Notice of Privacy Practices for Protected Health Information
Desert Ridge Rehabilitation & Health Group
DBA Sleep Therapy Solutions
8575 E. Princess Dr., Suite 205
Scottsdale, AZ 85255
480.563.8450
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
This office is required by a
federal regulation, known as the HIPAA Privacy Rule, to maintain the
privacy of your health information and to provide you with notice of
its legal duties and privacy practices. This office will not use or
disclose your health information except as described in this Notice.
The office 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. The health information about you is documented in a medical
record and on a computer. Such information may include documenting
your symptoms, medical history, examination and test results,
diagnoses, treatment, and applying for future care or treatment. It
also includes billing documents for those services.
Examples of uses of your health information for treatment
purposes are:
-
A nurse or medical assistant obtains treatment information about
you and records it in a health record.
-
During the course of your treatment, the physician determines
he/she will need to consult with another specialist in the area.
He/she will share the information with such specialist and
obtain his/her input.
Example of use of your health information for payment
purposes:
-
We submit requests for
payment to your health insurance company. The health insurance
company (or other business associate helping us obtain payment)
requests health information from us regarding medical care
given. We will provide information to them about you and the
care given, which may include copies or excerpts of your medical
record which are necessary for payment of your account. For
example, a bill sent to your health insurance company may
include information that identifies your diagnosis, and the
procedures and supplies used.
Example of use of your health information for health care
operations:
-
We obtain services from
our insurers or other business associates (an individual or
entity under contract with us to perform or assist us in a
function or activity that necessitates the use or disclosure of
health information) such as quality assessment, quality
improvement, outcome evaluation, protocol and clinical
guidelines development, training programs, credentialing,
medical transcription, medical review, legal services, and
insurance. We will share health information about you with our
insurers or other business associates as necessary to obtain
these services. We require our insurers and other business
associates to protect the confidentiality of your health
information.
Your Health
Information Rights
The health and billing
records we maintain are the physical property of the doctor’s
office. The information in it, however, belongs to you. You have a
right to:
Request a restriction on
certain uses and disclosures of your health information by
delivering the request in writing to our office—we are not required
to grant the request but we will comply with any request granted;
Obtain a paper copy of the
Notice of Privacy Practices for Protected Health Information
(“Notice”) by making a request at our office;
-
Request that you be allowed to inspect and copy your medical
record and billing record—you may exercise this right by
delivering the request in writing to our office using the form
we provide to you upon request;
-
Appeal a denial of access to your protected health information
except in certain circumstances;
-
Request that your medical record be amended to correct
incomplete or incorrect information by delivering a written
request, including a reason to support it, to our office using
the form we provide to you upon request. (We are not required to
make such amendments);
-
File a statement of disagreement if your amendment is denied,
and require that the request for amendment and any denial be
attached in all future disclosures of your protected health
information;
-
Obtain an accounting of disclosures of your health information
as required to be maintained by law by delivering a written
request to our office using the form we provide to you upon
request. An accounting will not include uses and disclosures of
information for treatment, payment, or health care operations;
disclosures or uses made to you or made at your request; uses or
disclosures made pursuant to an authorization signed by you; or
to family members or friends or uses relevant to that person’s
involvement in your care or in payment for such care; or uses or
disclosures to notify family or others responsible for your care
of your location, condition, or your death; we may charge a
cost-based fee for more than one accounting in a 12-month
period.
-
Request that confidential communication of your health
information be made by alternative means or at an alternative
location by delivering the request in writing to our office
using the form we provide to you upon request; and,
-
Revoke authorizations that you made previously to use or
disclose information except to the extent information or action
has already been taken by delivering a written revocation to our
office.
If you want to exercise any
of the above rights, please contact Jackie Gorman, Privacy Officer,
in person or in writing, during normal business hours. Our Privacy
Officer will provide you with assistance on the steps to take to
exercise your rights.
You have the right to review this Notice before signing the
acknowledgment authorizing use and disclosure of your protected
health information for treatment, payment, and health care
operations purposes.
Our Responsibilities
The office is required to:
-
Maintain the privacy of your health information as required by
law;
-
Provide you with a notice as to our duties and privacy practices
as to the information we collect and maintain about you;
-
Abide by the terms of this Notice;
-
Notify you if we cannot accommodate a requested restriction or
request; and
-
Accommodate your reasonable requests regarding methods to
communicate health information with you.
We reserve the right to amend, change, or eliminate provisions in
our privacy practices and access 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.
To Request
Information or File a Complaint
If you have questions, would
like additional information, want to report a problem regarding the
handling of your information, of if you believe your privacy rights
have been violated and wish to file a written complaint with our
office, please contact Jackie Gorman, Privacy officer. You may also
file a complaint by mailing it or e-mailing it to the Secretary of
Health and Human Services.
-
We cannot, and will not, require you to waive your rights under
the Privacy Rule including the right to file a complaint with
the Secretary of Health and Human Services (HHS) as a condition
of receiving treatment from the office.
-
We cannot, and will not, retaliate against you for filing a
complaint with the Secretary of Health and Human Services.
Other Disclosures
and Uses We Can Make Without Your Written Authorization
Notification of
Family/Friends
-
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.
Communication with
Family/Friends
-
Using our best judgment,
we may disclose to a family member, 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.
Disaster Relief
Employers
-
We may release health
information about you to your employer if we provide health care
services to you at the request of your employer, and the health
care services are provided either to conduct an evaluation
relating to medical surveillance of the workplace or to evaluate
whether you have a work-related illness or injury. In such
circumstances, we will give you written notice of such release
of information to your employer. Any other disclosures to your
employer will be made only if you execute an authorization for
the release of that information to your employer.
Deceased Persons
-
We may disclose your
health information to funeral directors, medical examiners, or
coroners consistent with applicable law to allow them to carry
out their duties. This may be necessary, for example, to
identify a deceased person or determine the cause of death. We
may also release health information about patients to funeral
directors as necessary for them to carry out their duties.
Organ Procurement
Organizations
-
Consistent with
applicable law, we may disclose your health information to organ
procurement organizations or other entities engaged in the
procurement, banking, or transplantation of organs for the
purpose of tissue donation and transplant.
Appointment Reminders,
Marketing and Treatment Alternatives
-
We may contact you to
provide you with appointment reminders, with information about
treatment alternatives, or with information about other
health-related benefits and services that may be of interest to
you. We may also encourage you to purchase a product or service
when we see you. We will not disclose your health information
without your written authorization.
Food and Drug
Administration (FDA)
-
We may disclose to the
FDA your health information relating to adverse events with
respect to food, supplements, products and product defects, or
post-marketing surveillance information to enable product
recalls, repairs, or replacements.
Workers’ Compensation
Public Health
-
As required by law, we
may disclose your health information to public health or legal
authorities charged with preventing or controlling disease,
injury, or disability; to report reactions to medications or
problems with products; to notify people of recalls; to notify a
person who may have been exposed to a disease or who is at risk
for contracting or spreading a disease or condition.
Abuse, Neglect & Domestic
Violence
Sign in Sheet
Inmates
Law Enforcement
-
We may disclose your
health information for law enforcement purposes as required by
law, such as when required by a court order; for identification
of a victim of a crime if certain protective requirements are
met; to report a crime on our premises; to report crime in
emergencies; and other appropriate situations permitted by law.
Health Oversight
Judicial/Administrative
Proceedings
-
We may disclose your
health information in the course of any judicial or
administrative proceeding as allowed or required by law or as
directed by a proper court order or in response to a subpoena,
with your authorization, discovery request or other lawful
process if certain specific requirements are met.
Serious Threat
-
To avert a serious threat
to health or safety, we may disclose your health information
consistent with applicable law to prevent or lessen a serious,
imminent threat to the health or safety of a person or the
public.
For Specialized
Governmental Functions
-
We may disclose your
health information for specialized government functions as
authorized by law such as to Armed Forces personnel, for
national security purposes, or to public assistance program
personnel.
Other Uses
Website
Research
Fund Raising
Original Effective Date:
April 14, 2003
Effective Date of Last Revision (if any): February 1, 2009
