Medical Practices & Information Policy
MARY LOUISE LENAHAN
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.
Mary Louise Lenahan Dermatology (“Lenahan”) uses your Protected Health Information for your treatment, to obtain payment for our services and for our operational purposes, such as improving the quality of care we provide to you. We are committed to maintaining your confidentiality and protecting your health information. We are required by law to provide you with this Notice which describes our health information privacy practices and those of our affiliated health care providers.
This Notice applies to all information and records related to your care that Lenahan’s workforce members and Business Associates (described below) have received or created. It informs you about the possible uses and disclosures of your Protected Health Information and describes your rights and our obligations regarding your Protected Health Information.
We are required by law to:
· maintain the privacy of your Protected Health Information;
· provide to you this detailed Notice of our legal duties and privacy practices relating to your Protected Health Information; and
· abide by the terms of the Notice that are currently in effect. We reserve the right to change the terms of this Notice, and will notify you or your personal representative by letter if we make any material changes to the Notice.
I. WITH YOUR CONSENT WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION FOR TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS
You will be asked to sign a Consent allowing us to use and disclose your Protected Health Information to others to provide you with treatment, obtain payment for our services, and run our health care operations. Here are examples of how we may use and disclose your health information.
For Treatment. Our staff and affiliated health care professionals may review and record information in your record about your treatment and care. We will use the information to dispense prescription medications to you. In addition we will disclose this health information to health care professionals in order to coordinate your treatment and care. For example, a pharmacist may consult with your physician to determine how to best treat you or with an emergency room physician who is treating you to avoid dangerous drug interactions.
For Payment. Lenahan may use and disclose your Protected Health Information to others in order for Lenahan to bill for your health care services and receive payment. For example, we may contact your insurance company to determine whether it will pay for your prescription and the payment amount. We may also include your health information in our claim to your insurance company, Medicare or Medicaid in order to receive payment for services provided to you or disclose your health information to other health care providers so that they can receive payment for their services.
For Health Care Operations. We may use and disclose your Protected Health Information to others for Lenahan’s business operations. For example, we may use your Protected Health Information to monitor drug usage and inventory levels or to evaluate Lenahan’s services, including the performance of our staff, and to educate our staff. We may also or disclose your health information to other health care providers who treat you for their health care operations.
II. WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION FOR OTHER SPECIFIC PURPOSES
Business Associates We may share your Protected Health Information with our vendors and agents who help us with obtaining payment or carrying out our business functions. These are called our “Business Associates”. For example, we may give your health information to a billing company to assist us with our billing for services, or to a law firm or an accounting firm that assists us in complying with the law and or improving our services.
Family and Friends Involved in Your Care Unless you object, we may disclose your Protected Health information to a family member or close personal friend, including clergy, who is involved in your care or payment for that care.
Disaster Relief. We may disclose your Protected Health Information to an organization assisting in a disaster relief effort.
Public Health Activities. We may disclose your Protected Health Information for public health activities including the reporting of disease, injury, vital events, and the conduct of public health surveillance, investigation and/or intervention. We may also disclose your information to notify a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition if a law permits
Health Oversight Activities. We may disclose your Protected Health Information to health oversight agencies authorized by law to conduct audits, investigations, inspections and licensure actions or other legal proceedings. These agencies provide oversight for the Medicare and Medicaid programs, among others.
Reporting Victims of Abuse, Neglect or Domestic Violence. If we have reason to believe that you have been a victim of abuse, neglect or domestic violence, we may use and disclose your Protected Health Information to notify a government authority if required or authorized by law, or if you agree to the report.
Law Enforcement. We may disclose your Protected Health information for certain law enforcement purposes or other specialized governmental functions.
Judicial and Administrative Proceedings. We may disclose your Protected Health Information in the course of certain judicial or administrative proceedings.
Research In general, we will request that you sign a written authorization before using your Protected Health Information or disclosing it to others for research purposes. However, we may use or disclose your health information without your written authorization for research purposes provided that the research has been reviewed and approved by a special Privacy Board or Institutional Review Board.
Coroners, Medical Examiners, Funeral Directors, Organ Procurement Organizations We may release your health information to a coroner, medical examiners, funeral director or, if you are an organ donor, to an organization involved in the donation of organs and tissue.
To Avert a Serious Threat to Health or Safety We may use and disclose your Protected Health Information when necessary to prevent a serious threat to your health or safety or the health or safety of the public or another person. However, any disclosure would be made only to someone able to help prevent the threat.
Military and Veterans If you are a member of the armed forces, we may use and disclose your Protected Health Information as required by military command authorities. We may also use and disclose Protected Health Information about foreign military personnel as required by the appropriate foreign military authority.
Workers’ Compensation. We may use or disclose your Protected Health Information to comply with laws relating to workers’ compensation or similar programs.
National Security and Intelligence Activities; Protective Services. We may disclose health information to authorized federal officials who are conducting national security and intelligence activities or as needed to provide protection to the President of the United States, or other important officials.
As Required By Law. We will disclose your Protected Health Information when required by law to do so.
Treatment Alternatives and Health-Related Benefits [if applicable] Lenahan may contact you to provide information about treatment alternatives or other health-related benefits and services that may be of interest to you.
III. YOUR AUTHORIZATION IS REQUIRED FOR OTHER USES OF YOUR PROTECTED HEALTH INFORMATION
We will use and disclose your Protected Health Information other than as described in this Notice or required by law only with your written Authorization. You may revoke your Authorization to use or disclose Protected Health Information in writing, at any time. To revoke your Authorization, contact the Medical Records staff. If you revoke your Authorization, we will no longer use or disclose your Protected Health Information for the purposes covered by the Authorization, except where we have already relied on the Authorization.
IV. YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
You have the following rights with respect to your health information. If you wish to exercise any of these rights, you should make your request to the Medical Records Director.
Right of Access to Protected Health Information. You have the right to request to inspect and obtain a copy of your Protected Health Information, subject to some limited exceptions. Your request for access must be in writing. We must allow you to inspect your records within a reasonable time but not more than30 days from the date of your request if the records are maintained onsite or 60 days if the records are maintained off-site. We may charge a reasonable fee for our costs in copying and mailing your requested information. If we are unable to provide you with access within 60 days, we may extend the time by 30 days. We will provide you with a written statement of the reasons for the delay.
In certain limited circumstances, we may deny your request to inspect or receive copies. If we deny access to your Protected Health Information, you have a right to request review of the denial. We will provide you with information on how to request a review of our denial and how to file a complaint with us or the Secretary of the Department of Health and Human Services.
Right to Request Restrictions. You have the right to request restrictions on the way we use and disclose your Protected Health Information to carry out treatment, payment or health care operations. You also have the right to request restrictions on the way we disclose your Protected Health Information to a family member, friend or other person who is involved in your care or the payment for your care.
We are not required to agree to your requested restriction, and in some cases, the law may not permit us to accept your restriction. However, if we do agree to accept your restriction, we will comply with your restriction except in the case of an emergency or if the use or disclosure is required by law.
Right to an Accounting of Disclosures. You have the right to request an “accounting” ofcertain disclosures of your Protected Health Information. This is a listing of certain disclosures of your Protected Health Information made by Lenahan or by others on our behalf, but does not include disclosures made for treatment, payment and health care operations, with your consent or authorization or in certain othersituations.
You must submit a request in writing, stating a time period beginning after April 13, 2003 that is within six years from the date of your request. For example, you may request a list of disclosures Lenahan made between May 1, 2015 and May 1, 2016. You are entitled to one free accounting within one 12-month period. For additional requests, we may charge you our costs.
We will usually respond to your request within 60 days. Occasionally, we may need additional time to prepare the accounting. If so, we will notify you of our delay, the reason for the delay, and the date when you can expect the accounting.
Right to Request Amendment. If you think that your Protected Health Information is not accurate or complete, you have the right to request that Lenahan amend such information for as long as the information is kept in our records. Your request must be in writing and state the reason for the requested amendment. We will usually respond within 60 days, but will notify you within 60 days if we need additional time to respond, the reason for the delay and when you can expect our response. We may deny your request for amendment, and if we do so, we will give you a written denial including the reasons for the denial and an explanation of your right to submit a written statement disagreeing with the denial.
Right to a Paper Copy of This Notice. You have the right to obtain a paper copy of this Notice, even if you have agreed to receive this Notice electronically. You may request a copy of this Notice at any time. You may obtain a copy of this Notice at our website, www.Lenahandermatology.com.
Right to Request Confidential Communications. You have the right to request that we communicate with you concerning personal health matters in a certain manner or at a certain location. For example, you can request that we speak to you only at a private location such as your home, rather than at work. Your request for confidential communications must be in writing. We will accommodate your reasonable requests.
If you believe that your privacy rights have been violated, you may file a complaint in writing with us or with the Office of Civil Rights in the U.S. Department of Health and Human Services. To file a complaint with Lenahan, contact:
6507 Transit Road
East Amherst, NY 14051
To file a complaint with the U.S. Department of Health and Human Services, contact
Region II Office of Civil Rights
U.S. Department of Health and Human Services
Jacobs Javits Federal Building
26 Federal Plaza – Suite 3312
New York, New York 10278
No one will retaliate or take action against you for filing a complaint.
VI. CHANGES TO THIS NOTICE
We will promptly revise and distribute this Notice whenever there is a material change to the uses or disclosures, your individual rights, our legal duties, or other privacy practices stated in this Notice. We reserve the right to change this Notice and to make the revised or new Notice provisions effective for all Protected Health Information already received and maintained by Lenahan as well as for all Protected Health Information we receive in the future. We will post a copy of the current Notice at Lenahan. In addition, we will provide a copy of the revised Notice to all patients at the next visit.
VII. FOR FURTHER INFORMATION
If you have any questions about this Notice or would like further information concerning your privacy rights, please contact email@example.com (716) 689-4378
Effective Date of this Notice: January 1st, 2017