Patient Privacy
Patient Privacy
Simpsonville Family Medicine, P.A.

PRIVACY POLICY

A federal regulation, known as the “HIPAA Privacy Rule,” requires that we establish detailed privacy practices and policy.

OUR COMMITMENT TO PROTECTING HEALTH INFORMATION
This policy describes the ways that we may use and disclose health information about our patients. The HIPAA Privacy Rule requires that we protect the privacy of health information that identifies a patient, or where there is a reasonable basis to believe the information can be used to identify a patient. This information is called “protected health information” or “PHI”. We are required by law to:
-Maintain the privacy of PHI about our patients;
-Provide a copy of our privacy practices to our patients if requested.
-Comply with the terms of our Notice of Privacy Practices that is currently in effect.

We reserve the right to make changes to our privacy practices. If and when our policy is changed, we will post a copy in our office in a prominent location. We will also provide patients with a copy of the revised notice upon request made to our Privacy Official.

I.HOW WE MAY USE AND DISCLOSE PROTECTED HEALTH INFORMATION ABOUT PATIENTS

USES AND DISCLOSURES FOR TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS

The following categories describe the different ways we may use and disclose PHI for treatment, payment, or health care operations. The examples included with each category do not list every type of use or disclosure that may fall within that category.

We may use and disclose PHI about patients to provide, coordinate and manage health care with others. For example, we may use and disclose PHI when a patient needs a prescription, lab work, an X-ray, or other health care services. In addition, we may use and disclose PHI about a patient when referring to another health care provider.

We may also disclose PHI about a patient for the treatment activities of another health care provider. For example, we may send a report about a patient’s care from us to a physician that we refer a patient to so that the other physician may treat the patient.

Payment: We may use and disclose PHI so that we can bill and collect payment for the treatment and services provided to the patient. Before providing treatment or services, we may share details with the patient’s health plan concerning the services they are scheduled to receive. For example, we may ask for payment approval from the patient’s health plan before we provide care or services. We may use and disclose PHI to find out if the patient’s health plan will cover the cost of care and services we provide. We may use and disclose PHI to confirm that patients are receiving the appropriate amount of care to obtain payment for services. We may use and disclose PHI for billing, claims management, and collection activities. We may disclose PHI to insurance companies providing the patient with additional coverage. We may disclose limited PHI to consumer reporting agencies relating to collection of payments owed to us.

We may also disclose PHI to another health care provider or to a company or health plan required to comply with the HIPAA 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 a patient’s care.

Health Care Operations: We may use and disclose PHI in performing business activities which are called health care operations. Health care operations include doing things that allow us to improve the quality of care we provide and to reduce health care costs. We may use and disclose PHI about a patient in the following health care operations:
-Reviewing and improving the quality, efficiency and cost of care that we provide to our patients. For example, we may use PHI to develop ways to assist our physicians and staff in deciding how we can improve the medical treatment we provided to others.
-Improving health care and lowering costs for groups of people who have similar health problems and helping to manage and coordinate the care for these groups of people. We may use PHI to identify groups of people with similar problems to give them information, for instance, about treatment alternatives, and educational classes.
-Reviewing and evaluating the skills, qualifications, and performance of health care providers taking care of our patients.
-Providing training programs for students, trainees, health care providers, or non-health care professionals (for example, billing personnel) to help them practice or improve their skills.
-Cooperating with outside organizations that assess the quality of the care that we provide.
-Cooperating with outside organizations that evaluate, certify. Or license health care providers or staff in a particular field or specialty. For example, we may use or disclose PHI so that one of our nurses may become certified as having expertise in a specific field of nursing.
-Cooperating with various people who review our activities. For example, PHI may be seen by doctors reviewing the services provided to patients, and by accountants, lawyers, and others who assist us in complying with the law and managing our business.
-Assisting us in making plans for our practice’s future operations.
-Resolving grievances within our practice.
-Reviewing our activities and using or disclosing PHI in the event that we sell our practice to someone else or combine with another practice.
-Business planning and development, such as cost management analyses.
-Business management and general administrative activities of our practice, including managing our activities related to complying with the HIPAA Privacy Rule and other legal requirements.
-Creating “de-identified” information that is not identifiable to any individual.

If another health care provider, company, or health plan that is required to comply with the HIPAA Privacy Rule has or once had a relationship with a patient, we may disclose PHI about the patient for certain health care operations of that health care provider or company. For example, such health care operations may include: reviewing and improving the quality, efficiency, and cost of care provided to patients; reviewing and evaluating the skills, qualifications, and performance of health care providers; providing training programs for students, trainees, health care providers, or non-health care professionals; cooperating with outside organizations that evaluate, certify, or license health care providers or staff in a particular field or specialty; and assisting with legal compliance activities of that health care provider or company.

We may also disclose PHI for the health care operations of an “organized health care arrangement” in which we participate. An example of an “organized health care arrangement” is the joint care provided by a hospital and the doctors who see patients at the hospital.

Communication From Our Office: We may contact our patients to remind them of appointments and to provide information about treatment alternatives or other health related benefits and services that may be of interest to them.

OTHER USES AND DISCLOSURES WE CAN MAKE WITHOUT WRITTEN AUTHORIZATION

Uses and Disclosure For Which Patients Have the Opportunity To Agree or Object

We may use and disclose PHI about our patients in some situations where they have the opportunity to agree or object to certain uses and disclosures of PHI. If the patient does not object, then we may make these types of disclosures of PHI.
-Individuals Involved in a Patient’s Care or Payment for a Patient’s Care: We may disclose PHI about a patient to a family member, close friend, or any other person identified by the patient if that information is directly relevant to the person’s involvement in the patient’s care or payment for care. If the patient is present and able to consent or object (or if the patient is available in advance), then we may only use or disclose PHI if the patient does not object after being informed of the opportunity to object. If the patient is not present or unable to consent or object, we may exercise professional judgment in determining whether the use or disclosure of PHI is in the patient’s best interest. For example, if a patient is brought into this office and is unable to communicate normally with a physician for some reason, we may find it is in the patient’s best interest to give the patient’s prescriptions and other medical supplies to the friend or relative who brought that patient in for treatment.

We may also use and disclose PHI to notify such persons of a patient’s location, general condition, or death. We also may coordinate with disaster relief agencies to make this type of notification. We also may use professional judgment and our experience with common practice to make reasonable decisions about the patient’s best interests in allowing a person to act on the patient’s behalf to pick up filled prescriptions, medical supplies, X-rays, or other things that contain PHI.

OTHER USES AND DISCLOSURES WE CAN MAKE WITHOUT WRITTEN AUTHORIZATION OR OPPORTUNITY TO AGREE OR OBJECT

We may use and disclose PHI in the following circumstances without authorization or opportunity to agree or object, provided that we comply with certain conditions that may apply.

Required By Law: We may use and disclose PHI as required by federal, state, or local law. Any Disclosure complies with the law and is limited to the requirements of the law.

Public Health Activities: We may use or disclose PHI to public health authorities or other authorized persons to carry out certain activities related to public health, including the following activities:
-To prevent or control disease, injury, or disability.
-To report disease, injury, birth, or death.
-To report child abuse or neglect.
-To report reactions to medications or problems with products or devices regulated by the federal Food and Drug Administration or other activities related to qualify, safety, or effectiveness or FDA-regulated products or activities.
-To locate and notify persons or recalls of products they may be using.
-To notify a person who may have been exposed to a communicable disease in order to control who may be at risk of contracting or spreading the disease.
-To report to your employer, under limited circumstances, information related primarily to workplace injuries or illness, or workplace medical surveillance.

Abuse, Neglect, or Domestic Violence: We may disclose PHI in certain cases to proper government authorities if we reasonably believe that a patient has been a victim of domestic violence, abuse, or neglect.

Health Oversight Activities: We may disclose PHI to a health oversight agency for oversight activities including, for example, audits, investigations, inspections, licensure and disciplinary activities and other activities conducted by health oversight agencies to monitor the health care system, government health care programs, and compliance with certain laws.

Lawsuits and Other Legal Proceedings: We may use or disclose PHI when required by a court or administrative tribunal order. We may also disclose PHI in response to subpoenas, discovery requests, or other required legal process when efforts have been made to advise the patient of the request or to obtain an order protecting the information requested.

Law Enforcement: Under certain conditions, we may disclose PHI to law enforcement officials for the following purposes where the disclosure is:
-About a suspected crime victim if, under certain limited circumstances, we are unable to obtain a person’s agreement because of incapacity or emergency.
-To alert law enforcement of a death that we suspect was the result of criminal conduct.
-Required by law.
-In response to a court order, warrant, subpoena, summons, administrative agency request, or other authorized process.
-To identify or locate a suspect, fugitive, material witness, or missing person.
-About a crime or suspected crime committed at our office.
-In response to a medical emergency not occurring at the office, if necessary to report a crime, including the nature of the crime, the location of the crime or the victim, and the identity of the person who committed the crime.

Coroners, Medical Examiners, Funeral directors: We may disclose PHI to a coroner or medical examiner to identify a deceased person and determine the cause of death. In addition, we may disclose PHI to funeral directors, as authorized by law, so that they may carry out their jobs.

Organ and Tissue Donation: If you are an organ donor, we may use or disclose PHI to organizations that help procure, locate, and transplant organs in order to facilitate an organ, eye, or tissue donation and transplantation.

Research: We 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 a patient for research purposes except in situations where a research project meets specific, detailed criteria established by the HIPAA Privacy Rule to ensure the privacy of PHI.

To avert a Serious Threat to Health and Safety: We may use or disclose PHI in limited circumstances when necessary to prevent a threat to the health or safety of a person or to the public. This disclosure can only be made to a person who is able to help prevent the threat.

Specialized Government Functions: Under certain circumstances we may disclose PHI:
-For certain military and veteran activities, including determination of eligibility for veterans for veterans benefits and where deemed necessary by military command authorities.
-For national security and intelligence activities.
-To help provide protective services for the president and others.
-For the health or safety of inmates an others at correctional institutions or other law enforcement custodial situations for the general safety and health related to corrections facilities.

Disclosures required by HIPAA Privacy Rule: We are required to disclose PHI to the Secretary of the United States Department of Health and Human Services when requested by the Secretary to review our compliance with the HIPAA Privacy Rule. We are also required in certain cases to disclose PHI to you upon your request to access PHI or for an accounting of certain disclosures of PHI about you (those requests are described in Section III of this notice).

OTHER USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION THAT DO NOT REQUIRE YOUR AUTHORIZATION

Workers’ Compensation: We may disclose PHI as authorized by workers’ compensation laws or other similar programs that provide benefits for work-related injuries or illness.

OTHER USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION THAT REQUIRE AUTHORIZATION

All other uses and disclosures of PHI will only be made with written authorization. If a patient has authorized us to use or disclose PHI, the patient may revoke that authorization at any time, except to the extent we have taken action based on the authorization.

II. YOUR RIGHTS REGARDING PROTECTED HEALTH INFORMATION ABOUT YOU

Under federal law, a patient has the following rights regarding his/her PHI:

Right to Request Restrictions: A patient has the right to request additional restrictions on the PHI that we may use for treatment, payment and health care operations. A patient may also request additional restrictions on our disclosure of PHI to certain individuals involved in the patient’s care that otherwise are permitted by the Privacy Rule. We are not required to agree to a patient’s request. If we do agree to the request, we are required comply with our agreement except in certain cases, including where the information is needed to treat the patient in the case of an emergency. To request restrictions, a patient must request in writing to our Privacy Official. The patient will need to include (1) the information to be restricted; (2) how to restrict the information (for example, restricting use to this office, only restricting disclosure to persons outside this office, or restricting both); and (3) to whom those restrictions apply.

Right to Receive Confidential Communications: A patient has the right to request to receive communications regarding PHI in a certain manner or at a certain location. For example, a patient may request that we contact him/her at home, rather than at work. The request must be in writing to our Privacy Official. The patient must specify how he/she would like to be contacted (for example, by regular mail to a post office box and not to the home). We are required to accommodate reasonable requests.

Right to Inspect and Copy: A patient has the right to request the opportunity to inspect and receive a copy of PHI about in certain records that we maintain. This includes medical and billing records but does not include psychotherapy notes or information gathered or prepared for a civil, criminal, or administrative proceeding. We may deny a request to inspect and copy PHI only in limited circumstances. To inspect and copy PHI please contact our Privacy Official. If a patient requests a copy of his/her PHI, we may charge a reasonable fee for the copying, postage, labor and supplies used in meeting the request.

Right to Amend: A patient has the right to request that we amend PHI as long as such information is kept by or for our office. To make this type of request the patient must submit a request in writing to our Privacy Official. The patient must also give us a reason for the request. We may deny a request in certain cases, including if it is not in writing or if the patient does not give us a reason for the request.

Right to Receive an Accounting of Disclosures: A patient has the right to request an “accounting” of certain disclosures that we have made of PHI. 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 the patient’s care; to the patient directly; pursuant to an authorization by the patient or personal representative, or for certain notification purposes (including national security, intelligence, correctional, and law enforcement purposes) and disclosures made before April 14, 2003. If a patient wishes to make such a request, they need to contact our Privacy Official. The first list that a patient requests 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. We will tell the patient about these costs who may choose to cancel a request at any time before costs are incurred.

Right to a Paper Copy of this Notice: A patient has a right to receive a paper copy of our privacy policy at any time. The patient is entitled to a paper copy of our notice even if they have previously agreed to receive this notice electronically.

III. COMPLAINTS

If a patient believes his/her privacy rights have been violated, he/she may file a complaint with us or the Secretary of the United States Department of Health and Human Services. To file a complaint with our office, please contact our Privacy Official at the address and number listed below. We will not retaliate or take action against a patient for filing a complaint.

IV.QUESTIONS

If you have any questions about this notice, please contact our Privacy Official at the address and telephone number listed below.

may contact our Privacy Official at the following address and phone number:
Dawn Bates, Administrator
Simpsonville Family Medicine
1336 Highway 14
Simpsonville SC 29681
(864) 527-8600

This notice was published and first became effective on April 14, 2003.