Notice of Privacy Practices
Dexter Family Practice
Notice of Privacy Practices
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.
If you have any questions about this Notice please contact: our Privacy Contact who is Margaret Towle
This Notice of Privacy Practices
describes how we may use and disclose your protected health information
to carry out treatment, payment or health care operations and for other
purposes that are permitted or required by law. It also describes your
rights to access and control your protected health information.
“Protected health information” is information about you, including
demographic information, that may identify you and that relates to your
past, present or future physical or mental health or condition and
related health care services.
We are required to abide by the terms
of this Notice of Privacy Practices. We may change the terms of our
notice, at any time. The new notice will be effective for all protected
health information that we maintain at that time. Upon your request, we
will provide you with any revised Notice of Privacy Practices by
accessing our website – DexterFamilyPractice.com, or by calling the
office and requesting that a revised copy be sent to you in the mail or
asking for one at the time of your next appointment.
1. Uses and Disclosures of Protected Health Information
Uses and Disclosures of Protected Health Information Based Upon Your Written Consent
You will be asked by your physician
to sign a consent form. Once you have consented to use and disclosure
of your protected health information for treatment, payment and health
care operations by signing the consent form, your physician will use or
disclose your protected health information as described in this Section
1. Your protected health information may be used and disclosed by your
physician, 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 you. Your protected health information may also be
used and disclosed to pay your health care bills and to support the
operation of the physician’s practice.
Following are examples of the types
of uses and disclosures of your protected health care information that
the physician’s office is permitted to make once you have signed our
consent form. These examples are not meant to be exhaustive, but to
describe the types of uses and disclosures that may be made by our
office once you have provided consent.
Treatment:
We will use and disclose your protected health information to provide,
coordinate, or manage your health care and any related services. This
includes the coordination or management of your health care with a
third party that has already obtained your permission to have access to
your protected health information. For example, we would disclose your
protected health information, as necessary, to a home health agency
that provides care to you. We will also disclose protected health
information to other physicians who may be treating you when we have
the necessary permission from you to disclose your protected health
information. For example, your protected health information may be
provided to a physician to whom you have been referred to ensure that
the physician has the necessary information to diagnose or treat you.
In addition, we may disclose your
protected health information from time-to-time to another physician or
health care provider (e.g., a specialist or laboratory) who, at the
request of your physician, becomes involved in your care by providing
assistance with your health care diagnosis or treatment to your
physician.
Payment:
Your protected health information will be used, as needed, to obtain
payment for your health care services. 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. For example, obtaining
approval for a hospital stay may require that your relevant protected
health information be disclosed to the health plan to obtain approval
for the hospital admission.
Healthcare Operations:
We may use or disclose, as-needed, your protected health information in
order to support the business activities of your physician’s practice.
These activities include, but are not limited to, quality assessment
activities, employee review activities, training of medical students,
licensing, marketing and fundraising activities, and conducting or
arranging for other business activities.
For example, we may disclose your
protected health information to medical school students that see
patients at our office. In addition, we may use a sign-in sheet at the
registration desk where you will be asked to sign your name and
indicate your physician. We may also call you by name in the waiting
room when your physician is ready to see you. We may use or disclose
your protected health information, as necessary, to contact you to
remind you of your appointment.
We will share your protected health
information with third party “business associates” that perform various
activities (e.g., billing, transcription services) for the practice.
Whenever an arrangement between our office and a business associate
involves the use or disclosure of your protected health information, we
will have a written contract that contains terms that will protect the
privacy of your protected health information.
We may use or disclose your protected
health information, as necessary, to provide you with information about
treatment alternatives or other health-related benefits and services
that may be of interest to you. We may also use and disclose your
protected health information for other marketing activities. For
example, your name and address may be used to send you a newsletter
about our practice and the services we offer. We may also send you
information about products or services that we believe may be
beneficial to you. You may contact our Privacy Contact to request that
these materials not be sent to you.
We may use or disclose your
demographic information and the dates that you received treatment from
your physician, as necessary, in order to contact you for fundraising
activities supported by our office. If you do not want to receive these
materials, please contact our Privacy Contact and request that these
fundraising materials not be sent to you.
Uses and Disclosures of Protected Health Information Based upon Your Written Authorization
Other uses and disclosures of your
protected health information will be made only with your written
authorization, unless otherwise permitted or required by law as
described below. You may revoke this authorization, at any time, in
writing, except to the extent that your physician or the physician’s
practice has taken an action in reliance on the use or disclosure
indicated in the authorization.
Other Permitted and Required Uses and Disclosures That May Be Made With Your Consent, Authorization or
We may use and disclose your
protected health information in the following instances. You have the
opportunity to agree or object to the use or disclosure of all or part
of your protected health information. If you are not present or able to
agree or object to the use or disclosure of the protected health
information, then your physician may, using professional judgement,
determine whether the disclosure is in your best interest. In this
case, only the protected health information that is relevant to your
health care will be disclosed.
Facility Directories:
Unless you object, we will use and disclose in our facility directory
your name, the location at which you are receiving care, your condition
(in general terms), and your religious affiliation. All of this
information, except religious affiliation, will be disclosed to people
that ask for you by name. Members of the clergy will be told your
religious affiliation.
Others Involved in Your Healthcare:
Unless you object, we may disclose to a member of your family, a
relative, a close friend or any other person you identify, your
protected health information that directly relates to that person’s
involvement in your health 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 protected health information 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. Finally, we may use or disclose your
protected health information to an authorized public or private entity
to assist in disaster relief efforts and to coordinate uses and
disclosures to family or other individuals involved in your health
care.
Emergencies:
We may use or disclose your protected health information in an
emergency treatment situation. If this happens, your physician shall
try to obtain your consent as soon as reasonably practicable after the
delivery of treatment. If your physician or another physician in the
practice is required by law to treat you and the physician has
attempted to obtain your consent but is unable to obtain your consent,
he or she may still use or disclose your protected health information
to treat you.
Communication Barriers:
We may use and disclose your protected health information if your
physician or another physician in the practice attempts to obtain
consent from you but is unable to do so due to substantial
communication barriers and the physician determines, using professional
judgement, that you intend to consent to use or disclosure under the
circumstances.
Other Permitted and Required Uses and Disclosures That May Be Made Without Your Consent, Authorization or
We may use or disclose your protected
health information in the following situations without your consent or
authorization. These situations include:
Required By Law:
We may use or disclose your protected health information to the extent
that the use or disclosure is required by law. The use or disclosure
will be made in compliance with the law and will be limited to the
relevant requirements of the law. You will be notified, as required by
law, of any such uses or disclosures.
Public Health:
We may disclose your protected health information for public health
activities and purposes to a public health authority that is permitted
by law to collect or receive the information. The disclosure will be
made for the purpose of controlling disease, injury or disability. We
may also disclose your protected health information, if directed by the
public health authority, to a foreign government agency that is
collaborating with the public health authority.
Communicable Diseases:
We may disclose your protected health information, if authorized by
law, to a person who may have been exposed to a communicable disease or
may otherwise be at risk of contracting or spreading the disease or
condition.
Health Oversight:
We may disclose protected health information to a health oversight
agency for activities authorized by law, such as audits,
investigations, and inspections. Oversight agencies seeking this
information include government agencies that oversee the health care
system, government benefit programs, other government regulatory
programs and civil rights laws.
Abuse or Neglect:
We may disclose your protected health information to a public health
authority that is authorized by law to receive reports of child abuse
or neglect. In addition, we may disclose your protected health
information if we believe that you have been a victim of abuse, neglect
or domestic violence to the governmental entity or agency authorized to
receive such information. In this case, the disclosure will be made
consistent with the requirements of applicable federal and state laws.
Food and Drug Administration:
We may disclose your protected health information to a person or
company required by the Food and Drug Administration to report adverse
events, product defects or problems, biologic product deviations, track
products; to enable product recalls; to make repairs or replacements,
or to conduct post marketing surveillance, as required.
Legal Proceedings:
We may disclose protected health information in the course of any
judicial or administrative proceeding, in response to an order of a
court or administrative tribunal (to the extent such disclosure is
expressly authorized), in certain conditions in response to a subpoena,
discovery request or other lawful process.
Law Enforcement:
We may also disclose protected health information, so long as
applicable legal requirements are met, for law enforcement purposes.
These law enforcement purposes include (1) legal processes and
otherwise required by law, (2) limited information requests for
identification and location purposes, (3) pertaining to victims of a
crime, (4) suspicion that death has occurred as a result of criminal
conduct, (5) in the event that a crime occurs on the premises of the
practice, and (6) medical emergency (not on the Practice’s premises)
and it is likely that a crime has occurred.
Coroners, Funeral Directors, and Organ Donation:
We may disclose protected health information to a coroner or medical
examiner for identification purposes, determining cause of death or for
the coroner or medical examiner to perform other duties authorized by
law. We may also disclose protected health information to a funeral
director, as authorized by law, in order to permit the funeral director
to carry out their duties. We may disclose such information in
reasonable anticipation of death. Protected health information may be
used and disclosed for cadaveric organ, eye or tissue donation
purposes.
Research:
We may disclose your protected health information to researchers when
their research has been approved by an institutional review board that
has reviewed the research proposal and established protocols to ensure
the privacy of your protected health information.
Criminal Activity:
Consistent with applicable federal and state laws, we may disclose your
protected health information, if we believe that the use or disclosure
is necessary to prevent or lessen a serious and imminent threat to the
health or safety of a person or the public. We may also disclose
protected health information if it is necessary for law enforcement
authorities to identify or apprehend an individual.
Military Activity and National Security:
When the appropriate conditions apply, we may use or disclose protected
health information of individuals who are Armed Forces personnel (1)
for activities deemed necessary by appropriate military command
authorities; (2) for the purpose of a determination by the Department
of Veterans Affairs of your eligibility for benefits, or (3) to foreign
military authority if you are a member of that foreign military
services. We may also disclose your protected health information to
authorized federal officials for conducting national security and
intelligence activities, including for the provision of protective
services to the President or others legally authorized.
Workers’ Compensation:
Your protected health information may be disclosed by us as authorized
to comply with workers’ compensation laws and other similar
legally-established programs.
Inmates:
We may use or disclose your protected health information if you are an
inmate of a correctional facility and your physician created or
received your protected health information in the course of providing
care to you.
Required Uses and Disclosures:
Under the law, we must make disclosures to you and when required by 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.
2. Your Rights
Following is a statement of your
rights with respect to your protected health information and a brief
description of how you may exercise these rights.
You have the right to inspect and copy your protected health information.
This means you may inspect and obtain a copy of protected health
information about you that is contained in a designated record set for
as long as we maintain the protected health information. A “designated
record set” contains medical and billing records and any other records
that your physician and the practice uses for making decisions about
you.
Under federal law, however, you may
not inspect or copy the following records; psychotherapy notes;
information compiled in reasonable anticipation of, or use in, a civil,
criminal, or administrative action or proceeding, and protected health
information that is subject to law that prohibits access to protected
health information. Depending on the circumstances, a decision to deny
access may be reviewable. In some circumstances, you may have a right
to have this decision reviewed. Please contact our Privacy Contact if
you have questions about access to your medical record.
You have the right to request a restriction of your protected health information.
This means you may ask us not to use or disclose any part of your
protected health information for the purposes of treatment, payment or
healthcare operations. You may also request that any part of your
protected health information not be disclosed to family members or
friends who may be involved in your care or for notification purposes
as described in this Notice of Privacy Practices. Your request must
state the specific restriction requested and to whom you want the
restriction to apply.
Your physician is not required to
agree to a restriction that you may request. If physician believes it
is in your best interest to permit use and disclosure of your protected
health information, your protected health information will not be
restricted. If your physician does agree to the requested restriction,
we may not use or disclose your protected health information 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 your physician. You may request a restriction by
discussion with Dr. Challa Reddy.
You have the right to request to receive confidential communications from us by alternative means or at an alternative location.
We will accommodate reasonable requests. We may also condition this
accommodation by asking you for information as to how payment will be
handled or specification of an alternative address or other method of
contact. We will not request an explanation from you as to the basis
for the request. Please make this request in writing to our Privacy
Contact.
You may have the right to have your physician amend your protected health information.
This means you may request an amendment of protected health information
about you in a designated record set for as long as we maintain this
information. 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 Contact to determine if you have
questions about amending your medical record.
You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information.
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
You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice electronically.
3. Complaints
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 contact of your complaint. We will not retaliate
against you for filing a complaint.
You may contact our Privacy Contact,
Margaret Towle at (207)924-7349, ext. 3 for further information about
the complaint process.
This notice was published and becomes effective on
