PROXY MEDICAL HIPAA PRIVACY NOTICE
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION CAN BE USED AND DISCLOSED. PLEASE REVIEW IT CAREFULLY.
Proxy Medical Inc. understands that the medical information is private and confidential. Further, we are required by law to maintain the privacy of "protected health information." "Protected health information "includes any individually identifiable information that we obtain from the provider or others that relates to the patient past, present or future physical or mental health, the health care received, or payment for the health care. As required by law, this notice provides you with information about the rights of the patients and our legal duties and privacy practices with respect to the privacy of protected health information. This notice also discusses the uses and disclosures we will make of protected health information. We must comply with the provisions of this notice as currently in effect.
PERMITTED USES AND DISCLOSURES
When authorized by the patient, we can use or disclose the protected health information for purposes of payment. Payment means the activities undertaken to obtain reimbursement for the health care provided, including verification of eligibility and coverage, billing, collections and claims management. Before providing health care services, we may need to inform the insurance company about the patient medical condition to determine whether the treatment will be covered. When we subsequently bill the insurance companies, we can provide them with information regarding the patient care if necessary to obtain payment. Federal or State may law require us to obtain a written release from the patient prior to disclosing certain specially protected health information for payment purposes. In addition, we may use or disclose protected health information to the patient family, friend or any other individual authorized by the patient to receive protected health information directly relevant to such person’s involvement with the care or payment.
OTHER USES OF YOUR HEALTH INFORMATION
Other uses and disclosure of protected health information not covered by this notice or the laws that apply to us will be made only with permission of the patient in a written authorization. The patient has the right to revoke that authorization at any time, provided that the revocation is in writing, except to the extent that we already have taken action in reliance on such authorization.
THE RIGHTS OF THE PATIENTS
Under HIPAA’s Privacy Rule, patients can exercise their right to privacy:
1. You have the right to request restrictions on the uses and disclosures of protected health information for treatment, payment and health care operations. To request a restriction, you must make your request in writing to the Provider of Service.
2. You have the right to reasonably request to receive confidential communications of protected healthinformation by alternative means or at alternative locations. To make such a request, you must submit your request in writing to the Provider of Service.
3. You have the right to inspect and copy the protected health information contained in your medical and billing records and in any other Practice records used by the Provider of Service.
In order to inspect and copy your health information, you must submit your request in writing to the provider of service. If you request a copy of your health information, we may charge you a fee for the costs of copying and mailing your records, as well as other costs associated with your request.
4. You have the right to request an amendment to your protected health information. In any event, any agreed upon amendment will be included as an addition to, and not a replacement of, already existing records. In order to request an amendment to your health information, you must submit your request in writing to the Provider of Service, along with a description of the reason for your request.
5. You have the right to receive an accounting of disclosures of protected health information made by he Provider of Service or by us to individuals or entities other than to you for the six years prior to your request. To request an accounting of disclosures of your health information, you must submit your request in writing to the Provider of Service. Your request must state a specific time period for the accounting (e.g., the past six months). We may charge you for the costs of providing the list. We will notify you of the costs involved, and you may choose to withdraw or modify your request at that time before any costs as incurred.
If you believe that your privacy rights have been violated, you should immediately contact the Provider of Service.
If you have any questions or would like further information about this notice, please contact the Provider of Service.
|Copyright © 2007 PROXY MEDICAL INC|