USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION
Treatment, payment and health care operations.
This secion describes how we may use and disclose your protected health information for treatment, payment and health care operations purposes. The desciptions include examples. Not every possible use or disclosure for treatment, payment and health care operations purposes will be listed.
We may use and disclose your protected health information for our treatment purposes as well as the treatment purposes of other health care providers. Treatment includes the provision, coordination or management of health care services to you by one or more health care providers. Some examples of treatment uses and disclosures include:
During an office visit, practice physicians and other staff involved in your care may review your medical record and share and discuss your medical information with each other.
We may access and discuss medications prescribed by all physicians and dispensed by all pharmacies.
We may share and discuss your medical information with an outside physician to whom we have referred you for care.
We may share and discuss your medical information with an outside physician with whom we are consulting regarding you.
We may share and discuss your medical information with an outside laboratory, radiology center, or other health care facility where we have referred you for testing.
We may share and discuss your medical information with an outside home health agency, durable medical equipment agency or other health care provider to whom we have referred you for health care services and products.
We may share and discuss your medical infomation with a hospital or other health care facility where we are admitting or treating you or referring you for admission or treatment.
We may share and discuss your medical information with another health care povide who seeks this information for the purpose of treating you. One example of this type of health care provider is a school nurse.
We may use a patient sign-in sheet in the waiting area which is accessible to all patients.
We may page patients in the waiting room when it is time for them to go to an examining room.
We may contact you by telephone, and leave a message on your voice mail identifying ourselves as staff from Allergy and Asthma Specialists, PC, to provide appointment reminders, lab test and x-ray results, prescription and extract refills, or account financial information.
We may contact you by mail, using a return address as Allergy and Asthma Specialists, PC on the outside of the mailing to provide newsletters, appointment reminders, marketing information, lab test and x-ray results, extract information, or account financial information.
We may use and disclose your protected health information for our payment purposes as well as the payment purposes of other health care providers and health plans. Payment uses and disclosures include activities conducted to obtain payment for the care provided to you or so that you can obtain reimbursement for that care, for example, from your health insurer. Some examples of payment uses and disclosures include:
Sharing information with your health insurer to determine whether you are eligible for coverage or whether proposed treatment is a covered service.
Submission of a claim form to your health insurer.
Providing supplemental information to your health insurer so that your health insurer can obtain reimbursement from another health plan under a coordination of benefits clause in your subscriber agreement.
Sharing your demographic information (for example, your address) with other health care providers who seek this information to obtain payment for health care services provided to you.
Mailing you bills in envelopes with our practice name and return address.
Allowing your health insurer access to your medical record for a medical necessity or quality review audit.
Providing information to a collection agency or our attorney for purposes of securing payment of a delinquent account.
Health care operations
We may use and disclose your protected health information for our health care operation purposes as well as certain health care operation purposes of other health care providers and health plans. Some examples of health care operation purposes include:
Quality assessment and improvement activities.
Population based activities relating to improving health or reducing health care costs.
Reviewing the competence, qualifications, or performance of health care professionals.
Conducting training programs for interns and residents, medical students and other students.
Accreditation, certification, licensing and credentialing activities.
Health care fraud and abuse detection and compliance programs.
Conducting other medical review, legal services, and auditing functions.
Business planning and development activities, such as conducting cost management and planning related analyses.
Sharing information regarding patients with entities that are interested in purchasing our practice and turning over patient records to entities that have purchased our practice.
Other business management and general administrative activities, such as compliance with the federal privacy rule and resolution of patient grievances.
Our practice may use and disclose your PMI for research purposes in certain limited circumstances. We will obtain your written authorization to use your PMI for research purposes except when: (a) our use or disclosure was approved by an Institutional Review Board or a 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 PMI is being used only for the research and (iii) the researcher will not remove any of your PMI from our practice; or (c) the PMI sought by the researcher only relates to decedents and the researcher agrees either orally or in wiriting that the use or disclosure is necessary for the research and, if we request it, to provide us with proof of death prior to access to the PMI of the decedents.
Uses and disclosures for other purposes.
We may use and disclose your protected health information for other purposes. This section generally describes thoses purposes by category. Each category includes one or more examples. Not every use or disclosure in a category will be listed. Some examples fall into more that one category - not just the category under which they are listed.
Individuals involved in care or payment for care
We may disclose your protected health information to someone involved in your care or payment for your care, such as a spouse, a family member, or close friend. For example, if you have surgery, we may discuss your physical limitations with a family member assisting in your post- operative care.
We may use and disclose your protected health information to notify, or to assist in the notification of, a family member, a personal representative, or another person responsible for your care, regarding your location, general condition, or death. For example, if you are hospitalized, we may notify a family member of the hospital and your general condition. In addition, we may disclose your protected health information to a disaster relief entity, such as the Red Cross, so that it can notify a family member, a personal representative, or another person involved in your care regarding your location, general condition or death.
Required by law
We may use and disclose protected health information when required by federal, state, or local law. For example, we may disclose protected health information to comply with mandatory reporting requirements involving births and deaths and serious injuries, gunshot and other injuries by a deadly weapon or criminal act, driving impairments and blood alcohol testing.
Other public health activities
We may use and disclose protected health information for public health activities, including:
Public health reporting, for example, communicable disease reports.
Child abuse and neglect reports
FDA-related reports and disclosures, for example, adverse event reports.
Public health warnings to third parties at risk of a communicable disease or condition
OSHA requirements for workplace surveillance and injury reports.
Victims of abuse, neglect or domestic violence
We may use and disclose protected health information for purposes of reporting of abuse, neglect or domestic violence in addition to child abuse, for example, reports of elder abuse to the Department of Aging or abuse of a nursing home patient to the Department of Public Welfare.
Health oversight activities
We may use and disclose protected health information for purposes of health oversight activities authorized by law. These activities could include audits, inspections, investigations, licensure actions, and legal proceedings. For example, we may comply with a Drug Enforcement Agency inspection of patient records.
Judicial and administrative proceedings
We may use and disclose protected health information disclosures in judicial and administrative proceedings in response to a court order or subpoena, discovery request or other lawful process. For example, we may comply with a court order to testify in a case at which your medical condition is at issue.
Law enforcement purposes
We may use and disclose protected health information for certain law enforcement purposes including to:
- Comply with legal process, for example, a search warrant.
- Comply with a legal requirement, for example, mandatory reporting of gun shot wounds.
- Respond to a request for information for identification/location purposes.
- Respond to a request for information about a crime victim.
- Report a death suspected to have resulted from criminal activity.
- Provide information regarding a crime on the premises.
- Report a crime in an emergency.
Coroners and medical examiners
We may use and disclose protected health information for purposes of providing information to a coroner or medical examiner for the purpose of identifying a deceased patient, determining a cause of death, or facilitating their performance of other duties required by law.
We may use and disclose protected health information for purposes of providing information to funeral directors as necessary to carry out their duties.
Organ and tissue donation
For purposes of facilitating organ, eye and tissue donation and transplantation, we may use protected health information and disclose protected health information to entities engaged in the procurement, banking or transplantation of cadaveric organs, eyes, or tissue.
Threat to public safety
We may use and disclose protected health information for purposes involving a threat to public safety, including protection of a third party from harm and identification and apprehension of a criminal. For example, in certain circumstances, we are required by law to disclose information to protect someone from imminent serious harm.
Specialized government functions
We may use and disclose protected health information for purposes involving specialized government functions including:
- Military and veteran activities
- National security and intelligence
- Protective services for the President and others.
- Medical suitability determinations for the Department of State
- Correctional institutions and other law enforcement custodial situations.
Workers' compensation and similar programs
We may use and disclose protected health information as authorized by and to the extent necessary to comply with laws relating to workers' compensation or similar programs, established by law, that provide benefits for work-related injuries or illness without regard to fault. For example, this would include submitting a claim for payment to your employer's workers' compensation carrier if we treat you for a work injury.
Certain functions of the practice are performed by a business associate such as a billing company, an accountant firm, or a law firm. We may disclose protected health information to our business associates and allow them to create and receive protected health information on our behalf. For example, we may share with our billing company information regarding your care and payment for your care so that the company can file health insurance claims and bill you or another responsible party.
Creation of de-identified information
We may use protected health information as by-product or an otherwise permitted use or disclosure. For example, other patients may overhear your name being paged in the waiting room.
(Other possible categories: facility directory and research)
Uses and disclosures with authorization
For all other purposes which do not fall under a category listed under sections II. A and II. B, we will obtain our written authorization to use or disclose your protected health information. Your authorization can be revoked at any time except to the extent that we have relied on the authorization.