HIPAA NOTICE OF PRIVACY PRACTICES

_________________________

 

WESTFIELD PLASTIC SURGERGERY CENTER

9900 NICHOLAS STREET SUITE 300

OMAHA, NE 68114

 

 

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.

EFFECTIVE DATE: January 1,2012

 

Westfield Plastic Surgery Center Responsibilities:

 

We are required by law to (1) maintain the privacy of your health information; (2) provide you with notice of our legal duties and privacy practices with respect to your health information; (3) abide by the terms of this Notice of Privacy Practices; (4) notify you if we are unable to agree to a requested restriction; and (5) accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.

 

We reserve the right to change this Notice of Privacy Practices and to make the new provisions effective for all health information we maintain.  Should our privacy practices change, we will provide a revised Notice of Privacy Practices at your next appointment.

 

Westfield Plastic Surgery center engages in the following practices involving the use and disclosure of protected health information to carry out treatment, payment and healthcare operations:

 

Treatment:  We will use and disclose your health information for treatment including the provision, coordination or management of healthcare, and related services.  For example, information may be disclosed in order to coordinate the different things you need, or to support and maintain your continuum of care.

 

Payment:  We will use your health information for payment.  For example, a bill may be sent to you or a third party payer.  The information accompanying the bill may include information that identifies you, as well as your diagnosis, procedures and supplies used.

 

Healthcare Operations:  We may use or disclose your health information to carry out our daily activities as they relate to the provision of healthcare.  Healthcare operations include but are not limited to quality assessment activities, and licensing activities.  For example, we may disclose your information with third parties that perform various business activities (e.g., billing or computer software services) provided we have a written contract with the business that requires it to safeguard the privacy of your protected health information.

 

Uses and Disclosures of Protected Health Information Requiring an Authorization:  In situations other than those listed below, we will request your written authorization before using or disclosing protected health information about you.  If you choose to sign such authorization to disclose information, you may, in writing, revoke that authorization to stop any future uses and disclosures except to the extent that action has been taken in reliance on the use or disclose, or if the authorization was obtained as a condition of obtaining insurance coverage and the insurer has a legal right to contest a claim.

 

Notification:  In an emergency situation, we may use or disclose your health information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, of your location, and general condition.

 

Public Health Activities:  We may disclose your health information to a public health authority that is permitted to collect or receive the information.  We may be required to report information to help prevent or control disease, injury, or disability.  We may also disclose information, if directed by the public health authority, to a foreign government agency that collaborates with the public health authority.  This includes reporting child abuse or neglect, FDA regulated product or activity, and exposure to communicable diseases.

 

Abuse or Neglect:  If we believe you have been a victim of abuse or neglect we may disclose your health information to an authorized governmental entity or agency.  The disclosure will be made pursuant to the requirements of federal and state laws.  We may also disclose your information to a public health entity that is authorized to receive reports of child abuse or neglect.

 

Healthcare Oversight Activities:  We may disclose your health information to appropriate authorities for activities including but not limited to monitoring, investigating, inspecting, and disciplining or licensing those who work in the healthcare system or for government benefit programs.

 

Judicial and Administrative Proceedings:  We may disclose your health information that is expressly authorized by an administrative proceeding, in response to an order of a court or administrative tribunal, and under certain conditions in response to a subpoena, discovery request or other lawful process.

 

Law Enforcement Purposes:  We may disclose health information for law enforcement purposes as required by law, or in response to a valid subpoena.

 

Disclosure About Decedents:  We may disclose health information about decedents to coroners and medical examiners for the purpose of identifying a deceased individual, determining a cause of death, or carrying out other duties permitted by law.  Additionally, we may disclose decedent’s information to funeral directors as authorized by law.

 

 

Avoid Threat to Health or Safety:  We may disclose information to specified authorities if we believe in good faith that a disclosure of your health information is necessary to prevent or minimize a serious threat to you or the public’s health or safety.

 

Military, National Security and Law Enforcement Custody:  Under certain conditions, if you are involved with the military, national security, or intelligence activities, we may release your health information to the proper authorities so that they may carry out their duties.  Also, if you are in a correctional institution or other law enforcement custodial situation we may disclose your health information to a correctional institution or law enforcement official.

 

Inmates:  If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release your protected health information to the correctional institution or law enforcement official.  The release would be necessary 1) for the institution to provide you with health care; 2) to protect your health and safety or the health and safety of others; or 3) for the safety and security of the correctional institution.

 

Workers Compensation:  We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers’ compensation or other similar programs established by the law.

 

Charges Against Provider:  In the event you should file suit against us, we may disclose health information necessary to defend such action.  Also, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate and determine our compliance with the law.

 

Your Individual Rights:  You have several rights with regard to your health information.

 

Specifically you have the right to:

 

Request a Provider Not to Disclose:  You may request, in writing, that we not use or disclose your information for treatment, payment, or administrative purpose, or to persons involved in your care except when specifically authorized by you, when required by law, or in emergency situations.  We will consider your request, however we are not legally required to accept it.

 

Receive Confidential Communication:  You have the right to request that your health information be communicated to you in a confidential manner, in certain situations, such as sending mail to an address other than your home.

 

Inspect and Copy Information:  Within the limits of the State statutes and regulations, you have the right to inspect and copy your health information.  You may not inspect or copy psychotherapy notes, information compiled in anticipation of litigation, or information subject to a law that prohibits access.  The decision to deny access may be reviewable in certain cases.

 

Request to Amend Healthcare Information:  If you believe that information in your record is incorrect or if important information is missing, you have the right to submit a request to us to amend your health information by correcting the existing information or adding the missing information.  We may, under certain circumstances, deny your request.

 

Receive an Accounting:  You have the right to receive an accounting of disclosures of your health information.  This includes disclosures made other than for treatment, payment, healthcare operation, for a facility directory, to family member or friends involved in your care, requests made by you, pursuant to an authorization, or for notification purposes.  The right to receive this information is subject to certain exceptions and limitations.

 

Receive a Paper Copy of this Notice: If this notice was sent to you electronically, you may obtain a paper copy of the notice upon request.

 

For More Information or to Report a Problem:

 

If you are concerned that we have violated your privacy rights, or you disagree with a decision we have made about access to your record, you may contact the individual listed below.  You may also send a written complaint to the U.S. Department of Health and Human Services.  The individual listed below can provide you with the appropriate address upon request.  Under no circumstances will you be retaliated against for filing a complaint.

 

If you have any questions or complaints, please contact the Privacy Officer by phone or in writing at:

 

____________________

Privacy Officer

____________________

____________________

 

____________________