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THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. THE PRIVACY OF YOUR HEALTH INFORMATION IS IMPORTANT TO US. OUR LEGAL DUTY We reserve the right to change our privacy practices and the terms of this Notice at any time, provided such changes are permitted by applicable law. We reserve the right to make the changes in our privacy practices and the new terms of our Notice effective for all health information that we maintain, including health information we created or received before we made the changes. Before we make any significant change in our privacy practices, we will change this Notice and make the new Notice available upon request. You may request a copy of our Notice at any time. For more information about our privacy practices or for additional copies of this Notice, please contact us at the address below. We use and disclose health information about you for treatment, payment, and healthcare operations. For example: Treatment: We may use or disclose your health information to a physician or other healthcare provider providing treatment to you. Payment: We may use and disclose medical information about you so that the treatment and services you receive at ENT Specialists of Northwestern Pennsylvania may be billed to and payment maybe collected from you, an insurance company, or health plan, or other third party. We may also tell your health plan about a treatment you are going to receive in order to obtain prior approval or to determine whether your plan will cover the treatment. We may have our bills and payment arrangements outsourced to one or more third party service provider(s) who issue, provide, and collect bills on our behalf Healthcare Operations: We may use and disclose your health information in connection with our healthcare operations. Healthcare operations include quality assessment and improvement activities, reviewing the competence or qualifications of healthcare professionals, evaluating practitioner and provider performance, conducting training programs, accreditation, certification, licensing or credentialing activities. These uses and disclosures are necessary to run ENT Specialists of Northwestern Pennsylvania and to make sure all of our patients receive quality care. Your Authorization: In addition to our use of your health information for treatment, payment or healthcare operations, you may give us written authorization to use your health information or disclose it to anyone for any purpose. If you give us an authorization, you may revoke it in writing at any time. Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect. Unless you give us a written authorization, we cannot use or disclose your health information for any reason except those described in this Notice. Individuals Involved in your care or Payment for your Care: This practice is obligated to disclose your health information to you, as described later in this Notice. We may release medical information about you to a friend or family member who is involved in your medical care, but only with your approval. If you are present, we will provide you with an opportunity to object to such uses or disclosures, prior to such use. For telephone encounters, we will ask you to validate your identity by use of a designated password. In the event that you are unable to speak for yourself due to catastrophic events, this practice will use professional discretion when disclosing your health information. Marketing Health-Related Services: We will not use your health information for marketing communications without your written authorization. As Required by Law: We will disclose medical information about you when required to do so by federal, state, or local law. Abuse or Neglect: We may disclose your health information to appropriate authorities, if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes. We may disclose your health information to the extent necessary to avert a serious threat to your health or safety or the health or safety of others. Research: Research conducted in this practice is voluntary. If your condition meets the criteria for participation in a research study affiliated with this practice, you will be given the option to take part in such research. Your written authorization to disclose your medical information will be necessary. It will always be your right to revoke participation/authorization in any research study at any given time. Your revocation from such participation in the research study will not, in any way, jeopardize any present or future treatment you receive from this practice. Military Veterans and National Security: If you are a member of the Armed Forces, we may release medical information about you as required by military command authorities or, in some cases, if needed to determine benefits, to the Department of Veteran Affairs. Disclosure may also be made to authorized federal officials required for lawful intelligence, and other national security activities. We may also disclose your information to law enforcement officials or correctional facilities who have lawful custody of inmate or patient. Workers' Compensation: We may release information about you for Workers = Compensation or similar programs. These programs provide benefits for work-related injuries or illnesses. Health Oversight Activities: We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include; for example: 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. Appointment Reminders/Rescheduling: We may use or disclose your health information to provide you with appointment reminders, such as postcards. In the event of a change in your provider's schedule, we may disclose your health information by leaving a message at your home. Other uses of Medical Information: Other uses and disclosures of medical information, not covered by this Notice or the laws that apply to us, will be made only with your written authorization. A form for those authorizations, both those that you request and those that we request, are available from our Medical Records Department. If you give us an authorization, you may later revoke that permission in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered under your written authorization. In that case; however, we will be unable to take back any disclosures we have already made with your permission, and we will still be required to retain our records of the care that we provided you. You, as the patient, are guaranteed the following rights regarding medical information we maintain about you: Right to Access: You have the Right to look at or obtain copies of your health information; to obtain records from this practice you must do so in writing. Requests can be obtained from the Medical Records Department - 814-864-9994, extension 271. You may also request access by making a request to the Medical Records Department at this office. Correspondence information is provided at the bottom of page one of this Notice. Disclosure Accounting: You have the Right to receive a list of instances in which we or our Business Associates have disclosed your health information for purposes other than treatment, payment, and healthcare operations, You must submit in writing - any request for an accounting of such disclosures to our Medical Records Department (a form for that request is available from that department). Your written request must state a time period, which may not be longer than six years and may not include dates prior to April 15, 2003, when current Federal Health Privacy Laws became effective. Right to Request Restrictions: You have the Right to request a restriction or limitation on medical information we use or disclose about you for treatment, payment, or health care operations. You also have the Right to request a limit on the medical information we disclose about you to someone who is involved in the payment of your care; like family members or friends. Be advised that this practice is not required to agree with your request. However, if we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment. This request must be made in writing. Forms for this request may be obtained from the Medical Records Department in this office. Right to Request Confidential Communications: You have the Right to request that we communicate with you about medical matters in a certain manner or at a certain location (i.e.: You request that we contact you only at work or by mail). You must submit any request for confidential communications restrictions to our Medical Records Department in writing. This request should state how or where you wish to be contacted. To the best of our ability, we will accommodate your request. Right to Amendment: You have the Right to amend any medical information you believe to be incorrect or incomplete. You may amend any erroneous information for as long as the information is kept for ENT Specialists of Northwestern Pennsylvania. Your request for amendment must be submitted in writing to the Medical Records Department of this office. Forms will be made available per your request. Your written request must provide a reason supporting your request. This practice may deny your request for amendment due to and not limited to the following:
Conclusion: The privacy of your health information is regulated by a federal law known as the: Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the regulations passed in connection with HIPAA. State laws also regulate the privacy of your health information. This Notice attempts to summarize those rules, but the laws and regulations will control any discrepancy between this Notice and these laws and regulations. ^
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Copyright ©2008 ENT Specialists of Northwestern Pennsylvania. All rights reserved.
3580 Peach Street Erie, Pennsylvania 16508
