| EAST BAY PEDIATRIC CARDIOLOGY MEDICAL
GROUP, INC.
NOTICE OF PRIVACY PRACTICES
Effective April 14, 2003
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE
USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
This Notice of Privacy Practices describes how East Bay Pediatric
Cardiology Medical Group, Inc. (EBPCMG) may use and disclose your
protected health information in order to carry out treatment, payment
and health care operations and for other purposes permitted or
required by law. It also describes your rights to access and control
your protected health information (PHI). Your protected health
information (PHI) means any of your written or oral health information,
including demographic data, which can be used to identify you.
This is health information that is created or received by your
health care provider, and that relates to your past, present or
future physical or mental health or condition.
EBPCMG is required to abide by the terms of this Notice. However,
EBPCMG may modify the terms of this Notice at any time, and the
new Notice will be effective for all PHI in our possession at the
time of the change, and any received thereafter. Upon request,
we will provide you with any revised Notice.
USES AND DISCLOSURES OF HEALTH INFORMATION
EBPCMG uses PHI about you for purposes of providing treatment,
obtaining payment for treatment, and conducting health care operations.
Your protected health information may be used or disclosed only
for these purposes unless EBPCMG has obtained your authorization
or the use or disclosure is otherwise permitted by the HIPAA Privacy
Regulations or State law. Disclosures of your protected health
information for the purposes described in this Notice may be made
in writing, orally or by facsimile.
A. Treatment. EBPCMG will use and disclose your protected health
information to provide, coordinate, or manage your health care
and any related services. This includes the coordination or management
of your health care with a third party for treatment purposes.
For example, we may disclose your protected health information
or a pharmacy to fill a prescription or to a radiology provider
to order a xray. We may also disclose protected health information
to other physicians who may be treating you or consulting with
your physician with respect to your care. In some cases, EBPCMG
may also disclose your protected health information to an outside
treatment provider for purposes of the treatment activities of
the other provider.
B. Payment. Your PHI
will be used, as needed, to obtain payment for the services
that EBPCMG provides. This
may include certain
communications to your health insurer to get approval for the
treatment that we recommend. For example, if a hospital admission
is recommended,
we may need to disclose information to your health insurer to
get prior approval for the hospitalization. We may also disclose
PHI
to your insurance company to determine whether you are eligible
for benefits or whether a particular service is covered under
your health plan. In order to get payment for your services, we
may
also need to disclose your PHI to your insurance company to demonstrate
the medical necessity of the services or, as required by your
insurance company, for utilization review. We may also disclose
PHI to another
provider involved in your care for the other provider’s
payment activities.
C. Operations. EBPCMG may use or disclose your PHI, as necessary,
for our own health care operations in order to facilitate the function
of the office and its physicians and to provide quality care to
all patients. Health care operations include such activities as:
- Business management and general administrative activities.
- Employee training and performance review activities.
- Quality
assessment and improvement activities.
- Accreditation, certification,
licensing or credentialing activities.
- Review and auditing, including
compliance reviews, medical reviews, legal services
and maintaining compliance programs.
In certain situations, we may also disclose patient information
to another provider or health plan for
their health care operations.
D. Other Uses and Disclosures. As part of treatment,
payment and health care operations, we may also use or disclose
your PHI for
the following purposes:
- To remind you of an appointment.
- To inform you of potential
treatment alternatives or options.
II. Uses and Disclosures Beyond Treatment, Payment, and Health
Care Operations Permitted without Authorization or Opportunity
to Object
Federal privacy rules allow us to disclose your PHI without your
permission or authorization for a number of reasons including the
following:
A. When Legally Required. EBPCMG will disclose your PHI when we
are required to do so by any Federal, State of local law.
B. When there are Risks to
Public Health. EBPCMG may disclose
your PHI for the following public activities and purposes:
- To prevent,
control, or report disease, injury or disability as permitted
by law.
- To report vital events such as birth or death as permitted
or required by law.
- To conduct public health surveillance, investigations
and interventions as permitted or required by law.
- To collect
or report adverse events and product defects, track FDA regulated
products, enable product recalls, repairs or replacements
to the FDA and to conduct post marketing surveillance.
- To notify
a person who has been exposed to a communicable disease or who
may be at risk of contracting or spreading a disease as
authorized by law.
- To report to an employer information about
an individual who is a member of the workforce as legally permitted
or required.
C. To Report
Abuse, Neglect or Domestic Violence. EBPCMG may notify
government authorities if we believe that a patient is the victim
of abuse, neglect or domestic violence. We will make this disclosure
only when specifically required or authorized by law or when the
patient agrees to the disclosure.
D. To Conduct Health Oversight
Activities. EBPCMG may disclose
your PHI to a health oversight agency for activities including
audits; civil, administrative, or criminal investigations, proceedings,
or actions; inspections; licensure or disciplinary actions; or
other activities necessary for appropriate oversight as authorized
by law. We will not disclose your PHI if you are the subject of
an investigation and your health information is not directly related
to your receipt of health care or public benefits.
E. In Connection with Judicial
and Administrative Proceedings.
EBPCMG may disclose your PHI in the course of any judicial or administrative
proceeding in response to an order of a court of administrative
tribunal as expressly authorized by such order or in response to
a subpoena in some circumstances.
F. For Law Enforcement Purposes.
EBPCMG may disclose your PHI to a law enforcement official for
law enforcement purposes as follows:
- As required by law for reporting
of certain types of wounds or
other physical injuries.
- Pursuant to court order, court-ordered
warrant, subpoena, summons or similar process.
- For the purpose
of identifying or locating a suspect, fugitive, material witness
or missing person.
- Under certain limited circumstances, when you
are the victim of a crime.
- To a law enforcement official if the
provider has a suspicion that your death was the result of criminal
conduct.
- In an emergency in order to report a crime.
G. To Coroners,
Funeral Directors, and for Organ Donation. EBPCMG
may disclose PHI to a coroner or medical examiner for identification
purposes, to determine cause of death or for the coroner or medical
examiner to perform other duties authorized by law. We may also
disclose PHI to a funeral director, as authorized by law, in order
to permit the funeral director to carry out their duties. We may
disclose such information in reasonable anticipation of death.
PHI may be used and disclosed for cadaveric organ, eye or tissue
donation purposes.
H. For Research Purposes. EBPCMG may disclose your PHI for research
when the use or disclosure for research has been approved by an
institutional review board or privacy board that has reviewed the
research proposal and research protocols to address the privacy
of your PHI.
I. In the Event of a Serious
Threat to Health or Safety. EBPCMG
may, consistent with applicable law and ethical standards of conduct,
use or disclose your PHI if we believe, in good faith, that such
use or disclosure is necessary to prevent or lessen a serious and
imminent threat to your health or safety or to the health and safety
of the public.
J. For Specified Government
Functions. In certain circumstances,
the Federal regulations authorize EBPCMG to use or disclose your
PHI to facilitate specified government functions relating to military
and veterans activities, national security and intelligence activities,
protective services for the president and others, medical suitability
determinations, correctional institutions and law enforcement custodial
situations.
K. For Worker’s Compensation. EBPCMG may release your PHI
to comply with worker’s compensation law or similar programs.
III. Uses and Disclosures Permitted without Authorization BUT with
Opportunity to Object
EBPCMG may disclose your PHI to your family
member or a close personal friend if it is directly relevant
to the person’s
involvement in your care or payment related to your care. We can
also disclose your PHI in connection with trying to locate or notify
family members or others involved in your care concerning your
location, condition or death.
You may object to these disclosures. If you
do not object to these disclosures or we can infer from the circumstances
that you do
not object or we determine, in the exercise of out professional
judgment, that it is in your best interests for us to make disclosure
of PHI that is directly relevant to the person’s involvement
with your care, we may disclose your PHI as described.
IV. Uses and Disclosures which you Authorize
Other than as stated above, EBPCMG will not disclose your health
information other than with your written authorization. You may
revoke your authorization in writing at any time except to the
extent that we have taken action in reliance upon the authorization.
V. Your Rights
You have the following rights regarding your protected health
information:
A. The right to inspect and
copy your PHI.
You may inspect and obtain a copy of your PHI that is contained
in a designated record
set for as long as we maintain the PHI. A “designated record
set” contains medical and billing records and any other records
that EBPCMG and its physicians use for making decisions about you.
Under Federal law, however, you may not inspect or copy the following
records: psychotherapy notes; information compiled in reasonable
anticipation of, or for use in, a civil, criminal, or administrative
action or proceeding; and PHI that is subject to a law that prohibits
access to PHI. Depending on the circumstances, you may have the
right to have a decision to deny access reviewed.
EBPCMG may deny your request to inspect or copy your PHI if, in
our professional judgment, we determine that the access requested
is likely to endanger your life or safety or that of another person,
or that it is likely to cause substantial harm to another person
referenced within the information. You have the right to request
a review of this decision.
To inspect and copy your medical information, you must submit
a written request to the Privacy Officer whose contact information
is listed on the last pages of this Notice. If you request a copy
of your information, we may charge you a fee for the costs of copying,
mailing or other costs incurred by us in complying with complying
with your request.
Please contact our Privacy Officer if you have questions about
access to your medical record.
B. The right to request a restriction
on uses and disclosures of your PHI. You may ask us not to use or disclose certain parts
of your protected health information for the purposes of treatment,
payment or health care operations. You may also request that we
not disclose your PHI to family members or friends who may be involved
in your care or for notification purposes as described in this
Notice of Privacy Practices. Your request must state the specific
restriction requested and to whom you want the restriction to apply.
EBPCMG is not required to agree to a restriction that you may
request. We will notify you if we deny your request to a restriction.
However, if we do agree to the requested restriction, we may not
use or disclose your PHI in violation of that restriction unless
it is needed to provide emergency treatment. Under certain circumstances,
we may terminate our agreement to a restriction. You may request
a restriction by contacting the Privacy Officer.
C. The right to request to
receive confidential communications from us by alternative means
or at an alternative location. You
have the right to request that EBPCMG communicate with you in certain
ways. We will accommodate reasonable requests. We may condition
this accommodation by asking you for information as to how payment
will be handled or specification or an alternative address or other
method of contact. We will not require you to provide an explanation
for your request. Requests must be made in writing to our Privacy
Officer.
D. The right to have your physician
amend your protected health information. You may request an amendment of PHI about you in a
designated record set for 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 statement of disagreement with us and we may prepare a rebuttal
to your statement and will provide you with a copy of any such
rebuttal. Requests for amendment must be in writing and must be
directed to our Privacy Officer. In this written request, you must
also provide a reason to support the requested amendments.
E. The right to receive an
accounting. You have the right to request
an accounting of certain disclosures of your PHI made by EBPCMG.
This right applies to disclosures for purposes other than treatment,
payment or health care operations as described in this Notice of
Privacy Practices. We are also not required to account for disclosures
that you requested, disclosures that you agreed to by signing an
authorization form, to friends or family members involved in your
care, or certain other disclosures we are permitted to make without
your authorization. The request for an accounting must be made
in writing to our Privacy Officer. The request should specify the
time period sought for the accounting. We are not required to provide
an accounting for disclosures that take place prior to April 14,
2003. Accounting requests may not be made for periods of time in
excess of six years. We will provide the first accounting you request
during any 12-month period without charge. Subsequent accounting
requests may be subject to a reasonable cost-based fee.
F. The right to obtain a paper
copy of this notice. Upon request,
you have the right to a paper copy of this Notice.
VI. Our Duties
EBPCMG is required by law to maintain the privacy of your PHI
and to provide you with this Notice of our duties and privacy practices.
We are required to abide by the terms of this Notice as may be
amended from time to time. We reserve the right to change the terms
of this Notice and to make the new Notice provisions effective
for all PHI that we maintain. If EBPCMG changes its Notice, we
will provide a copy of the revised Notice by sending a copy of
the Revised Notice via regular mail or through in-person contact.
VII. Complaints
You have the right to express complaints to EBPCMG and to the
Secretary of Health and Human Services if you believe that your
privacy rights have been violated. You may complain to the provider
by contacting the Privacy Officer verbally or in writing, using
the contact information below. We encourage you to express any
concerns you may have regarding the privacy of your information.
You will not be retaliated against in any way for filing a complaint.
VIII. Contact Person
The EBPCMG's contact
person for all issues regarding patient privacy and your rights
under the Federal
privacy standards is the Privacy Officer. Information regarding
matters covered by this Notice can be requested by contacting the
Privacy Officer. Complaints against the provider can be mailed
to the Privacy Officer by sending it to:
East Bay Pediatric Cardiology Medical Group, Inc.
747 52nd Street
Oakland, CA 94609
Attn: Privacy Officer
The Privacy Officer can be contacted by telephone at 510-428-3885
x2986.
IX. Effective Date
This Notice is effective April 14, 2003.
|
