Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION
We are committed to preserving the privacy of your health information generated and maintained by Lynchburg Pulmonary Associates, Inc. We are required by law to maintain the privacy of your health information and provide you with this notice of our legal duties and privacy practices with respect to your protected health information. Lynchburg Pulmonary Assoc. will abide by the terms of this notice; however, we reserve the right to change the terms of this notice and to make a new notice effective with respect to your health information that we maintain. You may request a copy of the revised notice by contacting our office. This notice describes the ways in which we may use or disclose your health information and also describes your rights and our duties regarding use and disclosure of your health information.
WRITTEN ACKNOWLEDGMENT
You will be asked to sign a statement acknowledging receipt of a copy of this notice.
USES AND DISCLOSURES OF YOUR HEALTH INFORMATION
The following describes the different ways we may use and disclose your health information and includes some examples of types of uses or disclosures:
Treatment: Your medical information may be used and disclosed by us for providing and coordinating your healthcare. We may disclose health information about you to doctors, nurses, healthcare students, and other providers involved in your care and treatment. For example, a nurse may disclose your health information to an x-ray technician or another physician providing medical treatment to you.
Payment: Your medical information may be used and disclosed by us for the purpose of determining coverage, billing, claims management, reimbursement and collections of unpaid account or to assist another heath care provider in obtaining payment for their health care bills. For example, we may send a bill to your insurance company that may include information that identifies you, your diagnosis and any procedures performed. 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.
You may request non-disclosure of your information if you pay in full, out-of-pocket, prior to the delivery of the service.
Health Care Operations: Your medical information may be used and disclosed during routine operations including quality assessment review, employee performance review, training of healthcare students, licensing, and other activities necessary for our operations. For example, we may use your health information to review our treatment and services and to evaluate our performance in providing you care.
Appointment Reminders: We may use or disclose your health information to contact you to remind you of your appointment by mail or by telephone.
Treatment Alternatives: We may use or disclose your health information for purposes of contacting you to inform you of treatment alternatives or other health related benefits and services that may be of interest to you. For example, we may contact a home health agency to discuss services they provide which might assist you.
Business Associates: We will share your health information with “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 other way than we allow.
Individuals Involved in Your Health Care: Unless you object, we may disclose your health information to a member of your family, a close friend or any other person you identify who is directly involved 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 also use or disclose your medical information to a person or organization to assist in disaster relief efforts for the purpose of notifying to family or other individuals involved in your health care regarding your condition, status and location.
Required by Law: We may use and/or disclose your health information to the extent that the use and disclosure is required by law and the use or disclosure complies with and is limited to the relevant requirements of such law.
Public Health Activities: We may disclose your health information to public health authorities authorized to receive and collect health information for the purpose of controlling disease, injury or disability. We may also disclose your health information at the direction of the public health authority, to any other government agency that is collaborating with the public health authority.
Food and Drug Administration: We may disclose your medical information to a person subject to the jurisdiction of the Food and Drug Administration to collect or report product defects or problems, track products, enable product recalls/repairs/replacements or to conduct post marketing surveillance, etc.
Communicable Disease: We may disclose your medical information 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 if authorized by law to notify such person.
Required by Law: We may use and/or disclose your health information to the extent that the use and disclosure is required by law and the use or disclosure complies with and is limited to the relevant requirements of such law.
Public Health Activities: We may disclose your health information to public health authorities authorized to receive and collect health information for the purpose of controlling disease, injury or disability. We may also disclose your health information at the direction of the public health authority, to any other government agency that is collaborating with the public health authority.
Food and Drug Administration: We may disclose your medical information to a person subject to the jurisdiction of the Food and Drug Administration to collect or report product defects or problems, track products, enable product recalls/repairs/replacements or to conduct post marketing surveillance, etc.
Communicable Disease: We may disclose your medical information 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 if authorized by law to notify such person.
Organ Donation: We may disclose your health information to organ procurement organizations or other entities engaged in the procurement, banking or transplantation of cadaver organs, eyes or tissue for the purpose of facilitating organ, eye or tissue donation and transplantation.
Criminal Activity: Consistent with applicable laws and ethical conduct, we may disclose your medical information if we believe, in good faith, that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person in the public. We may also disclose your medical information if it is necessary for law enforcement authorities to identify or apprehend an individual.
Military Activity and National Security: We may use or disclose health information of individuals who are Armed Forces personnel for activities deemed necessary by appropriate military command authorities. We may also disclose your health information for the purposes of a determination by the Department of Veteran Affairs of your eligibility for benefits or to foreign military authority if you are a member of that foreign military service. We may also disclose your medical information to authorized federal officials for purposes of national security and intelligence activities, including for the provision of protective services to the President or other persons as authorized by the law.
Worker’s Compensation: Your medical information may be disclosed to the extent necessary to comply with laws relating to worker’s compensation or as required by laws that provide benefits for work related injuries or illness.
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.
Research: We may disclose your health information for research purposes when it has been established that the research meets the requirements of federal and state laws.
Use and disclosure of your medical information for any other reason other than those set forth above will be made only with your written authorization. You may revoke your authorization in writing at any time. You understand, however, the revocation will not apply to any actions we have already taken.
Marketing/ Fundraising: Any disclosures of protected health information that we make for marketing purposes or disclosures which constitute the sale of protected health information will require an authorization. You have the right to opt out of any communication involving fundraising.
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.
Right to inspect and copy your medical information: You may inspect and obtain a copy of your medical information that may be used to make decisions about your health care. Usually this information includes medical and billing records, but does not include 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. You must submit your request in writing. We may deny your request in limited circumstances. You may request to have this decision reviewed. We may charge a fee for the cost of copying, postage, or other supplies associated with your request. Please contact our Privacy Officer if you have questions about access to your medical record.
Right to request restrictions: You may request a restriction or limitation on the health information that we use or disclose about you for purposes of treatment, payment or health care operations. You may also request that your health information not be disclosed to family members or friends who may be involved in your care. Your request must state the specific restriction and to whom the restriction is to apply.
We are not required to agree to your request, except for a restriction on a disclosure to a health plan where services have been paid in full, out-of-pocket. If we do agree to your request, we will abide by the restriction unless the information is needed to provide emergency treatment to you or unless we otherwise notify you that we can no longer honor your request. You must make your request in writing to our Privacy Officer.
Right to request confidential communications: You may request that we communicate with you about your health care in a certain way or at certain location. You must make your request in writing to our Privacy Officer and specify how or where you wish to be contacted. 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.
Right to request amendment of your health information: If you feel your health information maintained by us 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 maintain this information. To request an amendment, your request must be made in writing and submitted to our Privacy Officer. In addition, you must provide a reason to support your request. We may deny your request for an amendment. If we deny your request, you have the right to file a disagreement with us.
Right to receive an accounting of disclosures: This accounting of disclosures is for purposes other than treatment, payment or health care operations as described in this Notice of Privacy Practices. It excludes information we may disclose have pursuant to your authorization or made directly to you. The right to receive this information is subject to certain exceptions, restrictions and limitations. To receive this listing, your request must state a time period, which may not be longer than six years and may not include dates prior to April 14, 2004. You must submit your request in writing to our Privacy Officer.
Right to a paper copy of this notice: You may ask us to give you a paper copy of this notice at any time. Please request one from our Privacy Officer or request one when you are in the office.
Right to receive notification in the event of a breach: You will receive a notification of any breaches of your unsecured protected health information.
Notice of Organized Health Care Arrangement
We are a participant in Archetype Health (Archetype). Archetype, a clinically integrated network, is an organized health care arrangement under HIPAA. An organized health care arrangement is an organized system of health care in which the participants jointly conduct health care operations functions, such as utilization review, quality assessment and improvement activities, or payment activities. As of the date of this notice, a current list of Archetype’s participants who participate in the
organized health care arrangement, their locations of operations, and more information about Archetype may be found at www.archetypehealth.com.
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 assist you. You may file a complaint in writing to include as much detail as possible why you believe your privacy rights were violated. 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.
PRIVACY CONTACT:
If you have any questions about this Notice, Please contact our Privacy Officer. Our privacy Officer will discuss with you any of your privacy questions, concerns or complaints.
EFFECTIVE DATE OF THIS NOTICE: April 14, 2003
Revised 8/8/2013:lm
Revised 11/18/2013: sch
Revised 12/04/2015:sch