MID ATLANTIC SPINE NOTICE OF PRIVACY PRACTICES
As Required By The Privacy Regulation Created as a Result of the Health Insurance Portability and Accountability Act of 1996 (HIPPA).
THIS NOTICE DESCRIBES HOW MID ATLANTIC SPINE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU AND HOW YOU CAN GET ACCESS TO YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION.
PLEASE REVIEW THIS NOTICE CAREFULLY.
OUR COMMITMENT TO YOUR PRIVACY
Mid Atlantic Spine and Pain Physicians is dedicated to maintaining the privacy of your individually identifiable health information (IIHI). In the course of treating you, we will create records of the treatment and services we provide you. We are required by law to maintain the confidentiality of health information that identifies you. We are also required by law to provide you with this notice of our legal duties and our privacy practices.
The terms of this notice apply to all records containing your IIHI that we create or retain in our practice. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this Notice will be effective for all of your records created or maintained by this office in a visible location at all times. And you may request a copy of our most current Notice at any time.
IF YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT OF OUR PRIVACY OFFICERS:
FOR CONCERNS OR QUESTIONS CONCERNING CARE PROVIDED AT THE NEWARK AND MILFORD, DELAWARE OFFICES, PLEASE CONTACT THE PRIVACY OFFICIAL, Mid Atlantic Spine and Pain Physicians, 100 Biddle Avenue, Suite 101, Newark, Delaware 19702.
I. WE MAY USE AND DISCLOSE YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION (IIHI) IN THE FOLLOWING WAYS:
The following categories describe the different ways in which we may use and disclose your IIHI:
1. Treatment. Our practice may use your IIHI to treat you. We may ask you to have diagnostic studies (such as an MRI or x-ray), and we will use the results of these tests to help us reach a diagnosis. We may use your IIHI in order to write a prescription for you, or we may disclose your IIHI to a pharmacy when we order a prescription for you. Many of the people who work for our practice – including, but not limited to, assist others in your treatment. Additionally, we may disclose your IIHI to others, upon you designation.
2. Payment. Our practice may use and disclose your IIHI in order to bill and collect payments for the services and items that we provide. 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 detail regarding your treatment to determine if your insurer will cover, or pay for, your treatment. We may also use and disclose your IIHI to obtain payment from third parties that may be responsible for such costs. Also, we may use your IIHI to bill you directly for services and items.
3. Health Care Operations. Our practice may use and disclose your IIHI to operate our business operations. These uses and disclosures are necessary to monitor the quality of care that we provide. Our practice may use your IIHI to evaluate Mid-Atlantic Spine’s services, including the performance of our staff.
4. Appointments. In order to protect your IIHI, appointments, cancellations, and rescheduling cannot be made with the answering service. All calls of this nature must be made during office hours between 8:00am to 5:00pm and must be made directly with practice personnel.
5. Appointment Reminders. Our practice may use and disclose your IIHI to contact you and remind your of an appointment either by mail or phone, including leaving messages on your designated answering machine.
6. Test Results. Normally, test results will not be communicated to the patient over the phone. These results will typically be discussed in the office. Should you desire to have results mailed to your home or any other desired location, a specific request must be submitted in writing.
7. Prescriptions. Prescription requests must be made during office hours only (8:00am to 5:00pm). The practice’s answering service is not authorized to accept prescription requests.
8. Release of Information to Family/Friends. Our practice may release your IIHI to a friend or family member who is involved in your care, or who assists in taking care of you. For example, a parent or guardian may obtain information concerning the course of your treatment, provider consent has been provided.
9. Disclosures Required by Law. Our practice will use and disclose your IIHI when we are required to do so by federal or state law. Some of these required disclosures are listed in section II (1) below.
II. USE AND DISCLOSURE OF YOUR INDIVIDUAL IDENTIFIABLE HEALTH INFORMATION IN SPECIFIC SPECIAL CIRCUMSTANCES.
The following categories describe unique scenarios in which we may use or disclose your individually identifiable health information:
- Public Health Risks. Our practice may be required to disclose your IIHI 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 certain government agencies about the diagnoses of certain conditions that create a public risk,
- Notifying a person regarding a potential risk for spreading or contracting a disease or 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 agencies and authorities 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, and
- Notifying your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance.
- Health Oversight Activities. Our practice may disclose your IIHI 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 and actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.
- Lawsuits and Similar Proceedings. Our practice may use and disclose your IIHI in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding. We may also disclose your IIHI 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.
- Law Enforcement. We may release your IIHI if asked to do so by a law enforcement official:
- Regarding a crime victim in certain situation, 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, and
- In an emergency, to report a crime (including the location or victim(s) of a crime, or the description, identity or location of the perpetrator).
- Deceased Patients. Our practice may release your IIHI to a medical examiner or coroner to identify a deceased individual or to identify the cause of death. If necessary, we may also release information in order for funeral directors to perform their jobs.
- Organ and Tissue Donation. Our practice may release your IIHI to organizations that handle organ, eye or tissue procurement or transplantation, including organ donation banks, as necessary to facilitate organ or tissue donation or transplantation if you are and organ donor.
- Research. Our practice may use and disclose your IIHI for research purposes in certain limited circumstances. We will obtain your written authorization to use your IIHI for research purposes except when: (a) our use or disclosure was approved by an Institutional Review Board or Privacy Board; (b) we obtain the oral or written agreement of a researcher that (i) the information being sought is necessary for the research study; (ii) the use or disclosure of your IIHI is being used only for the research; and (iii) the researcher will not remove any of your IIHI from our practice; or (c) the IIHI sought by the researcher relates only to decedents and the researcher agrees either orally or in writing that the use or disclosure is necessary for the research and, if we request it, to provide use with proof of death prior to access of IIHI of the decedents.
- Serious Threats to Health or Safety. Our practice may use and disclose your IIHI when necessary to reduce or prevent a serious 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 organization able to help prevent the threat.
- Military. Our practice may disclose your IIHI if you are a member of U.S. or foreign military force (including veterans) and if required by the appropriate authorities.
- National Security. Our practice may disclose your IIHI to federal officials for intelligence and national security activities authorized by law. We may also disclose your IIHI to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.
- Inmates. Our practice may disclose your IIHI 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 your health and safety or the health and safety of other individuals.
- Worker’s Compensation. Our practice may release your IIHI for workers’ compensations and similar programs.
III. YOUR RIGHTS REGARDING YOUR IIHI
You have the following rights regarding the IIHI that we maintain about you:
- Confidential Communications. You have the right to request that our practice communicate with you about your health and related issues in a manner or at a certain location. For instance, you may ask that we contact you at home, rather then at work. In order to request a type of confidential communication, you must make a written request to the Privacy Officer,Mid Atlantic Spine and Pain Physicians, 100 Biddle Avenue, Suite 101, Newark, Delaware 19702, specifying the requested method of contact, or the location where you wish to be contacted. Our practice will accommodate all reasonable requests. You do not need to give a reason for your request.
- Requesting Restrictions. You have the right to request a restriction in our use or disclosure of your IIHI for treatment, payment or health care operations. Additionally, you have the right to request that we restrict our disclosure of your IIHI only to certain individuals involved in your care or for the payment of our 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 on our use or disclosure of your IIHI, you must make your request in writing to the Privacy Officer, Mid Atlantic Spine and Pain Physicians, 100 Biddle Avenue, Suite 101, Newark, Delaware 19702. Your request must describe in a clear and concise fashion in the following items:
(a) the information you wish restricted;
(b) whether you are requesting to limit our practice’s use, disclosure or both; and
(c) to whom you may want the limits apply.
- Inspection and Copies. You have the right to inspect and obtain a copy of the IIHI 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 the Privacy Officer, Mid Atlantic Spine and Pain Physicians, 100 Biddle Avenue, Suite 101, Newark, Delaware 19702, in order to inspect and/or obtain a copy of your IIHI. 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 and another licensed health care professional chosen by us will conduct reviews.
- Amendment. Your may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request and amendment as long as the information is kept for our practice. To request an amendment, your request must be made in writing and submitted to the Privacy Officer, Mid Atlantic Spine and Pain Physicians, 100 Biddle Avenue, Suite 101, Newark, Delaware 19702. You must provide us this a reason that supports your request for amendment. Our practice will deny your request if you fail to submit your request (and 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 IIHI Kept by or for the practice; (c) not party of the IIHI which you would be permitted to inspect and copy; (d) not created by our practice, unless the individual or entity that created the information is not available to amend the information.
- Accounting of Disclosures. All of our patients have the right to request and “accounting of disclosures.” An “accounting of disclosures” is a list of certain non-routine disclosures our practice has made of your IIHI for non-treatment or operations purposes. Use of your IIHI 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 the Privacy Officer, Mid Atlantic Spine and Pain Physicians, 100 Biddle Avenue, Suite 101, Newark, Delaware 19702. All requests for an “accounting of disclosures” must state a time period, which may not be longer then six (6) years form 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.
- 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 given time. To obtain a paper copy of this Notice, contact the Privacy Officer, Mid Atlantic Spine and Pain Physicians, 100 Biddle Avenue, Suite 101, Newark, Delaware 19702.
- 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 the Privacy Officer, Mid Atlantic Spine and Pain Physicians, 100 Biddle Avenue, Suite 101, Newark, Delaware 19702. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
- 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 us regarding the use and disclosure of your IIHI may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your IIHI for any reasons described in the authorization. Please note that we are required to retain records of your care.
Again, if you have any questions regarding this Notice or our health information privacy policies, please contact the Privacy Officer, Mid Atlantic Spine and Pain Physicians, 100 Biddle Avenue, Suite 101, Newark, Delaware 19702.