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Health
Insurance Portability and Accountability Act of 1996 (HIPAA)
K. Paul Gerstenberg, D.O., P.A.
& Chad W. Hammett, M.D.
NOTICE
OF PRIVACY PRACTICES As
Required by the Privacy Regulations Created as a Result of the Health
Insurance Portability and Accountability Act of 1996 (HIPAA) THIS
NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU (AS A PATIENT OF THIS
PRACTICE) MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO YOUR
INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION. PLEASE REVIEW THIS NOTICE
CAREFULLY.
A. OUR COMMITMENT TO YOUR PRIVACY Our practice is dedicated to
maintaining the privacy of your protected health
information (PHI). In conducting our business, we will create records
regarding you and the treatment and services we provide to you. We are
required by law to maintain the confidentiality of health information
that identifies you. We also are required by law to provide you with
this notice of our legal duties and the privacy practices that we
maintain in our practice concerning your PHI.
By federal and state
law, we must follow the terms of the notice of privacy practices that
we have in effect at the time. We realize these laws are complicated,
but we must provide you with the following important information:
• How we may use and disclose your PHI • Your privacy rights
in your PHI • and Our obligations concerning the use and
disclosure
of your PHI. The terms of this notice apply to all records containing
your PHI that are created or retained by our practice. We reserve the
right to revise or amend this Notice of Privacy Practices. Our
practice will post a copy of our
current Notice in our offices in a visible location at all times, and
you may request a copy of our most current Notice at any time.
B. IF YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT: K. Paul
Gerstenberg, D.O., P.A., or Chad W. Hammett, M.D., 2200 Highway 365,
Nederland, Texas 77627 (409)
722-4321
C. WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH
INFORMATION (PHI) IN THE FOLLOWING WAYS
THE FOLLOWING CATEGORIES DESCRIBE THE DIFFERENT WAYS IN WHICH WE MAY
USE AND DISCLOSE YOUR PHI. 1. Treatment. Our practice may use your PHI
to treat you. For example, we may ask you to have laboratory test
(such as blood or urine tests), and we may use the results to help us
reach a diagnosis. We might use your PHI in order to write a
prescription for you, or we might disclose your PHI to a pharmacy when
we order a prescription for you. Many of the people who work for our
practice – including, but not limited to, our doctors and nurses
– may use or disclose your PHI in order to treat you or to
assist others in your treatment. Additionally, we may disclose your PHI
to others who may assist in your care, such as your spouse,
children or parents. Finally, we may also disclose your PHI to other
health care providers for purposes related to your treatment. 2.
Payment. Our practice may use and disclose your PHI in order to bill
and collect payment for the services and items you may receive from us.
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 also my use
and disclose your PHI to obtain payment from third parties that may be
responsible for such costs, such as family members. Also, we may use
your PHI to bill you directly for services and items. We may disclose
your PHI to other health care providers and entities to assist in the
billing and collection efforts. 3. Health Care Options. Our practice
may use and disclose your PHI to operate our business. As examples of
the ways in which we may use and disclose your information for our
operations, our practice may use your PHI to evaluate the quality
of
care you received from us, or to conduct cost management and business
planning activities for our practice. We may disclose your PHI to
other health care providers and entities to assist in their health care
operations. 4. Appointment Reminders. Our practice may use and disclose
your PHI to contact you and remind you of an appointment. 5. Treatment
Options. Our practice may use and disclose your PHI to inform you of
potential treatment options or alternatives. 6. Health-Related Benefits
and Services. Our practice may use and disclose your PHI to inform
you of health-related benefits or services that may be of interest to
you. 7. Release of Information to Family/Friends. Our practice may
release your PHI to a friend or family member that is involves 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
pediatrician’s medical information. 8. Disclosures Required By
Law. Our practice will use and disclose your PHI when we are required
to do so by federal, state or local law.
D. USE AND DISCLOSURE OF YOUR PHI IN CERTAIN SPECIAL CIRCUMSTANCES
The following categories describe unique scenarios in which we may use
or disclose your identifiable health information: 1. Public Health
Risks. Our practice may disclose your PHI to public health authorities
that are authorized by law to collect information for the purpose of:
• maintaining vital records, such as births and deaths •
reporting child abuse or neglect • preventing or controlling
disease, injury or disability • notifying a person regarding
potential exposure to a communicable disease • notifying a person
regarding a potential risk for spreading or contracting a disease
condition • reporting reactions to drugs or problems with products
or devices • notifying individuals if a product or device they may
be using has been recalled • notifying appropriate government
agency (ies) and authority (ies) regarding the potential abuse or
neglect of an adult patient (including domestic violence); however, we
will only disclose this information if the patient agrees or we are
required or authorized by law to disclose this information •
notifying your employer under limited circumstances related primarily
to workplace injury or illness or medical surveillance. 2. Health
Oversight Activities. Our practice may disclose you PHI to a health
oversight agency for activities authorized by law. Oversight activities
can include, for example, investigations, inspections, audits, surveys,
licensure and disciplinary actions; civil, administrative, and criminal
procedures or actions; or other activities necessary for the government
to monitor government programs, compliance with civil rights laws and
the health care system in general. 3. Lawsuits and Similar Proceedings.
Our practice may use and disclose your PHI in response to a court or
administrative order, if you are involved in a lawsuit or similar
proceeding. We also may disclose your PHI in response to a discovery
request, subpoena, or other lawful process by another party involved in
the dispute, but only if we have made an effort to inform you of the
request or to obtain an order protecting the information the party has
requested. 4. Law Enforcement. We may release PHI if asked to do so be
a law enforcement official: • Regarding a crime victim in certain
situations, if we are unable to obtain the person’s agreement
• Concerning a death we believe has resulted from criminal conduct
• Regarding criminal conduct at our offices • In response to
a warrant, summons, court order, subpoena or similar legal process
• To identify/locate a suspect, material witness, fugitive or
missing person • In an emergency, to report a crime (including the
location of victim(s) of the crime, or the description, identity or
location of the perpetrator) 5. Deceased Patients. Our practice may
release PHI to a medical examiner or coroner to identify a deceased
individual or to identify the cause of death. If necessary, we also may
release information in order for funeral directors to perform their
jobs. 6. Organ and Tissue Donation. Our practice may release your PHI
to organizations that handle organ, eye or tissue procurement or
transplantation, including organ donation banks, as necessary to
facilitate organ or tissue donation and transplantation if you are an
organ donor. 7. Research. Our practice may use and disclose your PHI
for research purposes in certain limited circumstances. We will obtain
your written authorization to use your PHI for research purposes
except when an Internal Review Board or Privacy Board has determined
that the waiver of your authorization satisfies the following: (i) the
use or disclosure involves no more than a minimal risk to your privacy
based on the following: (A) an adequate plan to protect the identifiers
from improper use and disclosure; (B) an adequate plan to destroy the
identifiers at the earliest opportunity consistent with the research
(unless there is a health or research justification for retaining the
identifiers or such retention is otherwise required by the law); and
(C) adequate written assurances that the PHI will not be re-used or
disclosed to any other person or entity (except as required by the law)
for authorized oversight of the research study, or for other research
for which the use or disclosure would otherwise be permitted; (ii) the
research could not be conducted without the waiver; and
(iii) the research could not practicably be conducted without access to
and use of the PHI. 8. Serious Threats to Health or Safety. Our
practice may use and disclose your PHI when necessary to reduce or
prevent a 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 organized able to help prevent the
threat. 9. Military. Our practice may disclose your PHI if you are a
member of U.S. or foreign military forces (including veterans) and if
required by the appropriate authorities. 10. National Security. Our
practice may disclose you PHI to federal officials for intelligence
and national security activities authorized by law. We also may
disclose your PHI to federal officials in order to protect the
President, other officials or foreign heads of state, or to conduct
investigations. 11. Inmates. Our practice may disclose you PHI to
correctional institutions or law enforcement officials if you are an
inmate or under the custody of a law enforcement official. Disclosure
for these purposes would be necessary: (a) for the institution to
provide health care services to you, (b) for the safety and security of
the institution, and/or (c) to protect the health and safety of other
individuals. 12. Workers’ Compensation. Our practice may release
your PHI for workers’ compensation and similar programs.
E. YOUR RIGHTS REGARDING YOUR PHI You have the following rights
regarding the PHI that we maintain about you: 1. Confidential
Communications. You have the right to request that our practice
communicate with you about your health and related issues in a
particular manner or at a certain location. For instance, you may ask
that we contact you at home, rather than work. In order to request a
type of confidential communication, you must make a written request to
K. Paul Gerstenberg, D.O.,P.A.,
or Chad W. Hammett, M.D.,
2200 Highway 365, Nederland, Texas 77627
(409) 722-4321 specifying the requested method of contact, or the
location where you wish to be contacted. Our practice will accommodate
reasonable requests. You do not need to give a reason for your request.
2. Requesting Restrictions. You have the right to request a restriction
in our use or disclosure of your PHI for treatment, payment or health
care operations. Additionally, you have the right to request that we
restrict our disclosure of your PHI to 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, you must make your request in writing to K. Paul Gerstenberg,
D.O.,P.A.,
or Chad W. Hammett, M.D.,
2200 Highway 365, Nederland, Texas 77627 (409) 722-4321. Your
request must describe in a clear and concise fashion: (a) the
information you wish restricted; (b) whether you are requesting to
limit our practice’s use, disclosure or both; (c) to whom
you
want the limits to apply. 3. Inspection and Copies. You have the right
to inspect and obtain a copy of the PHI that may be used to make
decisions about you, including patient medical records and billing
records, but not including psychotherapy notes. You must submit your
request in writing to K. Paul Gerstenberg, D.O.,P.A.,
or Chad W. Hammett, M.D.,
2200 Highway 365,
Nederland, Texas 77627 (409) 722-4321 in order to inspect and/or obtain
a copy of your PHI. Our practice may charge a fee for the costs of
copying, mailing, labor and supplies associated with your request. Our
practice may deny your request to inspect and/or copy in certain
limited circumstances; however, you may request a review of our denial.
Another licensed health care professional chosen by us will conduct
reviews. 4. Amendment. Your may ask us to 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, your request must be made in writing
and submitted to K. Paul Gerstenberg, D.O.P.A.,
or Chad W. Hammett, M.D.,,
2200 Highway 365,
Nederland, Texas 77627 (409) 722-4321. You must provide us with a
reason that supports your request for amendment. Our practice will deny
your request if your fail to submit your request (and the reason
supporting your request) in writing. Also, 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 PHI 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.
5. Accounting of Disclosures. All of our patients have the right to
request an “accounting of disclosures.” An
“accounting of disclosures” is a list of certain
non-routine disclosures our practice has made of your PHI for
non-treatment, non-payment or non-operations purposes. Use of your PHI
as part of the routine patient care in our practice is not required to
be documented. For example, the doctor sharing information with the
nurse; or the billing department using your information to file your
insurance claim. In order to obtain an accounting of disclosures, you
must submit your request in writing to K. Paul Gerstenberg, D.O.,P.A.,
or Chad W. Hammett, M.D.,
2200
Highway 365, Nederland, Texas 77627 (409) 722-4321. All requests for an
“accounting of disclosures” must state a time period, which
may not be longer than six (6) years from the date of disclosure and
may not include dates before April 14, 2003. The first list you request
within a 12-month period is free of charge, but our practice may charge
you for additional lists within 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. 6. 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 paper copy of this notice, contact
K. Paul Gerstenberg, D.O.,P.A.,
or Chad W. Hammett, M.D.,
2200 Highway 365, Nederland, Texas 77627
(409) 722-4321. 7. 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 practice, contact K. Paul
Gerstenberg, D.O.,P.A.,
or Chad W. Hammett, M.D.,
2200 Highway 365, Nederland, Texas 77627 (409)
722-4321. All complaints must be submitted in writing. You will not be
penalized for writing a complaint. 8. 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
use 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. Please note, we are required to retain records of your
card.
Again, if you have any questions regarding this notice or our health
information privacy policies, contact: K. Paul Gerstenberg, D.O., P.A.,
or Chad W. Hammett, M.D.,2200
Highway 365, Nederland, Texas 77627 (409) 722-4321
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