NOTICE
OF PRIVACY PRACTICES
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
our office manager at 503.561.4043.
WHO WILL FOLLOW
THIS NOTICE
This notice describes
our office's practices and that of:
- Any healthcare
professional authorized to enter information into your medical record
that we maintain at this office.
- All employees,
staff, and other office personnel.
YOUR MEDICAL
INFORMATION
We create a record
of the care and services you receive at this office. We need this record
to provide you with quality care and to comply with certain legal requirements.
This notice applies to all of the records of your care maintained by
this office. Other physicians or health care providers that you use
may have different policies or notices regarding the use and disclosure
of your medical information.
This notice will
tell you about the ways in which we may use and disclose medical information
about you. We also describe your rights and certain obligations we have
regarding the use and disclosure of medical information.
We are required
by law to :
- Make sure that
medical information that identifies you is kept private;
- Give you this
notice of our legal duties and privacy practices with respect to medical
information about you; and
- Follow the terms
of the notice that is currently in effect.
HOW WE MAY USE
AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
The following
categories describe different ways that we use and disclose medical
information. "Use" is what we do with your information in this office.
"Disclose" means sharing your information with others outside
this office. For each category of use or disclosure, we will explain
what we mean and try to give some examples. Not every use or disclosure
in a category will be listed. However, all of the ways we are permitted
to use and disclose information will fall within one of the categories.
For Treatment
We may use medical information about you to provide you with medical
treatment or services. We may disclose medical information about you
to doctors, nurses, technicians, office staff or other personnel who
are involved in taking care of you at this office. For example, your
doctor may be treating you for a broken leg, and may need to know if
you have diabetes because diabetes may slow the healing process. In
addition, the doctor may need to tell a laboratory technician that you
have diabetes so we can arrange for appropriate testing.
Different personnel
in the office also may share medical information about you in order
to coordinate the different things you need, such as prescriptions,
lab work, and x-rays. We also may disclose medical information about
you to people who do not work in our office or other health care providers
we use to provide services may be part of your medical care outside
this office and may require information about you that we have.
For Payment
We may use and disclose medical information about you so that the treatment
and services you receive at this office may be billed to and payment
may be collected from you, an insurance company, or a third party. For
example, we may need to give your health plan information about a service
you received here at this office so your health plan will pay us or
reimburse you for the service. We may also tell your health plan about
a treatment you are going to receive to obtain prior approval or to
determine whether your plan will cover the treatment.
For Health Care
Operations We may use and disclose medical information about you
for office operations. These uses and disclosures are necessary to run
the office and make sure that all of our patients receive quality care.
For example, we may use medical information to review our treatment
and services and to evaluate the performance of our staff in caring
for you. We may also combine medical information about many patients
to decide what additional services we should offer, what services are
not needed, and whether certain new treatments are effective. We may
also disclose information to other doctors, nurses, technicians, and
other office personnel for review and learning purposes. We may also
combine the medical information we have with medical information from
other offices and groups to compare how we are doing and see where we
can make improvements in the care and services we offer. We may remove
information that identifies you from this set of medical information
so others may use it to study health care and health care delivery without
learning who the specific patients are.
- Appointment
Reminders We may contact you as a reminder that you have an appointment
for treatment or medical care at the office.
- Treatment
Alternatives We may tell you about or recommend possible treatment
options or alternatives that might be of interest to you.
- Health Related
Benefits and Services We may tell you about health-related benefits
or services that might be of interest to you.
- Individuals
Involved in Your Care or Payment for Your Care We may release
medical information about you to a friend or family member who is
involved in your medical care. We may also give information to someone
who helps pay for your care. We may also tell your family or friends
your condition and that you are in a hospital. In addition, we may
disclose medical information about you to an entity assisting in a
disaster relief effort so that your family can be notified about your
condition, status, and location.
- Research
Under certain circumstances, we may use and disclose medical information
about you for research purposes. For example, a research project may
involve comparing the health and recovery of all patients who received
one medication to those who received another, for the same condition.
All research projects, however, are subject to a special approval
process. This process evaluates a proposed research project and its
use of medical information, trying to balance the research needs with
patients' need for privacy of their medical information. Before we
use or disclose medical information for research, the project will
have been approved through this research approval process, but we
may, however, disclose medical information about you to people preparing
to conduct a research project, for example, to help them look for
patients with specific medical needs, so long as the medical information
they review does not leave this office. We will almost always ask
for your specific permission if the researcher will have access to
your name, address, or other information that reveals who you are,
or will be involved in your care at the office
- As Required
by Law We will disclose medical information about you when required
to do so by federal, state, or local law.
- To Avert a
Serious Threat to Health or Safety We may use and disclose medical
information about you when necessary to prevent a serious threat to
your health and safety, or the health and safety of the public or
another person. Any disclosure, however, would only be to someone
able to help prevent the threatened harm.
SPECIAL SITUATIONS
- Organ and
Tissue Donation If you are an organ donor, we may release medical
information to organizations that handle organ procurement or organ,
eye or tissue transplantation or to an organ donation bank, as necessary
to facilitate organ or tissue donation and transportation.
- Military and
Veterans If you are a member of the armed forces, we may release
medical information about you as required by military command authorities.
We may also release medical information about foreign military personnel
to the appropriate foreign military authority.
- Workers' Compensation
We may release medical information about you for worker's compensation
or similar programs. These programs provide benefits for work-related
injuries or illness.
- Public Health
Risks We may disclose medical information about you for public
health activities. These activities may include the following:
- to prevent
or control disease, injury, or disability
- to report
births and deaths
- to report
child abuse or neglect
- to report
reactions to medications or problems with products
- to notify
people of recalls of products they may be using
- to notify
a person who may have been exposed to a disease or may be at risk
for contracting or spreading a disease or condition.
- to notify
the appropriate government authority if we believe a patient has
been the victim of abuse, neglect, or domestic violence. We will
only make this disclosure if you agree or when required or authorized
by law.
- Health Oversight
Activities We may disclose medical information to a health over-sight
agency for activities authorized by law. These may include 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.
- Lawsuits and
Disputes
We may release medical information if asked to do so by a law enforcement
official:
- in response
to a court order, subpoena, warrant, summons, or similar process.
- about a death
we believe may be the result of criminal conduct.
- about criminal
conduct at the office; or
- in emergency
circumstances 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 medical
information to a coroner or medical examiner. This may be necessary,
for example, to identify a deceased person or determine the cause
of death.
- National Security
and Intelligence Activities We may release medical information
about you to authorized federal officials for intelligence, counterintelligence,
and other national security activities authorized by
law.
- Inmates
If you are an inmate of a correctional institution or under the custody
of a law enforcement official, we may release medical information
about you to the correctional institution or law enforcement official.
This release would be necessary
- for the institution
to provide you with health care;
- to protect
your health and safety or the health and safety of others;
- for the safety
and security of the correctional institution.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU
- Right to Inspect
and Copy You have the right to inspect and copy medical information
that may be used to make decisions about your care. Usually, this
includes medical and billing records, but does not
include psychotherapy notes.
To inspect and copy medical information that may be used to make
decisions about you, you must submit your request in writing to
the Privacy Official of Salem Gastroenterology. If you request a
copy of the information, we may charge a fee for the costs of copying,
mailing, or other supplies associated with your request.
We may deny
your request to inspect and copy in certain very limited circumstances.
If you are denied access to medical information, you may request
that the denial be reviewed. We will select a licensed health care
professional to review your request and the denial. The person conducting
the review will not be the person who denied your request. We will
comply with the outcome of the review.
- Right to Amend
If you feel that medical information we have about you 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, this office.
To request an
amendment, complete and submit a MEDICAL RECORD AMENDMENT/CORRECTION
FORM to the Salem Gastroenterology Office Manager.
We may deny
your request for an amendment if it is not in writing or does not
include a reason to support the request. In addition, we may deny
your request if you ask us to amend information that
-
Was not created
by us, unless the person or entity that created the information
is no longer available to make the amendment;
-
Is not part
of the medical information kept by or for the office;
-
Is not part
of the information which you would be permitted to inspect or
copy; or
-
Is accurate
and complete.
- Right to an
Accounting of Disclosures You have the right to request an "accounting
of disclosures". This is a list of the disclosures we made of
medical information about you.
To
request this list or "accounting of disclosures", you
must submit your request in writing to the Salem Gastroenterology
Office Manager.
Your request must state a time period which may not be longer than
six years and may not include dates before April 14, 2003. Your
request
should indicate in what form you want the list (e.g., on paper, electronically).
The first list you request within a 12 month period will be free.
For additional lists, we may charge you for the costs of providing
the list. We will notify you of the cost involved and you may choose
to withdraw or modify your request at that time before any costs
are
incurred.
- Right to Request
Confidential Communications 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 contact you
only at work or by mail.
To request
confidential communications, you may complete and submit the REQUEST
FOR RESTRICTION ON USE/DISCLOSURE OF MEDICAL INFORMATION AND/OR CONFIDENTIAL
COMMUNICATION to the Office Manager. We will not ask you the reason
for your request. We will accommodate all reasonable requests. Your
request must specify how or where you wish to be contacted
- 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. The staff of the reception desk can provide a paper copy for
you. Even if you have agreed to receive this notice electronically,
you are still entitled to a paper copy of this notice; to obtain a
paper copy of this notice, please contact the Office Manager of Salem
Gastroenterology.
CHANGES TO THIS NOTICE
We reserve the right
to change this notice. We reserve the right to make the revised or changed
notice effective for medical information we already have about you as
well as any information we receive in the future. We will post a summary
of the current notice in the office. The summary will contain, in the
top right-hand corner the effective date. You are entitled to a copy
of the current notice in effect.
COMPLAINTS
If you believe your
privacy rights have been violated, you may file a complaint with the
office or with the Secretary of the Department of Health and Human Services.
To file a complaint with the office, contact the Office Manager at (503)
561-4043. You will not be penalized for filing a complaint.
OTHER USES OF
MEDICAL INFORMATION
Other uses and disclosures
of medical information not covered by this notice or the laws that apply
to us will be made only with your written permission. If you provide
us permission to use or disclose medical information about you, you
may revoke that permission, in writing, at any time. If you revoke your
permission, we will no longer use or disclose medical information about
you for the reasons covered by your written authorization. You understand
that we are unable to take back any disclosures we have already made
with your permission, and that we are required to retain our records
of the care that we provided to you.
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