally, we may use or disclose your medical information to an
authorized public or private entity to assist in (1) disaster relief
efforts and (2) to coordinate uses and disclosures to family or other
individuals involved in your health care. ü
As required by law:
We may use or disclose your medical 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. ü
For public health
activities: We may
disclose your medical 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 medical information, if directed by the public health
authority, to any other government agency that is collaborating with the
public health authority. ü
As required by the
Food and Drug Administration: We
may disclose your medical information to a person or company required by
the Food and Drug Administration to report adverse events, product defects
or problems, biologic product deviations, or to track products; to enable
product recalls; to make repairs or replacements; or to conduct post
marketing surveillance, as required. ü
For communicable
disease exposure: We may
disclose your medical 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. ü
To your employer:
We may disclose your medical information concerning a work
related injury or illness to your employer if you are covered under
your employer’s policy in order to conduct an evaluation relating to
medical surveillance of the work place or to evaluate whether you have a
work-related injury, in accordance with the law. ü
For abuse or neglect:
We may disclose your medical information to a public health
authority that is authorized by law to receive reports of child or adult
abuse or neglect. In
addition, we may disclose your medical information if we believe that you
have been a victim of abuse, neglect or domestic violence as may be
required or permitted by Virginia and/or federal law. ü
For health oversight:
We may disclose your medical information to a health oversight
agency for activities authorized by law.
Oversight agencies seeking this information include government
agencies that oversee the health care system, government benefit programs
(such as Medicare or Medicaid), other government regulatory programs and
civil rights laws. ü
In legal proceedings:
We may disclose your medical 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), and in certain conditions in response to a subpoena or other
lawful request. ü
For law enforcement:
We may also disclose your medical information, so long as all legal
requirements are met, for law enforcement purposes.
Examples of these law enforcement purposes include (1) information
requests for identification and location purposes, (2) pertaining to
victims of a crime, (3) suspicion that death has occurred as a result of
criminal conduct, (4) in the event that a crime occurs on the premises of
the Practice, and (5) in an medical emergency where it is likely that a
crime has occurred. ü
To coroners, to
funeral directors, and for organ donation:
We may disclose your medical 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 medical information to a funeral director in
order to permit the funeral director to carry out its duties.
We may disclose such information in reasonable anticipation of
death. Your medical
information may be used and disclosed for cadaveric organ, eye or tissue
donation purposes. ü
For research:
We may disclose your medical information to researchers when their
research has been established as required by federal and state law. ü
Due to criminal
activity: Consistent with
applicable federal and state laws, we may disclose your medical
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 your medical information if it is necessary for law
enforcement authorities to identify or apprehend an individual. ü
For military activity
and national security: When
the appropriate conditions apply, we may use or disclose medical
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 medical 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. ü
For workers’
compensation: Your
medical information may be disclosed by us as authorized to comply with
workers’ compensation laws and other similar legally established
programs. ü
Regarding inmates:
We may use or disclose your medical information if you are an
inmate of a correctional facility and your physician created or received
your medical information in the course of providing care to you. ü
For 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 the Health Insurance
Portability and Accountability Act and its regulations. 5.
Your Rights Following is a statement of
your rights with respect to your medical information and a brief
description of how you may exercise these rights. You
have the right to inspect and copy your medical information.
You may inspect and obtain a copy of your medical information that
we maintain. The information
may contain medical and billing records and any other records that we use
for making decisions about you. However,
under federal law, you may not inspect or copy the following records:
psychotherapy notes; information compiled related to a civil,
criminal, or administrative action; and medical information that is
subject to law that prohibits access to medical information in certain
circumstances. We may deny
your request to inspect your medical information.
In some circumstances, you may have a right to have this decision
reviewed. Please contact our Privacy Officer if you have questions
about access to your medical record. You
have the right to request a restriction of your medical information.
This means you may ask us not to use or disclose any part of your
medical information for the purposes of treatment, payment or health care
operations. You may also
request that any part of your medical information not be disclosed to
family members or friends who may be involved in your care.
Your request must state the specific restriction requested and to
whom you want the restriction to apply. We are not required to agree
to your request. If we agree
to the requested restriction, we may not use or disclose your medical
information in violation of that restriction unless it is needed to
provide emergency treatment or unless we otherwise notify you that we can
no longer honor your request. With
this in mind, please discuss any restriction you wish to request with your
physician. Please request all restrictions in writing to our Privacy
Officer. You
have the right to request that we accommodate you in communicating
confidential medical information.
We will accommodate reasonable requests, but we may condition this
accommodation by asking you for information as to how payment will be
handled or other information necessary to honor your request.
Please make this request in writing to our Privacy Officer. You
may have the right to ask us to amend your medical information.
You may request an amendment of your medical information 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
disagreement with us and we may respond in writing to you.
Please contact our Privacy Officer 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 medical information.
This right applies to disclosures for purposes other than
treatment, payment or health care operations as described in this Notice
of Privacy Practices. It
excludes disclosures we may have made pursuant to your authorization
(permission), made directly to you, to family members or friends involved
in your care, or for appointment notification purposes.
You have the right to receive specific information regarding these
disclosures that occurred after April 14, 2003. You may request 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.
If you would like a paper copy of this notice, please request one
from our Privacy Officer or request one when you are in our offices. 6.
Complaints. You may complain to us if
you believe your privacy rights have been violated by us.
To file a complaint, please contact our Privacy Officer who will be
happy to assist you. You may
file a complaint with us by notifying our Privacy Officer of your
complaint. We will not
retaliate against you for filing a complaint.
If you do not wish to file a complaint with us, you may contact the
Secretary of Health and Human Services. 7.
Privacy Contact. If you have any
questions about this Notice or require additional information, please
contact our Privacy Officer, Sherri DeWire, at (804) 290-0200 or at 3974
Springfield Road, Glen Allen, Virginia 23060.
Our Privacy Officer is available during normal business hours to
discuss your privacy questions, concerns or complaints. Revised: 12/10/2007 01:31:00 PM |
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| ©Copyright 1997-2003 Advanced Art of Cosmetic Surgery: Thomas M. DeWire, Sr, MD, FACS Revised December 10, 2007 01:31:00 PM |