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THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION
ABOUT YOU
MAY BE USED AND DISCLOSED AND
HOW YOU CAN GET ACCESS TO THIS INFORMATION.
If you have any questions
about this Notice, please contact our Privacy Offier
Robin Burns
804-726-8571 ext.107
1. Purpose
We understand that medical information about
you and your health is personal and we are committed to protecting that
information. We create a record of the care and services you receive at
the Virginia Physicians Inc in order to provide you with quality care
and to comply with certain legal requirements.
This Notice of Privacy Practices describes
how we may use and disclose medical information about you, including demographic
information, that may identify you and your related health care services
to carry out your treatment, obtain payment for our services, to perform
the daily health care operations of this practice and for other purposes
that are permitted or required by law. This notice also describes your
rights to access and control your medical information.
We are required to abide by the terms of
this Notice of Privacy Practices.
2. Written Acknowledgement
You will be asked to sign a written statement
acknowledging that you have received a copy of this notice. The acknowledgement
only serves to create a record that you have received a copy of the notice.
3. Changes to this Notice
We may change the terms of our Notice, at
any time. The new Notice will be effective for all medical information
that we maintain at that time. Upon your request, we will provide you
with any revised Notice of Privacy Practices. To request a revised copy,
you may call our office and request that a revised copy be sent to you
in the mail or you may ask for one at the time of your next appointment.
4. How We May Use and Disclose Medical Information about You
The following categories describe the different
ways that Virginia Physicians Inc may use and disclose your medical information
and a few examples of what we mean. These examples are not meant to describe
every circumstance, but to give you an idea of the types of uses and disclosures
that may be made by our office. Other uses and disclosures of your medical
information that are not listed or described below will be made only with
your written authorization. You may revoke this authorization, at any
time, in writing, but it will not apply to any actions we have already
taken.
- For your treatment:
Your medical information may be used and disclosed by us for the purpose
of providing medical treatment to you or for another health care provider
providing medical treatment to you. For example, a nurse obtains treatment
information about you and documents it in your medical record and the
physician has access to that information. If you require an x-ray to
be taken, the x-ray technician also has access to your medical information.
In addition, your medical information may be provided to a physician
to whom you have been referred or are otherwise seeing to ensure that
the physician has the necessary information to diagnose or treat you.
- To obtain payment for our
services: Your medical information may be used and disclosed
by us to obtain payment for your health care bills or to assist another
health care provider in obtaining payment for their health care bills.
For example, we may submit requests for payment to your health insurance
company for the medical services that you received. We may also disclose
your medical information as required by your health insurance plan before
it approves or pays for the health care services we recommend for you.
- For our health care operations:
Your medical information may be used and disclosed by us to support
our daily operations. These health care operation activities include,
but are not limited to, quality assessment activities, employee review
activities, training of medical students, licensing, fundraising activities,
and conducting or arranging for other business activities. For example,
we may disclose your medical information to medical school students
that see patients at our office. We may also use the medical information
we have to determine where we can make improvements in the services
and care we offer.
- For the health care operations
of other health care providers: We may also use your medical
information to assist another health care provider treating you with
its quality improvement activities, evaluation of the health care professionals
or for fraud and abuse detection or compliance. For example, we may
disclose your medical information to another physician to assist in
its efforts to make sure it is complying with all rules related to operating
a medical practice.
- For appointment reminders:
We may use or disclose your medical information to contact you to remind
you of your appointment, by mail or by telephone. Our message will include
the name of our practice or the name of our physician as well as the
date and time for your appointment or a reminder that an appointment
needs to be scheduled.
- To provide you with treatment
alternatives:
We may use or disclose your medical information to provide you with
information about treatment alternatives or other health-related benefits
and services that may be of interest to you. For example, we may contact
several home health agencies or physical therapy providers to discuss
the services they provide when we have a patient who needs these services.
- To our business associates:
We will share your medical information with third party “business
associates” that perform various activities (e.g., billing, transcription
services) for the practice. Whenever an arrangement between our office
and a business associate involves the use or disclosure of your medical
information, we will have a written agreement that contains terms that
will protect the privacy of your medical information. For example, Virginia
Physicians Inc may hire a billing company to submit claims to your health
care insurer. Your medical information will be disclosed to this billing
company, but a written agreement between our office and the billing
company will prohibit the billing company from using your medical information
in any way other than what we allow.
- Others 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 medical information
that directly relates to that person’s involvement in your health
care. If you are unable to agree or object to such a disclosure, we
may disclose such information as necessary if we determine that it is
in your best interest based on our professional judgment. We may use
or disclose your medical information to notify a family member or any
other person that is responsible for your care of your location and
general health condition. Finally, we may use or disclose your medical
information to an authorized public or private entity to assist in (1)
disaster relief efforts and (2) to coordinate uses and disclosures to
family or other individuals involved in your health care.
- As required by law:
We may use or disclose your medical information to the extent that the
use or disclosure is required by law. The use or disclosure will be
made in compliance with the law and will be limited to the relevant
requirements of the law. You will be notified, as required by law, of
any such uses or disclosures.
- For public health activities:
We may disclose your medical information for public health activities
and purposes to a public health authority that is permitted by law to
collect or receive the information. The disclosure will be made for
the purpose of controlling disease, injury or disability. We may also
disclose your medical information, if directed by the public health
authority, to any other government agency that is collaborating with
the public health authority.
- As required by the Food and
Drug Administration:
We may disclose your medical information to a person or company required
by the Food and Drug Administration to report adverse events, product
defects or problems, biologic product deviations, or to track products;
to enable product recalls; to make repairs or replacements; or to conduct
post marketing surveillance, as required.
- For communicable disease
exposure:
We may disclose your medical information, if authorized by law, to a
person who may have been exposed to a communicable disease or may otherwise
be at risk of contracting or spreading the disease or condition.
- To your employer:
We may disclose your medical information concerning a work related injury
or illness to your employer if you are covered under your employer’s
policy in order to conduct an evaluation relating to medical surveillance
of the work place or to evaluate whether you have a work-related injury,
in accordance with the law.
- For abuse or neglect:
We may disclose your medical information to a public health authority
that is authorized by law to receive reports of child or adult abuse
or neglect. In addition, we may disclose your medical information if
we believe that you have been a victim of abuse, neglect or domestic
violence as may be required or permitted by Virginia and/or federal
law.
- For health oversight:
We may disclose your medical information to a health oversight agency
for activities authorized by law. Oversight agencies seeking this information
include government agencies that oversee the health care system, government
benefit programs (such as Medicare or Medicaid), other government regulatory
programs and civil rights laws.
- In legal proceedings:
We may disclose your medical information in the course of any judicial
or administrative proceeding, in response to an order of a court or
administrative tribunal (to the extent such disclosure is expressly
authorized), and in certain conditions in response to a subpoena or
other lawful request.
- For law enforcement:
We may also disclose your medical information, so long as all legal
requirements are met, for law enforcement purposes. Examples of these
law enforcement purposes include (1) information requests for identification
and location purposes, (2) pertaining to victims of a crime, (3) suspicion
that death has occurred as a result of criminal conduct, (4) in the
event that a crime occurs on the premises of the Practice, and (5) in
an medical emergency where it is likely that a crime has occurred.
- To coroners, to funeral directors,
and for organ donation: We may disclose your medical information
to a coroner or medical examiner for identification purposes, determining
cause of death or for the coroner or medical examiner to perform other
duties authorized by law. We may also disclose medical information to
a funeral director in order to permit the funeral director to carry
out its duties. We may disclose such information in reasonable anticipation
of death. Your medical information may be used and disclosed for cadaveric
organ, eye or tissue donation purposes.
- For research:
We may disclose your medical information to researchers when their research
has been established as required by federal and state law.
- Due to criminal activity:
Consistent with applicable federal and state laws, we may disclose your
medical information if we believe that the use or disclosure is necessary
to prevent or lessen a serious and imminent threat to the health or
safety of a person or the public. We may also disclose your medical
information if it is necessary for law enforcement authorities to identify
or apprehend an individual.
- For military activity and
national security: When the appropriate conditions apply,
we may use or disclose medical information of individuals who are Armed
Forces personnel (1) for activities deemed necessary by appropriate
military command authorities; (2) for the purpose of a determination
by the Department of Veterans Affairs of your eligibility for benefits;
or (3) to foreign military authority if you are a member of that foreign
military services. We may also disclose your medical information to
authorized federal officials for conducting national security and intelligence
activities, including for the provision of protective services to the
President or others legally authorized.
- For workers’ compensation:
Your medical information may be disclosed by us as authorized to comply
with workers’ compensation laws and other similar legally established
programs.
- Regarding inmates:
We may use or disclose your medical information if you are an inmate
of a correctional facility and your physician created or received your
medical information in the course of providing care to you.
- For required uses and disclosures:
Under the law, we must make disclosures to you and, when required by
the Secretary of the Department of Health and Human Services, to investigate
or determine our compliance with the requirements of the Health Insurance
Portability and Accountability Act and its regulations.
5. Your Rights
Following is a statement of your rights
with respect to your medical information and a brief description of how
you may exercise these rights.
You have the right to inspect and copy your
medical information. You may inspect and obtain a copy of your medical
information that we maintain. The information may contain medical and
billing records and any other records that we use for making decisions
about you. However, under federal law, you may not inspect or copy the
following records: psychotherapy notes; information compiled related to
a civil, criminal, or administrative action; and medical information that
is subject to law that prohibits access to medical information in certain
circumstances. We may deny your request to inspect your medical information.
In some circumstances, you may have a right to have this decision reviewed.
Please contact our Privacy Officer if you have questions about access
to your medical record.
You have the right to request a restriction
of your medical information. This means you may ask us not to use or disclose
any part of your medical information for the purposes of treatment, payment
or health care operations. You may also request that any part of your
medical information not be disclosed to family members or friends who
may be involved in your care. Your request must state the specific restriction
requested and to whom you want the restriction to apply.
We are not required to agree to your request.
If we agree to the requested restriction, we may not use or disclose your
medical information in violation of that restriction unless it is needed
to provide emergency treatment or unless we otherwise notify you that
we can no longer honor your request. With this in mind, please discuss
any restriction you wish to request with your physician. Please request
all restrictions in writing to our Privacy Officer.
You have the right to request that we accommodate
you in communicating confidential medical information. We will accommodate
reasonable requests, but we may condition this accommodation by asking
you for information as to how payment will be handled or other information
necessary to honor your request. Please make this request in writing to
our Privacy Officer.
You may have the right to ask us to amend
your medical information. You may request an amendment of your medical
information as long as we maintain this information. In certain cases,
we may deny your request for an amendment. If we deny your request for
amendment, you have the right to file a disagreement with us and we may
respond in writing to you. Please contact our Privacy Officer if you have
questions about amending your medical record.
You have the right to receive an accounting
of certain disclosures we have made, if any, of your medical information. This right applies to disclosures for purposes other than treatment, payment
or health care operations as described in this Notice of Privacy Practices.
It excludes disclosures we may have made pursuant to your authorization
(permission), made directly to you, to family members or friends involved
in your care, or for appointment notification purposes. You have the right
to receive specific information regarding these disclosures that occurred
after April 14, 2003. You may request a shorter timeframe. The right to
receive this information is subject to certain exceptions, restrictions
and limitations.
You have the right to obtain a paper copy
of this notice from us. If you would like a paper copy of this notice,
please request one from our Privacy Officer or request one when you are
in our offices.
6. Complaints.
You may complain to us if you believe your
privacy rights have been violated by us. To file a complaint, please contact
our Privacy Officer, Robin Burns, who will be happy to assist you. You
may file a complaint with us by notifying our Privacy Officer of your
complaint. We will not retaliate against you for filing a complaint. If
you do not wish to file a complaint with us, you may contact the Secretary
of Health and Human Services.
7. Privacy Contact.
If you have any questions about this Notice
or require additional information, please contact our Privacy Officer, Robin Burns, at (804) 726-8571, ext.107or at 4900 Cox Road, Suite 155, Richmond,
Virginia 23060. Our Privacy Officer is available during normal business
hours to discuss your privacy questions, concerns or complaints.
8. Effective Date.
This notice was published and becomes effective on April 14, 2003. |
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