This
notice describes how medical information about you may be used and disclosed and how you
can get access to this information. Please review it carefully.
USES AND DISCLOSURES OF PHI
Uses and Disclosures of PHI for Treatment, Payment and Healthcare Operations
Your PHI may be used and disclosed by your healthcare provider, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services, to pay your health care bills and/or to support the operation of our practice. Below are some examples of the types of uses and disclosures we may make. These examples are not meant to be exhaustive or all-inclusive.
Treatment: We will use and disclose your PHI to provide, coordinate, or manage your health care and any related services. This includes the coordination of your health care with the healthcare personnel at the facilities at which we treat you. For example, we would disclose your PHI, as necessary, to a nursing facility that provides care to you. We would also disclose PHI to other physicians who may be treating you. We may also disclose your PHI to obtain durable medical equipment for you (e.g., eyeglasses or hearing aids).
Payment: Your PHI will be used, as needed, to obtain payment for your health care services, through billing, claims management and collection activities. 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 medical necessity, and undertaking utilization review activities, including preauthorization of services. For example, a claim submission to your insurer would require your condition and services rendered to be disclosed to the insurer for payment.
Healthcare Operations: We may use or disclose, as needed, your PHI to support our business activities. These activities include, but are not limited to, quality assessment, employee review and licensing. We may use or disclose your PHI, as necessary, to contact your facility to remind you or the staff of your scheduled care. We may share your health information with third party "business associates" that perform various activities (e.g., billing) for the practice. Any arrangement with a business associate involving the use or disclosure of your PHI, will have a written contract that contains terms to safeguard your PHI.
Uses & Disclosures of PHI with Your Written
Authorization
Other uses and disclosures of your PHI will be made only with your written authorization,
unless otherwise required by law as described below. You may revoke this authorization, at
any time, in writing, except to the extent that HealthDrive has taken an action in
reliance on the use or disclosure indicated in the authorization.
Permitted or Required Uses & Disclosures with Your Opportunity to Object
Others Involved in Your Healthcare: Unless you object, we may disclose your PHI to
a member of your family, a close friend or any others who are involved in your healthcare
or help pay for your 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 PHI 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.
Emergencies: We may use or disclose your PHI in an emergency treatment situation,
without your authorization.
Communication Barriers: We may use and disclose your PHI if we attempt to obtain
consent from you but are unable to due to substantial communication barriers and the
provider determines, using professional judgment, that you intend to consent to use or
disclosure under the circumstances.
Uses & Disclosures Without Your Authorization
We may use or disclose your PHI in the following situations without your consent or
authorization. These situations include:
· as required By Law;
· for public health activities;
· to report adult abuse, neglect, or domestic violence;
· To health oversight agencies;
· in response to court and administrative orders and other legal proceedings;
· To law enforcement officials pursuant to subpoenas and other lawful processes;
· to coroners, medical examiners, funeral directors, and organ procurement organizations;
· to avert a serious threat to health or safety;
· in connection with certain research activities;
· to the military and federal officials for lawful intelligence, counterintelligence and
national security activities;
· as authorized by state worker's compensation laws.
Required Uses & Disclosures: Under the law, we must make
disclosures to 1) you and 2) to the Secretary of the Department of Health and Human
Services to investigate or determine our compliance with the requirements of Section
164.500 et. seq.
YOUR RIGHTS
You have the right to access and receive copies of your PHI. You
must request this in writing. HealthDrive may charge a fee to cover certain costs.
Under federal law, however, you may not inspect or copy the following records: information
compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative
action or proceeding, and PHI that is subject to law that prohibits access to PHI. Please
contact our Privacy Officer about accessing your medical record.
You have the right to request a restriction of the use and disclosure of your
PHI. This means you may ask us not to use or disclose any part of your PHI
for the purposes of treatment, payment or healthcare operations. You may also request that
any part of your PHI 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.
HealthDrive is not required to agree to any restriction requested. If we believe it is in
your best interest to allow use and disclosure of your PHI, your PHI will not be
restricted. If we agree to the requested restriction, we may not use or disclose your PHI
in violation of that restriction unless it is needed to provide emergency treatment. With
this in mind, please discuss any restriction you wish to request with our Privacy Officer.
You have the right to receive confidential communications from us.
We will accommodate reasonable requests to communicate by alternative means. We will not
request an explanation from you as to the basis for the request. Please make this request
in writing to our Privacy Official.
You may have the right to have your PHI amended. You must request
this in writing. 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 with us
and we may prepare a rebuttal to your statement and will provide you with a copy of any
such rebuttal. Please contact our Privacy Officer about amending your medical record.
You have the right to receive an accounting of certain disclosures we have
made, if any, of your PHI. This right applies to disclosures for purposes
other than treatment, payment or healthcare operations as described in this Notice of
Privacy Practices. It excludes disclosures we may have made to you, for a facility
directory, to family members or friends involved in your care, or for notification
purposes. You have the right to receive specific information regarding these disclosures
that occurred after April 14, 2003. 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,
upon request.
COMPLAINTS
HealthDrive takes your privacy very seriously. You may complain to us or to the Secretary
of Health and Human Services if you believe your privacy rights have been violated by us.
You may file a complaint with us by notifying our Privacy Officer at (617) 964-6681. We
will not retaliate against you for filing a complaint.
To complain to the Office of Civil Rights, please see the appropriate address below.
For Connecticut, Massachusetts, New Hampshire, or Rhode Island: Region I, Office
for Civil Rights, U.S. Department of Health and Human Services, Government Center, J.F.
Kennedy Federal Building--Room 1875, Boston, Massachusetts 02203. Voice phone (617)
565-1340.
For New Jersey: Region II, Office for Civil Rights, U.S. Department of Health and
Human Services, Jacob Javits Federal Building, 26 Federal Plaza--Suite 3312, New York, New
York, 10278. Voice Phone (212) 264-3313.
For Pennsylvania: Region III, Office for Civil Rights, U.S. Department of Health
and Human Services, 150 S. Independence Mall West, Suite 372, Public Ledger Building,
Philadelphia, PA 19106-9111. Hotline (800) 368-1019.
For Wisconsin: Region V, Office for Civil Rights, U.S. Department of Health and
Human Services, 233 N. Michigan Ave., Suite 240, Chicago, Ill. 60601. Voice Phone (312)
886-2359.
HealthDrive Medical & Dental Practices is comprised of the corporate entities doing
business as:
HealthDrive Dental Group
HealthDrive Eye Care Group
HealthDrive Podiatry Group
HealthDrive Audiology Group
HealthDrive Corporation
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