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Millennium Neurosurgery, PA
Notice of Privacy Practices
Effective Date: 4/01/2003
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT
YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS
INFORMATION.
PLEASE REVIEW IT CAREFULLY.
If you have any questions about this notice, please contact
the Clinic Administrator at 651-748-1461
OUR OBLIGATIONS:
We are required by law to:
- Maintain the privacy of protected health information
- Give you this notice of our legal duties and privacy practices
regarding health information about you
- Follow the terms of our notice that is currently in effect
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION:
Described below are the ways we may
use and disclose health information that identifies you ("Health
Information"). Except for the following purposes, we will use
and disclose Health Information only with your written permission.
You may revoke such permission at any time by writing to our practice
Privacy Officer.
PERMITTED USES:
We may use and disclose your Health Information for:
Treatment. We may use and disclose Health Information
for your treatment and to provide you with treatment-related health
care services. For example, we may disclose Health Information
to doctors, nurses, technicians, or other personnel who are involved
in your medical care and need the information to provide you with
medical care. We will obtain your consent prior to releasing your
Health Information to providers outside our clinic.
Payment. We may use and disclose Health Information
so that we may bill and receive payment from you, an insurance
company, or a third party for the treatment and services you received.
For example, we may give your health plan information so that
they will pay for your treatment. We will obtain your consent
to send the necessary information to an insurance company or third
party payer.
Health Care Operations. We may use and disclose Health
Information for health care operation purposes. These uses and
disclosures are necessary to make sure that all of our patients
receive quality care and to operate and manage our office. For
example, we may use and disclose information to make sure the
care you receive is of the highest quality. With your consent
we also may share information with other entities that have a
relationship with you (for example, your health plan) for their
health care operation activities
SPECIAL SITUATIONS:
We may use and disclose your Health
Information without your specific authorization for:
Appointment Reminders, Treatment Alternatives and Health
Related Benefits and Services. We may use and disclose Health
Information to contact you and to remind you that you have an
appointment with us. We also may use and disclose Health Information
to tell you about treatment alternatives or health-related benefits
and services that may be of interest to you.
As Required by Law. We will disclose Health Information
when required to do so by international, federal, state or local
law.
To Avert a Serious Threat to Health or Safety. We may
use and disclose Health Information when necessary to prevent
a serious threat to your health and safety or the health and safety
of the public or another person. Disclosures, however, will be
made only to someone who may be able to help prevent the threat.
Research. We may disclose information to outside researchers,
solely for purposes of medical or scientific research, after we
have made reasonable efforts to disclose this intent to you. We
will attempt to obtain your written authorization to such a release
and you may object, in which case your record will not be released.
If we have been unable to contact you, we are allowed to complete
the disclosure of the information.
Business Associates. We may disclose Health Information
to our business associates that perform functions on our behalf
or provide us with services if the information is necessary for
such functions or services. For example, we may use another company
to perform billing services on our behalf. All of our business
associates are obligated to protect the privacy of your information
and are not allowed to use or disclose any information other than
as specified in our contract.
Public Health Risks. We may disclose Health Information
for public health activities. These activities generally include
disclosures to prevent or control disease, injury or disability;
report births and deaths; report child abuse or neglect; report
reactions to medications or problems with products; notify people
of recalls of products they may be using; a person who may have
been exposed to a disease or may be at risk for contracting or
spreading a disease or condition; and the appropriate government
authority if we believe a patient has been the victim of abuse,
neglect or domestic violence.
Health Oversight Activities. We may disclose Health
Information to a health oversight agency for activities authorized
by law. These oversight activities include, for example, audits,
investigations, inspections, and licensure. These activities are
necessary for the government to monitor the health care system,
government programs, and compliance with civil rights laws.
Law Enforcement. We may release Health Information if
asked by a law enforcement official if the information is: (1)
in response to a court order or federal grand jury subpoena; (2)
limited information to identify or locate a suspect, fugitive,
material witness, or missing person; (3) about the victim of a
crime even if, under certain very limited circumstances, we are
unable to obtain the person’s agreement; (4) about a death we
believe may be the result of criminal conduct; (5) about criminal
conduct on our premises; and (6) in an emergency to report a crime,
the location of the crime or victims, or the identity, description
or location of the person who committed the crime.
Coroners, Medical Examiners and Funeral Directors. We
may release Health Information to a coroner or medical examiner.
This may be necessary, for example, to identify a deceased person
or determine the cause of death. We also may release Health Information
to funeral directors as necessary for their duties.
Workers’ Compensation. We may release Health Information
for workers’ compensation or similar programs. These programs
provide benefits for work-related injuries or illness.
National Security and Intelligence Activities. We may
release Health Information to authorized federal officials for
intelligence, counter-intelligence, and other national security
activities authorized by law.
Independent Medical Examination. We may disclose Health
Information created as part of an independent medical examination
to the third party who requested or paid for the examination.
We will obtain your consent prior to use or disclosure of your
Health Information for:
Individuals Involved in Your Care or Payment for Your Care.
We may share Health Information with a person who is involved
in your medical care or payment for your care, such as your family
or a close friend. In an emergency, we also may notify, without
your consent, your family about your location or general condition
or disclose such information to an entity assisting in a disaster
relief effort.
Organ and Tissue Donation. If you are an organ donor,
we may use or release Health Information to organizations that
handle organ procurement or other entities engaged in procurement;
banking or transportation of organs, eyes, or tissues to facilitate
organ, eye or tissue donation; and transplantation.
Military and Veterans. If you are a member of the armed
forces, we may release Health Information as required by military
command authorities. We also may release Health Information to
the appropriate foreign military authority if you are a member
of a foreign military.
Lawsuits and Disputes. If you are involved in a lawsuit
or a dispute, we may disclose, without your consent, Health Information
in response to a court order or federal grand jury subpoena. We
also may disclose Health Information in response to a subpoena,
discovery request, or other lawful process by someone else involved
in the dispute, but only if efforts have been made to tell you
about the request or to obtain an order protecting the information
requested.
Inmates or Individuals in Custody. If you are an inmate
of a correctional institution or under the custody of a law enforcement
official, we may release Health Information to the correctional
institution or law enforcement official. This release would be
if necessary: (1) for the institution to provide you with health
care; (2) to protect your health and safety or the health and
safety of others; or (3) the safety and security of the correctional
institution.
YOUR RIGHTS:
You have the following rights regarding
Health Information we have about you:
Right to Inspect and Copy. You have a right to inspect
and copy Health Information that may be used to make decisions about
your care or payment for your care. This includes medical and billing
records, other than psychotherapy notes. To inspect and copy this
Health Information, you must make your request, in writing, to our
Medical Records Department.
Right to Amend. If you feel that Health Information we
have is incorrect or incomplete, you may ask us to amend the information.
You have the right to request an amendment for as long as the information
is kept by or for our office. To request an amendment, you must
make your request, in writing, to our Medical Records Department.
Right to an Accounting of Disclosures. You have the right
to request a list of certain disclosures we made of Health Information
for purposes other than treatment, payment and health care operations
or for which you provided written authorization. To request an accounting
of disclosures, you must make your request, in writing, to our Medical
Records Department.
Right to Request Restrictions. You have the right to request
a restriction or limitation on the Health Information we use or
disclose for treatment, payment, or health care operations. You
also have the right to request a limit on the Health Information
we disclose to someone involved in your care or the payment for
your care, like a family member or friend. For example, you could
ask that we not share information about a particular diagnosis or
treatment with your spouse. To request a restriction, you must make
your request, in writing, to our Medical Records Department. If
this is a greater restriction than provided by this notice, we are
not required to agree to your request. If we agree, we will comply
with your request unless the information is needed to provide you
with emergency treatment.
Right to Request Confidential Communication. You have the
right to request that we communicate with you about medical matters
in a certain way or at a certain location. For example, you can
ask that we only contact you by mail or at work. To request confidential
communication, you must make your request, in writing, to our Medical
Records Department. Your request must specify how or where you wish
to be contacted. We will accommodate reasonable requests and will
inform you if we are unable to comply with your request.
Right to a Paper Copy of This Notice. You have the right
to a paper copy of this notice. You may ask us to give you a copy
of this notice at any time. Even if you have agreed to receive this
notice electronically, you are still entitled to a paper copy of
this notice. You may obtain a copy of this notice at our web site,
www.millenniumneurosurgery.com.
To obtain a paper copy of this notice, please ask our reception
staff.
CHANGES TO THIS NOTICE:
We reserve the right to change this notice and make the new
notice apply to Health Information we already have as well as any
information we receive in the future. We will post a copy of our
current notice at our office. The notice will contain the effective
date at the bottom of each page.
COMPLAINTS:
If you believe your privacy rights have been violated, you
may file a complaint with our office or with the Secretary of the
Department of Health and Human Services. To file a complaint with
our office, contact our Clinic Administrator. All complaints must
be made in writing. You will not be penalized for filing a complaint.
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