NOTICE OF PRIVACY PRACTICES FOR PROTECTED HEALTH INFORMATION
With your consent, the practice is permitted by federal privacy laws to make uses and disclosures of your health information for purposes of treatment, payment, and health care operations. Protected health information is the information we create and obtain in providing our services to you. Such information may include documenting your symptoms, examination and test results, diagnoses, treatment, and applying for future care or treatment. It also includes billing documents for these services.
A surgical assistant obtains information about you and records it in a health record. During the course of your treatment, the doctor determines a need to consult with another specialist in the area. The doctor will share the information with such specialist and obtain input. We may use and disclose your health information to a physician or other healthcare provider providing treatment to you.
We submit a request for payment to your health or dental insurance company. The health or dental insurance company requests information from us regarding medical care given. We will provide information to them about you and the care given. We may use and disclose your health information to obtain payment for the services we provide you.
We obtain services from our insurers or other business associates such as quality assessment, quality improvement, outcome evaluation, protocol and clinical guidelines development, training programs, credentialing, medical review, accounting, and legal services, computer vendors, answering service and insurance. We will share information about you with such insurers or other business associates as necessary to obtain these services.
The health record we maintain and billing records are the physical property of the practice. The information in it, however, belongs to you. You have a right to:
If you want to exercise any of the above rights, please contact Monika, Privacy Officer, at 2620 Stewart Ave., Suite 218, Wausau, WI 54401; (715)842-8811, in person or in writing, during normal hours. She will provide you with assistance on the steps to take to exercise your rights.
The practice is required to:
We reserve the right to amend, change, or eliminate provisions in our privacy practices and assess practices, and to enact new provisions regarding the protected health information we maintain. If our information practices change, we will amend our Notice. You are entitled to receive a revised copy of the Notice by calling and requesting a copy of our “Notice” or by visiting our office and picking up a copy.
If you have questions, would like additional information, or want to report a problem regarding the handling of your information, you may contact Monika, Office Manager at (715)842-8811.
Additionally, if you believe your privacy rights have been violated, you may file a written complaint at our office by delivering the written complaint to Monika. You may also file a written complaint by mailing it to the Secretary of Health and Human Services at the U.S. Department of Health and Human Services.
Unless you object, we may use or disclose your protected health information to notify, or assist in notifying, a family member, personal representative, or other person responsible for your care, about your location, and about your general condition, or your death.
Using our best judgment, we may disclose to a family member, or other relative, close personal friend, or any other person you identify, health information relevant to that person’s involvement in your care or in payment for such care if you do not object or in an emergency.
We may use and disclose your health information to provide you with appointment reminders (such as voicemail messages, text messages, letters or emails).
We may disclose to the FDA your protected health information relating to adverse events with respect to products and product defects, or post-marketing surveillance information to enable product recalls, repairs, or replacements.
If you are seeking compensation through Workers Compensation, we may disclose your protected health information to the extent necessary to comply with laws relating to Workers Compensation.
As required by law, we may disclose your protected health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.
We may disclose your protected health information to public authorities as allowed by law to report abuse or neglect.
We may disclose your protected health information for law enforcement purposes as required by law, such as when required by a court order, or in cases involving felony prosecutions, or to the extent an individual is in the custody of law enforcement.
Federal law allows us to release your protected health information to appropriate health oversight agencies or for health oversight activities.
We may disclose your protected health information in the course of any judicial or administrative proceeding as allowed or required by law, with your consent, or as directed by a proper court order.
Other uses and disclosures besides those identified in this Notice will be made only as otherwise authorized by law or with your written authorization and you may revoke the authorization as previously provided.
Effective Date: April 14, 2003 and will remain in effect until we replace it.