CAPITAL DISTRICT PEDIATRIC CARDIOLOGY ASSOCIATES, P.C.
319 SOUTH MANNING BLVD., SUITE 203
ALBANY, NY 12208
PLEASE REVIEW THIS NOTICE CAREFULLY
As required by the privacy regulations created as a result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
This notice describes how Protected Health Information about you (as a patient of this practice) may be used and disclosed, and how you can get access to your Protected Health Information.
A. OUR COMMITMENT TO YOUR PRIVACY
Our practice is dedicated to maintaining the privacy of your protected health information (PHI). In conducting our business, we will create records regarding you and the treatment and services we provide to you. We are required by law to maintain the confidentiality of health information that identifies you. We also are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your PHI. By federal and state law, we must follow the terms of the notice of privacy practices that we have in effect at this time. We realize that these laws are complicated, but we must provide you with the following important information:
- How we may use and disclose your PHI
- Your privacy rights and your PHI
- Our obligations concerning the use and disclosure of your PHI
The terms of this Notice apply to all records containing your PHI that are created or retained by our practice. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment in this Notice will be effective for all of your records that our practice has created or maintained in the past, and for any of your records that we may create or maintain in the future. Our practice will post a copy of our current Notice in our office in a visible location at all times, and you may request a copy of our most current Notice at any time.
B. IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT:
Steven Kamenir, M.D.
319 South Manning Blvd., Suite 203
Albany, NY 12208
C. WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION (PHI) IN THE FOLLOWING WAYS
The following categories describe the different ways in which we may use and disclose your PHI:
1. Treatment. Our practice may use your PHI to treat you. For example, we may ask you to have laboratory tests, and we may use the results to help us reach a diagnosis. We might use your PHI in order to write a prescription for you, or we might disclose your PHI to a pharmacy when we order a prescription for you. All of the people who work for our practice–including, but not limited to our doctors–may use or disclose your PHI in order to treat you or to assist you in your treatment. Additionally, we may disclose your PHI to others who may assist in your care such as members of your family. Finally, we may also disclose your PHI to other health care providers for purposes related to your treatment.
2. Payment. Our practice may use and disclose your PHI in order to bill and collect payment for the services and items you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, and pay for, your treatment. We may also use and disclose your PHI to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your PHI to bill you directly for services and items. We may disclose your PHI to other health care providers and entities to assist in their billing and collection efforts.
3. Health Care Operations. Our practice may use and disclose your PHI to operate our practice. For example, we may use and disclose your PHI to evaluate the quality of care or services you received from us, to conduct management and business planning activities, or to educate our staff, medical residents and medical students on how to provide or improve care. We may disclosure your PHI to other health care providers and entities to assist in their health care operations.
4. Appointment Reminders. Our practice may use and disclose your PHI to contact you and remind you of an appointment.
5. Treatment Options and Services. Our practice may use and disclose your PHI to inform you of potential treatment options or alternatives. We may also inform you of health related benefits or services that may be of interest to you.
6. Release of Information to Family/Friends. Our practice may release your PHI to a friend or family member that is involved in your care or who assists in taking care of you. For example, a parent or guardian may ask that a baby sitter take their child to our office. In this example, the babysitter may have access to the child's medical information.
7. Disclosures Required by Law. Our practice will use and disclose your PHI when we are required to do so by a federal, state, or local law.
D. USE AND DISCLOSURE OF YOUR PROTECTED HEALTH INFORMATION (PHI) IN CERTAIN SPECIAL CIRCUMSTANCES
The following categories describe unique scenarios in which we may use or disclose your PHI.
1. Public Health Risks. Our practice may disclose your PHI to public health authorities that are authorized by law to collect information for the purposes of maintaining vital records, reporting child abuse or neglect, or preventing or controlling disease, injury, or disability. We may also disclose your PHI to notify a person regarding potential exposure to a communicable disease, or a potential risk for spreading or contracting a disease or condition, if a law or rule permits us to do so. We may also disclose your PHI to report reactions to drugs or problems with products or devices, and to notify individuals if a product or device they may be using has been recalled, or notify your employer or public/private school or college, under limited circumstances related primarily to workplace or school injury or illness or medical surveillance. We may disclose your PHI to a public health authority that is authorized by law to receive reports of abuse or neglect.
2. Health Oversight Activities. Our practice may disclose your PHI to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions.
3. Lawsuits and Similar Proceedings. Our practice may use and disclose your PHI in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding. We may also disclose your PHI in response to a discovery request, subpoena, or other lawful process by another party involved in a dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.
4. Law Enforcement. We may release your PHI if asked to do so by a law enforcement official in response to a warrant, summons, court order, subpoenas, or similar legal process regarding criminal conduct at our office, or concerning a death we believe has resulted from criminal conduct, regarding a crime victim in certain situations.
5. Deceased Patients. Our practice may release PHI to a medical examiner or coroner to identify a deceased individual or to identify the cause of death. If necessary, we may also release information in order for funeral directors to perform their jobs.
6. Organ and Tissue Donation. Our practice may release your PHI to organizations that handle organ, eye, or tissue procurement or transplantations, including organ donation banks, as necessary to facilitate organ or tissue donation and transplantation if you are an organ donor.
7. Research. Our practice may use and disclose your PHI for research purposes in certain limited circumstances. We will obtain your written authorization to use your PHI for research purposes except when an Institutional Review Board (IRB) or Privacy Board has determined that specific permission from you is not required.
8. Serious Threats to Health and Safety. Our practice may use and disclose your PHI when necessary to reduce or prevent a serious threat to your health and safety, or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threats.
9. Military. Our practice may disclose your PHI if you wish to enlist in, or are a member of US military forces, and if required by the appropriate authorities.
10. Workers’ Compensation. Our practice may release your PHI for Workers’ Compensation and similar programs.
11. Schools and Colleges. Our practice may release your PHI to public/private schools and colleges if required for mandated physical activities (gym class), participation in athletic activities, or student health offices for the care of individuals as students in that institution.
E. YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION (PHI)
You have the following rights regarding the PHI we maintain about you:
1. Confidential Communications. You have the right to request that our practice communicates with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home rather than work. In order to request a type of confidential communication, you must make a written request to this office specifying the requested method of contact, or the location where you wish to be contacted. Our practice will accommodate reasonable requests. You do not need to give a reason for your request.
2. Requesting Restrictions. You have the right to request a restriction in our use or disclosure of your PHI for treatment, payment, or health care operations. You also have the right to request that we restrict our disclosure of your PHI to only certain individuals involved in your health care or payment of your health care. We are not required to agree to your request. However, if we do agree, we are bound by our agreement except when otherwise required by law, and emergencies, or when the information is necessary to treat you. If you want to request a restriction in our use or disclosure, you must make your request in writing to this office. Your request must describe in a clear and concise fashion the information you wish restricted, whether you are requesting to limit our practice’s use, disclosure, or both, and to whom you want the limits to apply.
3. Inspection and Copies. You have the right to inspect and to obtain a copy of the PHI that may be used to make decisions about you, including patient medical records and billing records. You have the right to request a copy of your electronic health record in an electronic form. You must submit your request in writing to this office in order to inspect and/or obtain a copy of your PHI. Our practice may charge a fee for the cost of copying, mailing, labor and supplies associated with your request. Our practice may deny a request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial. Another licensed health care professional chosen by us will conduct reviews.
4. Amendment. You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by us or for our practice. Your request must be made in writing and submitted to this office and must provide us with a reason that supports your request for amendment. Our practice will deny your request if you fail to submit your request (and the reason supporting your request) in writing. We may deny your request if you ask us to amend information that is in our opinion: (a) accurate and complete; (b) not part of the PHI kept by or for the practice; (c) not part of the PHI which you would be permitted to inspect or copy; or (d) not created by our practice, unless the individual or entity that created the information is not available to amend the information.
5. Accounting of Disclosures. All of our patients have the right to request an "accounting of disclosures," which is a list of certain non-routine disclosures our practice has made of your PHI for non-treatment, nonpayment or non-operations purposes. These may also include disclosures for treatment, payment and health care operations. Use of your PHI as part of the routine patient care in our practice is not required to be documented; for example, the doctor sharing information with our technicians, or the billing secretary using your information to file your insurance claim. In order to obtain an accounting of disclosures, you must submit your request in writing to this office, and all requests must state a time period, which may not be longer than 6 years from the date of disclosure, and may not include dates before April 14, 2003. Your first request within a 12-month period is free of charge, but we may charge you for additional lists within the same 12-month period. We will notify you of the costs involved with additional requests and you may withdraw your request before you incur any costs.
6. Right to a Paper Copy of This Notice. You are entitled to receive a paper copy of our Notice of Privacy Practices. You may ask us to give you a copy of this Notice at any time.
7. Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of US Health and Human Services. To file a complaint with our office, contact Steven Kamenir, M.D., of this office. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
8. Right to Provide an Authorization for Other Uses and Disclosures. Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provided to us regarding the use and disclosure of your PHI may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your PHI for the reasons described in the authorization. Please note, we are required to retain records of your care.
F. AMENDMENTS TO THE PRIVACY, SECURITY, BREACH NOTIFICATION AND ENFORCEMENT RULES UNDER HIPAA
1. You have the right to be notified following a breach of unsecured PHI.
2. Most uses and disclosures of psychotherapy notes, uses and disclosures of PHI for marketing purposes, and disclosures that constitute a sale of PHI require your authorization.
3. Other uses and disclosures not described in this Notice of Privacy Practices will be made only with your authorization.
4. You have the right to restrict certain disclosures of PHI to health plans or insurance companies if you pay cash in full out of pocket for health services with our practice.
Effective Date. This Notice of Privacy Practices became effective initially on April 14, 2003. Amendments to this Notice of Privacy Practices are effective as of September 23, 2013.