Effective
date: April 14, 2003
THIS
NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY
BE USED AND DISCLOSED AND HOW TO GET ACCESS TO THIS INFORMATION.
PLEASE READ IT CAREFULLY.
If
you have any questions regarding this notice, you may
contact our privacy officer at:
Address: Drs.
Shanahan & Ferguson, P.C.
Attention:
Privacy Officer,
120
Speer Road, Suite 2
Chestertown,
MD 21620
Telephone: 410-778-9300
Facsimile: 410-778-9206
I.
Your protected health information
Drs. Shanahan & Ferguson,
P.C. is required by the federal privacy rule to maintain
the privacy of health information that is protected by
the rule, and to provide you with notice of our legal
duties and privacy practices with respect to your protected
health care information. We are required to abide by the
terms of the notice currently in effect.
Generally
speaking, your protected health information is any information
that relates to your past, present or future physical
or mental health or condition, the provision of health
care to you, or payment for health care provided to you,
and individually identifies you or reasonably can be used
to identify you.
Your
medical and billing records at our practice are examples
of information that usually will be regarded as your protected
health information.
II.
Uses and disclosures of your protected health information
A.
Treatment, payment, and health care operations
This
section describes how we may use and disclose your protected
health information for treatment, payment, and health
care operations purposes. The descriptions include examples.
Not every possible use or disclosure for treatment, payment,
and health care operations purposes will be listed.
1.
Treatment
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 your care may review your medical record and
share and discuss your medical information with each
other.
- 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 information with
a hospital or other health care facility where we are
admitting or treating you.
- We
may share and discuss your medical information with
another health care provider who seeks this information
for the purpose of treating you.
- 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 to provide appointment reminders.
2.
Payment
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.
- Provision
of a bill to a family member or other person designated
as responsible for payment for services rendered to
you.
- Providing
medical records and other documentation to your health
insurer to support the medical necessity of a health
service.
- Allowing
your health insurer access to your medical record for
a medical necessity or quality review audit.
- Providing
consumer-reporting agencies with credit information
(your name and address, date of birth, social security
number, payment history, account number, and our name
and address).
- Providing
information to a collection agency or our attorney for
purposes of securing payment of a delinquent account.
- Disclosing
information in a legal action for purposes of securing
payment of a delinquent account.
3.
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 medical 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.
- Uses
and disclosures for other purposes
We
may use and disclose your protected health information
for other purposes. This section generally describes those
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 than one category
— not just the category under which they are listed.
1.
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.
2.
Notification purposes
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 a 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.
3.
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, child abuse, disease prevention and control,
vaccine-related injuries, medical device-related deaths
and serious injuries, gunshot and other injuries by a
deadly weapon or criminal act, driving impairments, and
blood alcohol testing.
4.
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.
5.
Victims of abuse, neglect or domestic violence
We
may use and disclose protected health information for
purposes of reporting 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.
6.
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.
7.
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.
8.
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.
9.
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.
10.
Funeral directors
We
may use and disclose protected health information for
purposes of providing information to funeral directors
as necessary to carry out their duties.
11.
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.
12.
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.
