HIPAA NOTICE OF PRIVACY PRACTICES
Associates in ENT Notice of Privacy Practices:
Revised: September 2013
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 Associates in ENT HIPAA Privacy/Security Officer at (423)267-6738.
Associates in ENT are required by law to maintain the privacy of your health information; give you notice of our legal duties and privacy practices with respect to your health information; and follow the terms of this notice. This notice applies to all of your health records generated by Associates in ENT, whether made by our personnel or your personal physician. This notice will tell you about the ways in which we may use and disclose your health information. We also describe your rights and certain obligations we have regarding the use and disclosure of you health information.
How we may use and disclose your health information:
For Treatment: We will use your health information to provide you with health care treatment and to coordinate or manage services with other health care providers, including third parties.
We may disclose all or any portion of your health information:
Business Associate Rule:
Business Associates are defined as: entity, (non-employee) that in the course of their work will directly/indirectly use, transmit, view, transport, hear, interpret, process or offer PHI for this office. Business Associates and other third parties (if any) that receive your PHI from us will be prohibited from re-disclosing it unless required to do so by law or you give prior express written consent to the re-disclosure. Nothing in our Business Associate agreement will allow our Business Associate to violate this re-disclosure prohibition. Under Omnibus Rule, Business Associates will sign a confidentiality agreement binding them to keep your PHI protected and report any compromise of such information to us, you and the U.S. Department of Health and Human Services, as well as other required entites. Our Business Associates will also follow Omnibus Rule and have any of their Subcontractor that may directly or indrectly have contact with your PHI, sign Confidentiality Agreements to Federal Omnibus Standard.
Organized Health Care Arrangement:
Associates in ENT is a clinically integrated health care setting. You may receive health care services from your personal physician, other physicians who are members of the medical team, practitioners who have clinical privileges to practice at Associates in ENT and from Associates in ENT employees.
Your physician, and Associates in ENT must be able to share your health information in order to provide you with quality health care, receive payment and conduct health care operations. The members of Associates in ENT medical staff have agreed to follow uniform health information practices when using or disclosing your health information while you are a patient of Associates in ENT. This agreement is called an organized health care arrangement. This arrangement only applies when you receive the health care services at Associates in ENT. It does not apply to the information practices of any hospitals or other physician practices or private practices.
The organized health care arrangement includes Associates in ENT physicians and staff members.
You will receive a Notice of Privacy Practices form on behalf of Associates in ENT physicians and staff members for health care services provided by Associates in ENT.
We will use and disclose your health information for activities that are necessary to receive payment for our services, such as determining insurance coverage, billing, payment and collections, claims management and medical data processing. For example, we may tell your health plan about a treatment you are planning in order to receive approval or to determine whether your plan will cover the proposed treatment. We may disclose your health information to other health care providers so they can receive payment for health care services that they provide to you, such as lab or radiology services. We may also give information to other third parties or individuals who are responsible for payment for your health care.
Associates in ENT does not sell or share your personal information.
For Health Care Operations:
We may disclose your health information for routine facility operations, such as business planning and development, quality review of services provided, internal auditing, accreditation, certification, licensing or credentialing activities or education for staff and medical students, or to other health care entities that have a relationship with you and need the information for operational purposes.
Uses and disclosures that are required or permitted by law:
Subject to requirements of federal, state and local laws, we are either required or permitted to report your health information for various purposes. Some of these reporting requirements include:
Public Health Activities:
We may disclose your health information to public health officials for activities such as the prevention or control of communicable disease, injury or disability; to report deaths; to report suspected child abuse or neglect; to report reactions to medications or problems with medical products.
Disaster Relief Efforts:
We may disclose your health information to a health oversight agency in a disaster relief effort so that your family can be notified about your condition and location.
Health Oversight Activities:
We may disclose your health information to a health oversight agency for activities authorized by law. These oversight activities may include audits, investigations, inspections and licensure. These activities are necessary for the government to monitor the health care system, government programs and compliance with civil rights laws.
Judicial or Administrative Proceedings:
We may disclose your health information in response to a court or administrative order, a valid subpoena, discover request, civil or criminal proceedings, or other lawful process.
We may release your health information if asked to do so by a law enforcement official:
Coroners, Medical Examiners and Funeral Directors:
We may release health information to a coroner or a medical examiner. This may be necessary, for example, to identify a person who died or determine the cause of death. We may also release health information to help a funeral director carry out their duties.
We may release your health information for workers' compensation benefits or to similar programs that provide benefits for work-related injuries or illness.
To Avert a Serious Threat to Health or Safety:
We may disclose your health information when necessary to prevent a serious threat to your health and safety or the health and safety of another person or the public.
We may disclose your health information to federal official(s) for national security activities and for the protection of the President and other Heads of State.
Military and Veterans:
If you are a member of the armed forces, we may release your health information as required by military command authorities. We may also release health information about foreign military personnel to the appropriate foreign military authority.
If you are an inmate of a correctional institution or in the custody of a law enforcement official seeking medical attention by a physician of Associates in ENT, we may release your health information to the institution or law enforcement official. This release would be necessary (1) for the institution to provide you with health care; or (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
Other uses of your health information:
Other uses and disclosures of your health information not covered by this notice or the laws that apply to us will be made only with your written authorization. Submit your request in writing, using a Authorization for Disclosure of Protected Health Information form to Associates in ENT, Compliance Officer, Oasis Park Bldg 1, Suite 102, 1724 Hamill Road, Hixson, TN 37343. Phone (423)267-6738. If you provide us with authorization to use or disclose your health information, you may revoke that authorization in writing at any time. When we receive your written revocation we will no longer use or disclose your health information for the purpose of that authorizations. However, we are unable to retrieve any disclosures already made based on your prior authorization.
Your rights regarding your health information:
Right to Inspect any Copy:
You have a right to inspect your health information and copy medical, billing or other records that may be used to make decisions about your care. Submit your request in writing to Associates in ENT, Compliance Officer, Oasis Park Bldg 1, Suite 102, 1724 Hamill Road, Hixson, TN 37343. Phone (423)267-6738. We charge a fee for document requests to cover the costs of copying, mailing or other supplies. In limited circumstances we may deny your request to inspect and copy your health information. If you are denied access to your helath information, you may request that the denial be reviewed. A designated health care professional chosen by Associates in ENT will review your request and the denial. The person who conducts the review will not be the same person who denied your request. We will comply with the outcome of the request.
Right to Amend:
You have a right to request an amendment to your health information that you believe is incorrect or incomplete. Submit your request in writing, using a Request for Amendment to Protected Health Information form, and including your reason for the amendment, to Associates in ENT, Compliance Officer, Oasis Park Bldg 1, Suite 102, 1724 Hamill Road, Hixson, TN 37343. Phone (423)267-6738.
We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. We may also deny your request if you ask us to amend information that:
Was not created by Associates in ENT; unless the person or entity that created the information is no longer available to make the amendment; is not part of the medical information kept by Associates in ENT. Is not part of the information that you would be permitted to inspect and copy; is accurate and complete.
To obtain a paper copy of this request contact Associates in ENT, Compliance Officer, Oasis Park Bldg 1, Suite 102, Hixson, TN 37343. Phone (423)267-6738.
Right to an Accounting of Disclosures:
We are required to maintain a list of disclosures of your health information. However, we are not required to maintain a list of disclosures that we made by acting upon your written authorizations. You have the right to request an accounting of disclosures that were not subject to your written authorization. Submit your request in writing to Associates in ENT, Compliance Officer, Oasis Park Bldg 1, Suite 102, 1724 Hamill Road, Hixson, TN 37343. Phone (423)267-6738. Your request must state a time period, not longer than six years, and may not include dates before April 14, 2003. This will be available in paper and electronic format. The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request before any costs are incurred.
Right to Request Restrictions:
You have a right to request a restriction or limitation on how much of your health information we use or disclose for treatment, payment or health care operations. You also have the right to request a restriction on the disclosure of your health information to someone who is involved in your care or payment for your care, such as a family member or friend.
We are not required to agree to your request. However, if we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment. Submit your request in writing to Associates in ENT, Compliance Officer, Oasis Park Bldg 1, Suite 102, Hixson, TN 37343 or request and submit a Request for Restrictions to Protected Health Information form. Phone (423)267-6738. You must include: (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply.
Right to Request Confidential Communications:
You have the right to request that we communicate with you about health care matters in a certain way or at a certain location. For example, you can ask that we only contact you at an alternative location from your home address, such as work, or only contact you by mail instead of by phone. You must submit a Confidential Communications form to Associates in ENT, Compliance Officer, Oasis Park Bldg 1, Suite 102, 1724 Hamill Road, Hixson, TN 37415. Phone (423)267-6738. Your request must be specify how or where you wish to be contacted. We do not require a reason for the request. We will accommodate all reasonable requests.
Right to a Paper Copy of This Notice:
You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this notice contact, Associates in ENT, Compliance Officer, Oasis Park Bldg 1, Suite 102, 1724 Hamill Road, Hixson, TN 37343. Phone (423)267-6738.
Changes to this notice:
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in the facility and on the web site at www.myentonline.com. The notice will contain on the first page, in the top right-hand corner, the effective date. Upon your intial registration to the office for treatment or health care services as an outpatient, we will offer you a copy of the current notice in effect. Whenever the notice is revised, it will be available to you upon request.
You may file a complaint with us or with the Secretary of the Department of Health and Human Services if you beleive that we have not complied with our privacy practices. You may file a complaint with us verbally or in writing by contacting Associates in ENT, Compliance Officer, Oasis Park Bldg 1, Suite 102, 1724 Hamill Road, Hixson, TN 37343. Phone (423)267-6738. You will not be penalized for filing a complaint.