Privacy Policy
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.This Notice of Privacy Practices is provided to you as a requirement of the Health Information Portability and Accountability Act (HIPPA). It describes how we may use or disclose your protected health information, with whom that information may be shared, and the safeguards we have in place to protect it. This notice also describes your rights to access and amend you protected health information.
ACKNOWLEDGEMENT OF RECEIPT OF THIS NOTICEPlease sign the Acknowledgement of Receipt of this notice. Our intent is to make you aware of the possible uses and disclosures of your protected health information and your privacy rights, the delivery of you health care services will in no way be conditioned upon your signed acknowledgement.
OUR DUTIES TO YOU REGARDING PROTECTED HEALTH INFORMATION"Protected health information" is individually identifiable health information. This information includes demographics (age, address, e-mail address) and relates to your past, present, or future physical or mental health or condition and related health care services. We are required by law to (1) make sure that your protected health information is kept private; (2) give you this notice of our legal duties and privacy practices related to the use and disclosure of you protected health information; (3) follow the terms of the notice currently in effect; (4) communicate any changes in the notice to you. We reserve the right to change this notice. Its effective date is at the top of the first page and at the bottom of the last page. We reserve the right to make the revised or changed notice effective for health information we already have about you as well as any information we receive in the future. You may also obtain a Notice of Privacy Practices by calling our Privacy Officer and requesting a copy be mailed to you, or asking for a copy at your next appointment.
HOW WE MAY USE OR DISCLOSE YOUR PROTECTED HEALTH INFORMATIONRequired Uses and Disclosures
By law, we must disclose your health information to you unless it has been determined by a competent medical authority that it would be harmful to you. We must also disclose health information to the Secretary of the Department of Health and Human Services (DHHS) for investigations or determinations of our compliance with laws on the protection of your health information.
Treatment
We 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 example, we may disclose your protected health information, as necessary from time-to-time to another physician or health care provider (for example, a specialist, pharmacist or laboratory) who, at the request of your physician, becomes involved in your care by providing assistance with your health care diagnosis or treatment.
Payment
Your protected health information will be used, as needed, to obtain payment for your health care services. This may include certain activities that may be required before your insurance carrier, for example, approves or pays for the health care services recommended for you such as determining eligibility or coverage for benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example, obtaining approval for a hospital stay might require that your relevant protected health information be disclosed to obtain approval for the hospital admission.
Health Care Operations
We may use or disclose, as needed, your protected health information to support the daily activities related to health care. These activities include, but are not limited to, quality assessment activities, investigations oversight or staff performance reviews, performing auditing functions, resolving internal grievances, licensing, communications about a product or service, conducting or arranging for other health care related activities and other uses specifically authorized by law. For example, we may call you by name in the waiting room when your physician is ready to see you. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment.
We will share your protected health information with third-party "business associates": who perform various activities (for example, billing, transcription services) for us. The business associates will also be required to protect your health information.
We may used or disclose your protected health information, as necessary, to provide you with information about treatment alternatives or other health-related benefits and services that might interest you. For example, your name and address may be used to send you a newsletter about us and the services we offer. We may also send you information about practices or services that we believe might benefit you.
Required by Law
We may use or disclose your protected health information if law or regulation requires the use or disclosure.
Public Health
We may disclose your protected health information to a public health authority who is permitted by law to collect or receive the information. The disclosure may be necessary to (1) prevent or control disease, injury or disability.; (2) report births and deaths; (3) report child abuse or neglect; (4) report reactions to medications or problems with products; (5) notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and (6) notify the government authority if we believe a patient has been the victim of abuse, neglect or domestic abuse.
Communicable Diseases
We may disclose your protected health information, if authorized by law, to a person who might have been exposed to a communicable disease or might otherwise be at risk of contracting or spreading the disease or condition.
Health Oversight
We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations and inspections. These health oversight agencies might include government agencies that oversee the health care system, government benefit programs, other government regulatory programs, and civil right laws.
Food and Drug Administration
We may disclose your protected health information to a person or company required by the Food and Drug Administration to (l) report adverse events, product defects, or problems and biologic product deviations; (2) track products: (3) enable product recalls; (4) make repairs or replacement; and (5) conduct post-marketing surveillance as required.
Legal Proceedings
We may disclose protected health information during any judicial or administrative proceeding, in response to a court order or administrative tribunal (if such a disclosure is expressly authorized), and in certain conditions in response to a subpoena, discovery request, or other lawful process.
Law Enforcement
We may disclose protected health information for law enforcement purposes, including (I) responses to legal proceedings; (2) information requests for identification and locations; (3) circumstances pertaining to victims of a crime; (4) deaths suspected from criminal conduct; (5) crimes occurring at our site; and (6) medical emergencies (not on our premises) believed to result from criminal conduct.
Coroners, Funeral Directors and Organ Donations
We may disclose protected health information to coroners or medical examiners for identification to determine the cause of death or for the performance of other duties authorized by law. We may also disclose protected health information to funeral directors as authorized by law. Protected health information may be used and disclosed for cadaveric organ, eye, or tissue donations.
Research
We may disclose your protected health information to researchers when authorized by law, for example, if their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of you protected health information.
Criminal Activity
Under applicable Federal and State laws, we may disclose your protected health information if we believe that its use or disclosure is necessary to prevent or lessen a serious and imminent threat to the safety of a person or the public. We may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.
Military Activity and National Security
When the appropriate conditions apply, we may use or disclose protected health information on individuals who are Armed Forces personnel (1) for activities believed necessary by appropriate military command authorities to ensure the proper execution of the military mission including determination of fitness for duty (2) for determination by the Department of Veteran Affairs (VA) of eligibility for benefits; or (3) to a foreign military authority of you are a member of that foreign military service. We may also disclose your protected health information to authorized Federal officials for conducting national security and intelligence activities including protective services to the President or others.
Workers' Compensation
We may disclose your protected health information to comply with workers' compensation laws and other similar legally established programs.
Inmates
We may use or disclose your protected health information if you are an inmate of a correctional facility and our treatment facility created or received your protected health information while providing care to you. This disclosure would be necessary (1) for the institution to provide you with health care; (2) for your health and safety or the health and safety of others; or (3) for the safety and security of the correctional facility.
Prescription Monitoring in the State of VA
We may use a prescription monitoring program instituted by the Drug Enforcement Agency and State of Virginia to review history of medication prescription data/information obtained from a statewide prescription database.
Parental Access
Some state laws concerning minors permit or require disclosure of protected health information to parents, guardians, and persons acting in a similar legal status. We will act consistently with the law of the state where the treatment is provided and will make disclosures following such sate laws.
For any other activity or purpose not listed herein or as otherwise permitted by law, we must obtain your written permission (authorization) prior to using or sharing you protected health information. If you provide a written authorization and you change your mind, you may revoke your authorization in writing at any time. Once an authorization has been revoked, we will no longer use or share the protected health information as outlined in the authorization form; however, you should be aware that we may not be able to retract a use or disclosure that was previously made on a valid authorization.
Individuals Involved in Your Health Care
Unless you object, we may disclose to a member of your family, a relative, a close friend, or any other person you identify, your protected health information that directly related to that person's involvement in you health care. We may also give information to someone who helps pay for your care. Additionally, we may use or disclose protected health information to notify or assist in notifying a family member, personal representative, or any other person who is responsible for your care, of your location, general condition, or death. Finally, we may use or disclose your protected health information to an authorized public or private entity in disaster relief efforts and coordinate uses and disclosures to family or other individuals involved in your health care.
You may exercise the following rights by submitting a written request or electronic message to our Privacy Officer. Depending on your request, you may also have rights under the Privacy Act of 1974. The Privacy Officer can guide you in pursuing these options. Please be aware the Privacy Office might deny your request; however, you may seek a review of denial.
Right to Inspect and Copy
You may inspect and obtain a copy of your protected health information that is contained in a "designated records set" for as long as we maintain the protected health information. A designated record set contains medical and billing records and any other records that we use for making decisions about you.
This right does not include inspection and copying of the following records: psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding; and protected health information that is subject to law that prohibits access to protected health information.
If you request a copy of your designated record set, a fee for the costs of the c copying, mailing or other associated supplies may be charged. Under certain circumstances, we may deny your request to inspect or obtain a copy of your protected health information. If we deny your request, we will notify you in writing and may provide you the option to have the denial reviewed.
Right to Request Restrictions
You may ask us not to use or disclose any part of your protected health information for treatment, payment or health care options. Your request must be made in writing to our Privacy Office where you wish the restriction instituted. Restrictions are not transferable to our other facilities, if any, unless requested by you to bf throughout all of our facilities. In your request, you must tell us (1) what information you want restricted; (2) whether you want to restrict our use, disclosure or both; (3) to whom you want the restriction to apply, for example, disclosures to your spouse; and (4) an expiration date.
Right to Request Confidential Communications
You may request that we communicate with you using alternative means or at an alternative location. We will not ask you the reason for your request. We will accommodate reasonable requests, when possible.
Right to Request Amendment
If you believe that the information we have about you is incorrect or incomplete, you may request an amendment to your protected health information as long as we maintain this information. While we will accept requests for amendment, we are not required to agree to the amendment.
Right to Obtain a Copy of this Notice
You may obtain a paper copy of this notice from us or view it electronically on our web site, if any, listed in the Contact Information of the Notice.
This Notice of Privacy Practices is provided to you as a requirement of HIPPA. There are several other privacy laws that also apply including the Freedom of Information Act, The Privacy Act, and the Alcohol, Drug Abuse, and Mental Health Administration Reorganization Act. These laws have not been superseded and have been taken into consideration on developing our policies and this notice of how we will use and disclose your protected health information.
COMPLAINTSIf you believe these privacy rights have been violated, you may file a written complaint with out Privacy Office or the Department of Health and Human Services No retaliation will occur against you for filing a complaint.
CONTACT INFORMATIONFor further information about the complaint process, or for further explanation of this document, contact:
Administrator
Capitol Spine & Pain Centers,
3031 Javier Road, Suite 210, Fairfax VA 22031
Phone: 703-914-8000
Email: adm@treatingpain.com
Web: www.treatingpain.com
Policy Effective Date: 4/14/03