THIS
NOTICE DESCRIBES HOW CHIROPRACTIC AND MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
AND HOW YOU CAN GET ACCESS TO THAT INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.
Steven M. Horwitz, D.C., a
Maryland Chiropractic Practice (the “Practice”), in accordance with applicable
federal and state law, is committed to maintaining the privacy of your
protected health information (“PHI”).
Your PHI includes information about your health condition and the care
and treatment you receive from the Practice.
This Notice explains how your PHI may be used and disclosed to third
parties. This Notice also details your
rights regarding your PHI.
HOW
THE PRACTICE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION (PHI)
The Practice, in accordance
with this Notice and without asking for your express consent or authorization
may use and disclose your PHI for the purposes of:
·
Treatment – To
provide you with the health care you require, the Practice may use and disclose
your PHI to those health care professionals, whether on the Practice’s staff or
not, so that it may provide, coordinate, plan and manage your health care. For example, a chiropractor treating you
for lower back pain may need to know and obtain the results of your latest
physician examination or last treatment.
·
Payment
– To get paid for services provided to you, the Practice may provide
your PHI, directly or through a billing service, to a third party who may be
responsible for your care, including insurance companies and health plans. If necessary, the Practice may use your PHI
in other collection efforts with respect to all persons who may be liable for
the Practice’s bills related to your care.
For example, the Practice may need o provide the Medicare program with
information about health care services that you received from the Practice so
that the Practice can be reimbursed.
The Practice may also need to tell your insurance plan about treatment
you are going to receive so that it can determine whether or not it will cover
the treatment expense.
·
Health
Care Operations – To operate in accordance with applicable law and
insurance requirements, and to provide quality and efficient care, the Practice
may need to compile, use and disclose your PHI. For example, the Practice may use your PHI to evaluate the
performance of the Practice’s personnel in providing care to you.
OTHER EXAMPLES OF HOW THE PRACTICE MAY USE YOUR
PROTECTED HEALTH INFORMATION
·
Appointment Reminder - The Practice may, from time to
time, contact you to provide appointment reminders or information about
treatment alternatives or other health related benefits and services that may
be of interest to you. The following
appointment reminders may be used by the Practice: a) a postcard mailed to you
at the address provided by you; and b) telephoning your home and leaving a
message on your answering machine or with the individual answering the phone.
·
Directory / Sign – In Log - The Practice maintains a sign
– in log at its reception desk for individuals seeking care and treatment in
the office. The sign – in log is
located in a position where staff can readily see who is seeking care in the
office, as well as the individual’s location within the Practice’s office
suite. The information may be seen by,
and is accessible to, others who are seeking care or services in the Practice’s
offices.
·
Family / Friends - The Practice may disclose to your family member,
other relative, a close personal friend, or any other person identified by you,
your PHI directly relevant to such person’s involvement with your care or the
payment for your care. The Practice may
also use or disclose your PHI to notify or assist in the notification
(including identifying or locating) a family member, a personal representative,
or another person responsible for your care, of your location, general
condition or death. However, in both
cases, the following conditions will apply:
1.
If you are present at or prior to the use or disclosure of
your PHI, the Practice may use or disclose your PHI if you agree, or if the
Practice can reasonably infer from the circumstances, based on the exercise of
its professional judgment, that you do not object to the use or disclosure.
2.
If you are not present, the Practice will, in the exercise
of professional judgment, determine whether the use or disclosure is in your
best interests and, if so, disclose only the PHI that is directly relevant to
the person’s involvement with your care.
OTHER USE & DISCLOSURES WHICH MAY
BE PERMITTED OR REQUIRED BY LAW
The Practice may also use and disclose
your PHI, without your consent or authorization in the following instances:
·
De-identified
Information – The Practice may use and disclose health information
that may be related to your care but does not identify you and cannot be used
to identify you.
·
Business
Associate – The Practice may use and disclose PHI to a business
associate if the Practice obtains satisfactory written assurance, in accordance
with applicable law, that the business associate will appropriately safeguard
your PHI. A business associate is an
entity that assists the Practice in undertaking some essential function, such
as a billing company that assists the office in submitting claims for payment
to insurance companies.
·
Personal
Representative – The Practice may use and disclose PHI: a person who,
under applicable law, has the authority to represent you in making decisions
related to your health care.
·
Emergency
Situations – The Practice may use and disclose PHI: for the purpose
of obtaining or rendering emergency treatment to you provided that the Practice
attempts to obtain your Consent as soon as possible; or to a public or private
entity authorized by law or by its charter to assist in disaster relief
efforts, for the purpose of coordinating your care with such entities in an
emergency situation.
·
Public
Health Activities – The Practice may use and disclose PHI when authorized by
law to provide information if it believes that the disclosure is necessary to
prevent serious harm.
·
Abuse,
Neglect or Domestic Violence - The Practice may use and disclose PHI when
required by law to provide information if it believes that the disclosure is
necessary to prevent serious harm.
·
Health
Oversight Activities - The Practice may use and disclose PHI when
required by law to provide information if it believes that the disclosure is
necessary to prevent serious harm. The Practice may use and disclose PHI when
required by law to provide information in criminal investigations, disciplinary
actions, or other activities relating to the community’s health care system.
·
Judicial
and Administrative Proceeding - The Practice may use and disclose PHI in response
to a court order or a lawfully issued subpoena.
·
Law
Enforcement Purposes - The Practice may use and disclose PHI, when
authorized, to a law enforcement official.
For example, your PHI may be the subject of a grand jury subpoena, or if
the Practice believes that your death was the result of criminal conduct.
·
Coroner
or Medical Examiner - The Practice may use and disclose PHI to a
coroner or medical examiner for the purpose of identifying your or determining
your cause of death.
·
Organ,
Eye or Tissue Donation - The Practice may use and disclose PHI if you are
an organ donor, to the entity to whom you have agreed to donate your organs.
·
Research - The
Practice may use and disclose PHI subject to applicable legal requirements if
the Practice is involved in research activities.
·
Avert
a Threat to Health or Safety - The Practice may use and disclose PHI if it
believes that such disclosure is necessary to prevent or lessen a serious and
imminent threat to the health or safety of a person or the public and the
disclosure is to an individual who is reasonably able to prevent or lessen the
threat.
·
Specialized
Government Functions – The Practice may use and disclose PHI when
authorized by law with regard to certain military and veteran activity.
·
Workers’
Compensation – The Practice may use and disclose PHI if you are involved
in a Workers’ Compensation claim, to an individual or entity that is part of
the Workers’ Compensation system.
·
National
Security and Intelligence Activities - The Practice may use and
disclose PHI to authorized governmental officials with necessary intelligence
information for national security activities.
·
Military
and Veterans - The Practice may use and disclose PHI if you are a
member of the armed forces, as required by the military command authorities.
AUTHORIZATION
Uses
and/or disclosures, other than those described above will be made only with
your written Authorization.
YOUR RIGHTS
Your have
the right to:
·
Revoke any Authorization or consent you have given to the
Practice, at any time. To request a
revocation, you must submit a written request to the Practice’s Privacy
Officer.
·
Request restrictions on certain uses and disclosure of your
PHI as proved by law. Except in
certain instances, the Practice may not be obligated to agree to any requested
restrictions. To request restrictions,
you must submit a written request to the Practice’s Privacy Officer. In your written request, you must inform
the Practice of what information you want to limit, whether you want to limit
the Practice’s use or disclosure, or both, and to whom you want the limits to
apply. If the Practice agrees to your
request, the Practice will comply with your request unless the information is
needed in order to provide you with emergency treatment.
·
Receive confidential communication or PHI by alternative
means or at alternative locations. You
must make your request in writing to the Practice’s Privacy Officer. The Practice will accommodate all reasonable
requests.
·
Inspect and copy your PHI as provided by law. To inspect and copy your PHI, you must
submit a written request to the Practice’s Privacy Officer. The Practice can charge you a fee for the
cost of copying, mailing or other supplies associated with your request, but
you will have the right to have the denial reviewed as set forth more fully in
the written denial notice.
·
Amend your PHI as provided by law. To request an amendment, you must submit a
written request to the Practice’s Privacy Officer. You must provide a reason that supports your request. The Practice may deny your request if it is
not in writing, if you do not provide a reason in support of your request, if
the information to be amended was not created by the Practice (unless the
individual or entity that created the information is no longer available), if
the information is not part of your PHI maintained by the Practice, if the
information is not part of the information you would be permitted to inspect
and copy, and/or if the information is accurate and complete. If you disagree with the Practice’s denial,
you will have the right to submit a written statement of disagreement.
·
Receive an accounting of disclosures of your PHI as
provided by law. To request an
accounting, you must submit a written request to the Practice’s Privacy
Officer. The request must state a time
period, which may not be longer than six (6) years and may not include dates
before April 14, 2003. The request
should indicate in what form you want the list (such as a paper or electronic
copy). The first list you request
within a twelve (12) month period will be free, but the Practice may charge you
for the cost of providing additional lists.
The Practice will notify you of the costs involved and you can decide to
withdraw or modify your request before any costs are incurred.
·
Receive a paper copy of this Privacy Notice from the
Practice upon request to the Practice’s Privacy Officer.
·
Complain to the Practice or to the Secretary of HHS if you
believe your privacy rights have been violated. The file a complaint with the Practice, you must contact the
Practice’s Privacy Officer. All
complaints must be in writing.
·
To obtain more information on, or have your questions about
your rights answered, you may contact the Practice’s Privacy Officer, Steven M.
Horwitz, D.C., at 12200 Tech Road, Suite 104, Silver Spring, MD 20904 or via email at drsteve@youcanbefit.com
PRACTICE’S REQUIREMENTS
The
Practice:
·
Is required by federal law to maintain the privacy of your
PHI and to provide you with this Privacy Notice detailing the Practice’s legal
duties and privacy practices with respect to your PHI.
·
May be required by State law to maintain greater
restrictions on the use or release of your PHI than that which is provided for
under federal law. In particular, the
Practice is required to comply with the following State statutes: Health General Article, Title 4, Subtitle 3,
Confidentiality of Medical Records and Subtitle 4, Personal Medical Records.
·
Is required to abide by the terms of this Privacy Notice.
·
Reserves the right to change the terms of this privacy
Notice and to make the new Privacy Notice provisions effective for all of your
PHI that it maintains.
·
Will distribute any revised Privacy Notice to you prior to
implementation.
·
Will not retaliate against you for filing a complaint.
EFFECTIVE DATE
This
Notice is in effect as of January 1,
2003.