The Heart Group will use and disclose your protected health
information for purposes of treatment, payment and health care operations.
Following are examples of the types of uses and disclosures of your
protected health information that may occur.
These examples are not meant to be exhaustive, but to describe the
types of uses and disclosures that may be made by our office.
Treatment: The Heart
Group will use and disclose your protected health information to provide,
coordinate or manage your health care and any related services.
This includes the coordination or management of your health care with a
third party. For example, The
Heart Group would disclose your protected health information, as necessary, to
a home health agency that provides care to you.
We will also disclose protected health information to other physicians
who may be treating you. For
example, your protected 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.
In addition, we may disclose
your protected health information from time to time to another physician or
health care provider (a specialist or laboratory) who, at the request of your
physician, becomes involved in your care by providing assistance with your
health care diagnosis or treatment to your physician.
Payment: Your protected
health information will be used, as needed, to obtain payment for your health care services.
This may include certain activities that your health insurance plan may undertake before it approves
or pays for the health care services we recommend for you, such as: making a
determination of eligibility or coverage for insurance benefits, reviewing
services provided to you for protected health necessity, and undertaking
utilization review activities. For
example, obtaining approval for a hospital stay may require that your relevant
protected health information be disclosed to the health plan to obtain
approval for the hospital admission.
Health Care Operations: The
Heart Group may use or disclose your protected health information in order to
conduct certain business and operational activities.
These activities include, but are not limited to, quality assessment
activities, employee review activities, student training, licensing, and
conducting or arranging for other business activities.
For example, The Heart Group
may use a sign-in sheet at the registration desk where you will be asked to
sign your name. We may also call
you by name when your doctor is ready to see you.
We may use or disclose your protected health information, as necessary,
to contact you by telephone or mail to remind you of your appointment.
The Heart Group will share
your protected health information with third party “business associates”
that perform various activities (such as billing, transcription services) for
the practice. When an arrangement
between our office and a business associate involves the use or disclosure of
your protected health information, we will have a written contract that
contains terms that will protect the privacy of your protected health
information.
The Heart Group may use or
disclose your protected health information to provide you with information
about treatment alternatives or other health-related benefits and services
that may be of interest to you. We may also use and disclose your protected
health information for other marketing activities.
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 that we
believe may be beneficial to you. You
may contact us to request that these materials not be sent to you.
Uses and Disclosures Based on Your Written Authorization:
Other uses and disclosures of your protected health information
will be made only with your authorization, unless otherwise permitted or
required by law as described below.
You may give us written
authorization to use your protected health information or to disclose it to
anyone for any purpose. If you
give us an authorization, you may revoke it in writing at any time.
Your revocation will not affect any use or disclosures permitted by
your authorization while it was in effect.
Without your written authorization, we will not disclose your health
care information except as described in this notice.
Others Involved in Your Health Care:
Unless you object, The Heart Group
may disclose your protected health information to a member of
your family, a relative, a close friend or any other person you identify, 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 protected health information to notify or assist
in notifying a family member, personal representative or any other person that
is responsible for your care of your location, general condition or death.
Marketing: The Heart
Group may use your protected health information to contact you with
information about treatment alternatives that may be of interest to you.
We may disclose your protected health information to a business
associate to assist us in these activities.
Unless the information is provided to you by a general newsletter or in
person or is for products or services of nominal value, you may opt out of
receiving further such information by using the contact information listed at
the end of this notice.
Research; Death; Organ Donation: The Heart Group may use or disclose
your protected health information for research purposes in limited
circumstances. We may disclose the
protected health information of a deceased person to a coroner, protected
health examiner, funeral director or organ procurement organization for
certain purposes.
Public Health and Safety: The
Heart Group may disclose your protected health information to the extent
necessary to avert a serious and imminent threat to your health or safety, or
the health or safety of others. We
may disclose your protected health information to a government agency
authorized to oversee the health car system or government programs or its
contractors, and to public health authorities for public health purposes.
Health Oversight: We may disclose protected health information to a
health oversight agency for activities authorized by law, such as audits,
investigations and inspections. Oversight
agencies seeking this information include government agencies that oversee the
health care system, government benefit programs, other government regulatory
programs and civil right laws.
Abuse or Neglect: The
Heart Group may disclose your protected 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 protected 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: The
Heart Group may disclose your protected health information to a person or
company required by the Food and Drug Administration to report adverse events,
product defects or problems, biologic product deviations; to track products;
to enable product recalls; to make repairs or replacements; or to conduct
post-marketing surveillance as required.
Criminal Activity:
Consistent with federal and state laws, The Heart Group may disclose
your protected 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. We
may also disclose protected health information if it is necessary for law
enforcement authorities to identify or apprehend an individual.
Required
by Law: The Heart Group may
use or disclose your protected health information when we are required to do
so by law. For example, we
must disclose your protected health information to the U.S. Department of
Health and Human Services upon request for purposes of determining whether we
are in compliance with federal privacy laws.
We may disclose your protected health information when authorized by
worker’s compensation or similar laws.
Process and Proceedings: The
Heart Group may disclose your protected health information in response to a
court or administrative order, subpoena, discovery request or other lawful
process, under certain circumstances. Under
limited circumstances, such as a court order, warrant or grand jury subpoena,
we may disclose your protected health information to law enforcement
officials.
Law Enforcement: The
Heart Group may disclose limited information to a law enforcement official
concerning the protected health information of a suspect, fugitive, material
witness, crime victim or missing person.
We may disclose the protected health information of an inmate or other
person in lawful custody to a law enforcement official or correctional
institution under certain circumstances. We
may disclose protected health information where necessary to assist law
enforcement officials to capture an individual who has admitted to
participation in a crime or has escaped from lawful custody.
PATIENT
RIGHTS
Access: You have the
right to look at or get copies of your protected health information, with
limited exceptions. You must make
a request in writing to the contact person listed herein to obtain access to
your protected health information. You
may also request access by sending us a letter to the address at the end of
this notice. Your first copy is
free.
If you request additional
copies, The Heart Group will charge you $1.00 (one dollar) for each page and
postage, if you want the copies mailed to you.
If you prefer (and for a fee), we will prepare a summary or an
explanation of your protected health information.
Contact us using the information listed at the end of this notice for a
full explanation of our fee structure.
Accounting of Disclosures: You
have a right to receive a list of instances in which The Heart Group or our
business associates disclosed your protected health information for purposes
other than treatment, payment, health care operations, and certain other
activities after
April 14, 2003
. After
April 14, 2009
, the accounting will be provided for the past six (6) years.
The Heart Group will provide you with the date on which a disclosure
was made, the name of the person or entity to whom your protected health
information was disclosed, a description of the protected health information
disclosed, the reason for the disclosure, and certain other information.
If you request this list more than once in a 12 month period, we may
charge you a reasonable, cost-based fee for responding to these additional
requests. Contact us using the
information listed at the end of this notice for a full explanation of our fee
structure.
Restriction Requests: You
have the right to request that The Heart Group place additional restrictions
on our use or disclosure of your protected health information.
The Heart Group is not required to agree to these additional
restrictions, but if we do, we will abide by our agreement (except in an
emergency). Any agreement we may
make to a request for additional restrictions must be made in writing, signed
by a person authorized to make such an agreement on our behalf.
We will not be bound unless our agreement is so memorialized in
writing.
Confidential Communication: You
have the right to request that we communicate with you in confidence about
your protected health information by alternative means or to an alternative
location. You must make your
request in writing. We must
accommodate your request if it is reasonable, specifies the alternative means
or location, and continues to permit us to bill and collect payment from you.
Amendment: You have the
right to request that we amend your protected health information.
Your request must be in writing, and it must explain why the
information should be amended. We
may deny your request if we did not create the information you want amended or
for certain other reasons. If we
deny your request, we will provide you a written explanation.
You may respond with a statement of disagreement to be appended to the
information you wanted amended.
If we accept your request to amend the information, we will make
reasonable efforts to inform others, including people or entities you name, of
the amendment and to include the changes in any future disclosures of that
information.
Electronic Notice: If
you receive this notice on our website or by electronic mail (e-mail), you are
entitled to receive this notice in written work.
Please contact us using the information listed at the end of this
notice to obtain this notice in written form.
Acknowledgement
of Receipt of this Notice:
The Heart Group will request that you sign a separate form
or notice acknowledging that you have received a copy of this notice.
If you choose, or are not able to sign, a staff member will sign their
name and date. The acknowledgement
will be filed with your records.
Changes to this Notice: The
Heart Group reserves the right to change this notice and to make the revised
or changed notice effective for health information we already have about you
as well as any information we receive in the future.
We will post a copy of the current notice in our reception area.
The effective date of the notice will be placed on the first page of
the document. Each time you
register for health care services, The Heart Group will offer you a copy of
the current notice in effect.
QUESTIONS
AND COMPLAINTS
If you want more information about our privacy practices or have
questions and concerns, please contact us using the information below.
If you believe that we may have violated your privacy rights, or you
disagree with a decision we made about access to your protected health
information or in response to a request you made, you may complain to us using
the contact information below. You
may also submit a written complaint to the Department of Health and Human
Services. We will provide you with
the address to file your complaint with the Department of Health and Human
Services upon request.
We support your right to protect the privacy of your protected health
information. We will not retaliate
in any way if you choose to file a complaint with us or with the Department of
Health and Human Services.
Privacy Officer: Edith Whitledge
Telephone: 270-575-3113
Fax Number: 270-415-0362
Address: 2601 Kentucky Ave
Suite 301
Paducah, KY 42003
E-mail:
eyw@heartgroupky.com
