| The law requires
us to keep your medical records confidential and to provide you
with this Notice of Privacy Practices describing how we may use
and disclose your health information, including your medical history,
symptoms, examination and test results, diagnoses and treatment
plans, to carry out treatment, payment and health care operations
and for other purposes that are allowed or required by law. It also
describes your rights to review and control the use and disclosure
of your health information.
We are required to follow the privacy practices described in this
Notice. We may change our privacy practices at any time. The revised
privacy practices will be set forth in a revised Notice and will
be effective for all health information that we maintain at that
time. Upon your request, we will provide you with a copy of the
most recent Notice. A current copy of our Notice of Privacy Practices
will be posted in our office in a visible location at all times.
- Uses and Disclosures. The law allows us to use and disclose
your health information for treatment, payment and health care
operations. The following are examples of such uses and disclosures:
- Treatment. We will use and disclose your health information
to individuals within our office in order to provide, coordinate,
and manage your medical care and any related services. This
includes the use or disclosure of your health information
to aid in the coordination or management of your medical care
with a third party. For example, your health information may
be provided to a physician to whom you have been referred
to ensure that the physician has the necessary information
to diagnose or treat you.
- Payment. Your health information will be used or disclosed,
as needed, to allow us to obtain payment for health care services
provided to you. This may include disclosure to your health
insurance plan or carrier as they undertake certain activities
before approving or paying for medical services. Such activities
include making a determination of eligibility or coverage
for insurance benefits, reviewing services provided to you
for medical necessity, and undertaking utilization review
activities.
- Incidental Uses and Disclosures. There may also be incidental
uses or disclosures of your health information as a result
of otherwise allowed uses and disclosures. Such uses and disclosures
may occur because they cannot reasonably be prevented. For
example, when your name is called in the waiting room, we
cannot reasonably prevent others from overhearing your name.
- e. Other. We may use a sign-in sheet at the registration
desk where you will be asked to sign your name and indicate
your physician. We may use or disclose your health information,
as necessary, to contact you to schedule or remind you of
an appointment, including leaving messages on your answering
machine.
We may fax your health information to carry out treatment,
payment or health care operations.
We will share your health information with other organizations
that perform various activities on our behalf such as billing
or transcription services. Whenever an arrangement between
our office and another organization involves the use or disclosure
of your health information, we will have a written contract
that contains terms that will protect the privacy of your
health information.
We may use or disclose your health information, as necessary,
to provide you with information about treatment alternatives
or other health-related benefits and services that may be
of interest to you. For example, your name and address may
be used to send you a newsletter about our practice and the
services we offer. We may also send you information about
products or services we believe may be beneficial to you.
We may disclose your health information to another health
care provider of yours for their health care operations relating
to their quality assessment and improvement activities, reviewing
the competence or qualifications of their health care professionals,
or detecting or preventing health care fraud and abuse.
We may use or disclose demographic information about you and
the dates we provided health care services to you for the
purpose of raising funds for our organization.
We may use or disclose your health information for marketing
purposes in meetings between our physicians and you or when
we provide you with promotional gifts of nominal value.
- Uses and Disclosures Allowed or Required by Law. We may use
or disclose your health information in the following situations
as allowed or required by law:
- Required By Law. We may use or disclose your health information
if we are legally required to do so. We will limit the use
or disclosure to that required by such law.
- Public Health. We may disclose your health information to
a public health authority for purposes of controlling disease,
injury or disability. We may also disclose your health information,
if directed by the public health authority, to a foreign government
agency that is collaborating with the public health authority.
- Communicable Diseases. We may disclose your health 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.
- Health Oversight. We may disclose health information to
a health oversight agency for activities authorized by law,
such as audits, investigations, and inspections. Oversight
agencies seeking this information include, but are not limited
to, government agencies that oversee the health care system,
government benefit programs, other government regulatory programs
and entities subject to civil rights laws.
- Abuse or Neglect. We may disclose your health information
to a public health authority that is authorized by law to
receive reports of child abuse or neglect. In addition, we
may disclose your health information to the governmental entity
or agency authorized to receive such information if we believe
that you have been a victim of abuse, neglect or domestic
violence. In this case, the disclosure will be made consistent
with the requirements of applicable federal and state laws.
- Food and Drug Administration. We may disclose your health
information to a person or company as required by the Food
and Drug Administration ("FDA") for purposes relating to the
quality, safety or effectiveness of FDA regulated products
or activities.
- Legal Proceedings. We may disclose health 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, discovery
request or other lawful process.
- Law Enforcement. We may disclose health information, so
long as applicable legal requirements are met, to law enforcement
officials, for law enforcement purposes.
- Coroners, Funeral Directors and Organ Donation. We may disclose
health information to a coroner or medical examiner for identification
purposes, to determine cause of death or for the coroner or
medical examiner to perform other duties authorized by law.
We may also disclose health information to a funeral director,
as authorized by law, in order to permit the funeral director
to carry out his/her duties. Health information may be used
and disclosed for cadaveric organ, eye or tissue donation
purposes.
- Criminal Activity. Consistent with applicable federal and
state laws, we may disclose your health 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.
- Military Activity and National Security. When the appropriate
conditions apply, we may use or disclose health 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 health
information to authorized federal officials for conducting
national security and intelligence activities, including providing
protective services to the President of the United States
or others.
- Employers. We may disclose to your employer health information
obtained in providing medical services to you at the request
of your employer for purposes of conducting an evaluation
relating to medical surveillance of the workplace or determining
whether you have a work?related illness or injury when such
medical services are needed by the employer to comply with
certain legal requirements.
- Correctional Institutions. If you are an inmate or in legal
custody, we may disclose to the correctional institution or
law enforcement official having legal custody of you, certain
health information if necessary for health and safety purposes.
- Workers' Compensation. Your health information may be disclosed
by us as authorized to comply with workers' compensation laws
and other similar legally established programs.
- Compliance. Under the law, we must make disclosures of health
information to the Secretary of the Department of Health and
Human Services to enable it to investigate or determine our
compliance with the requirements of the privacy laws.
- Written Authorization. Any uses and disclosures of your health
information for purposes other than treatment, payment and health
care operations, or as otherwise allowed or required by law as
described above will be made only with your written authorization.
Any authorization you provide to us is effective for the period
specified in the authorization (which cannot exceed one year)
unless you revoke the authorization in writing. Any written authorization
may be revoked by you, at any time. Your revocation shall not
apply to those uses and disclosures we made on your behalf pursuant
to your authorization prior to the time we received your written
revocation. We will accept authorizations by facsimile and will
treat such as originals.
- Others Involved in Your Healthcare. We may disclose to a member
of your family, a relative, a close friend or any other person
you identify, your health information that directly relates to
that person's involvement in your health care or who has responsibility
for payment of your health care. We may also use or disclose your
health information to notify or assist in notifying a relative
or any person responsible for your care, of your location, general
condition or death. In addition, we may use or disclose your health
information to a public or private entity, authorized by law or
by its charter to assist in disaster relief efforts, for the purposes
of coordinating the above uses and disclosures to your family
or other individuals involved in your health care.
- Your Rights. Following is a statement of your legal rights
with respect to your health information and a brief description
of how you may exercise these rights.
- Access. You have the limited right, subject to certain grounds
for denial, to look at all of your health information that
we keep except for the following records: psychotherapy notes;
information compiled in reasonable anticipation of, or use
in, a civil, criminal, or administrative action or proceeding;
and certain laboratory information restricted by federal law.
You also have the limited right, subject to certain grounds
for denial, to obtain copies of that health information you
have a right to look at. Our office may charge you a reasonable
fee for copying, mailing, labor and supplies associated with
your request. Any request for access to or copies of your
health information must be in writing and provided to our
Privacy Officer. If your request for access to or copies of
your health information is denied, you may, depending on the
circumstances, have a right to have a decision to deny access
reviewed. We will provide you, in writing, with our reasons
for denial of access and, if, by law, you are allowed to have
such denial reviewed, we will provide you with instructions
for having a denial of access reviewed.
- Restrictions. You may ask us to restrict the use or disclosure
of any part of your health information to carry out treatment,
payment or healthcare operations. You may also request that
any part of your health information not be disclosed to family,
relatives or friends who may be involved in your care or to
notify them of your location, general condition or death.
In addition, you may request that we restrict the use and
disclosure of your health information for disaster relief
efforts. Your request must be in writing, addressed to our
Privacy Officer and state the specific restriction requested
and to whom you want the restriction to apply. If you are
not present or able to express an objection or request a restriction
to such use or disclosure, then your physician may, using
the physician's professional judgment, determine whether the
use or disclosure is in your best interest.
We are not required to agree to a restriction that you may
request. If your physician believes it is in your best interest
to permit use and disclosure of your health information, your
health information will not be restricted. If your physician
does agree to the requested restriction, we may not use or
disclose your health information in violation of that restriction
unless there is an emergency. We may terminate our agreement
to restrict uses and disclosures of your health information
by providing you with written notice of such; provided, however,
that our termination shall only be effective with respect
to health information created or received after we have given
you notice of termination of the restriction.
- Confidential Communication. You have the right to request
that we send your health information to you by alternative
means or to an alternative location. We will accommodate reasonable
requests. We may condition this accommodation by having you
sign an authorization, asking you for information as to how
payment will be handled or specification of an alternative
address or other method of contact. We will not request an
explanation from you as to the basis for the request. Your
request must be in writing, addressed to our Privacy Officer,
and state the accommodations you are requesting.
- Amendments. You may request an amendment of your health
information that we maintain. Such request must be in writing
and provided to our Privacy Officer. 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 statement of disagreement
that will become part of your health information. If you file
a statement of disagreement, we reserve the right to respond
to your statement. You will receive a copy of any response
we make and any such response will become part of your health
information.
- Accounting of Disclosures. You have the right to receive
an accounting of certain disclosures we have made, if any,
of your health information. This right applies to disclosures
made on and after April 14, 2003 for purposes other than (i)
treatment, payment or healthcare operations as described in
this Notice; (ii) disclosures made to you; (iii) disclosures
to a facility directory; (iv) disclosures to family members
or friends involved in your care or for notification purposes;
or (v) disclosures pursuant to an authorization. The right
to receive this information is subject to certain exceptions,
restrictions and limitations. Your request for an accounting
must be in writing, addressed to our Privacy Officer.
- Electronic Notice. If you receive a copy of this Notice
on our website or by e-mail, you have the right to obtain
a paper copy from us upon request.
- Complaints. You may complain to us or to the Secretary of Health
and Human Services if you believe we have violated your privacy
rights. To complain to us, you may send our Privacy Officer a
letter describing your concerns to the address found below. We
respect your privacy and support any efforts to protect the privacy
of your health information. We will not retaliate against you
for filing a complaint.
- Privacy Officer Contact Information. If you have any questions
about this Notice, you may contact our Privacy Officer by telephone,
e-mail, facsimile, or mail at the address set forth below. If,
however, you want to exercise any of your rights pursuant to this
Notice of Privacy Practices or have a complaint, such action must
be in writing and faxed or mailed to our Privacy Officer at the
address set forth below.
HEARTLAND CENTER FOR REPRODUCTIVE
MEDICINE, PC
ATTN: PRIVACY OFFICER
7308 S. 142ND STREET
OMAHA, NE 68138
PHONE: 866.465.7128
FAX: (402) 717-4231
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