�������������� ?span style='mso-tab-count:1'>������������?We
may contact you to provide appointment reminders for treatment or medical care.
�������������� ?span style='mso-tab-count:1'>������������?We
may contact you to tell you about or recommend possible treatment alternatives
or other health-related benefits and services that may be of interest to you.
�������������� ?span style='mso-tab-count:1'>������������?We
may disclose to your family or friends or any other individual identified by you
protected health information directly relevant to such person�s involvement
with your care or payment for your care.?
We may use or disclose your protected health information to notify, or
assist in the notification of, a family member, a personal representative, or
another person responsible for your care of your location, general condition or
death.?If you are present or otherwise
available, we will give you an opportunity to object to these disclosures, and
we will not make these disclosures if you object.?If you are not present or otherwise
available, we will determine whether a disclosure to your family or friends is
in your best interest, taking into account the circumstances and based upon our
professional judgment.
�������������� ?span style='mso-tab-count:1'>������������?When
permitted by law, we may coordinate our uses and disclosures of protected
health information with public or private entities authorized by law or by
charter to assist in disaster relief efforts.
�������������� ?span style='mso-tab-count:1'>������������?We
will allow your family and friends to act on your behalf to pick-up filled
prescriptions, medical supplies, X-rays, and similar forms of protected health
information, when we determine, in our professional judgment, that it is in
your best interest to make such disclosures.
�������������� ?span style='mso-tab-count:1'>������������?We
may contact you as part of our efforts to market our practice�s services as
permitted by applicable law.
�������������� ?span style='mso-tab-count:1'>������������?Subject
to applicable law, we may make incidental uses and disclosures of protected
health information.?Incidental uses and
disclosures are by-products of otherwise permitted uses or disclosures which
are limited in nature and cannot be reasonably prevented.
?span
style='mso-tab-count:1'>������������?We will use or disclose protected
health information about you when required to do so by applicable law.
��������������
SPECIAL SITUATIONS
�������������� Subject
to the requirements of applicable law, we will make the following uses and
disclosures of your protected health information:
��������������
?span style='mso-tab-count:
1'>������������?Organ and Tissue Donation.?If you are an organ donor, we may release
health information to organizations that handle organ procurement or organ, eye
or tissue transplantation or to an organ donation bank, as necessary to
facilitate organ or tissue donation and transplantation.
?span style='mso-tab-count:
1'>������������?Military and Veterans.?If you are a member of the Armed Forces, we
may release health information about you as required by military command
authorities.?We may also release health
information about foreign military personnel to the appropriate foreign
military authority.
?span style='mso-tab-count:
1'>������������?Worker�s Compensation.?We may release health information about you
for programs that provide benefits for work-related injuries or illnesses.
?span style='mso-tab-count:
1'>������������?Public Health Activities.?We may disclose health information about you
for public health activities, including disclosures:
�������������� *������������ to prevent or control disease,
injury or disability;
�������������� *������������ to
report births and deaths;
�������������� *������������ to
report child abuse or neglect;
�������������� *������������ to
persons subject to the jurisdiction of the Food and Drug Administration (FDA)
for activities related to the quality, safety, or effectiveness of
FDA-regulated products or services and to report reactions to medications or
problems with products;
�������������� *������������ to
notify a person who may have been exposed to a disease or may be at risk for
contracting or spreading a disease or condition;
�������������� *������������ to
notify the appropriate government authority if we believe that an adult patient
has been the victim of abuse, neglect or domestic violence.?We will only make this disclosure if the
patient agrees or when required or authorized by law.
?span style='mso-tab-count:
1'>������������?Health Oversight Activities.?We may disclose health information to Federal
or State agencies that oversee our activities.?
These activities are necessary for the government to monitor the health
care system, government benefit programs, and compliance with civil rights laws
or regulatory program standards.
��������������������������������������������������������������������������������������������������������
?span style='mso-tab-count:
1'>������������?Lawsuits and Disputes.?If you are involved in a lawsuit or a
dispute, we may disclose health information about you in response to a court or
administrative order.?We may also
disclose health information about you in response to a subpoena, discovery request,
or other lawful process by someone else involved in the dispute, but only if
the Practice?is given assurances that
efforts have been made by the person making the request to tell you about the
request or to obtain an order protecting the information requested.
?span style='mso-tab-count:
1'>������������?Law Enforcement.?
We may release health information if asked to do so by a law enforcement
official:
�������������� *������������ In
response to a court order, subpoena, warrant, summons or similar process;
�������������� *������������ To
identify or locate a suspect, fugitive, material witness, or missing person;
�������������� *������������ About
the victim of a crime under certain limited circumstances;
�������������� *������������ About
a death we believe may be the result of criminal conduct;
�������������� *������������ About
criminal conduct on our premises; and
�������������� *������������ In
emergency circumstances, to report a crime, the location of the crime or the
victims, or the identity, description or location of the person who committed
the crime.
?span style='mso-tab-count:
1'>������������?Coroners, Medical Examiners and Funeral Directors.?We may release health information to a
coroner or medical examiner.?Such
disclosures 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 to carry out their duties.
?span style='mso-tab-count:
1'>������������?National Security and Intelligence Activities.?We may release health information about you
to authorized Federal officials for intelligence, counterintelligence, or other
national security activities authorized by law.
?span style='mso-tab-count:
1'>������������?Protective Services for the President and Others.?We may disclose health information about you
to authorized Federal officials so they may provide protection to the President
or other authorized persons or foreign heads of state or may conduct special
investigations.
?span style='mso-tab-count:
1'>������������?Inmates.?
If you are an inmate of a correctional institution or under the custody
of a law enforcement official, we may release health information about you to
the correctional institution or law enforcement official.?This release would be necessary (1) for the
institution to provide you with health care; (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.
?span style='mso-tab-count:
1'>������������?Serious Threats.?
As permitted by applicable law and standards of ethical conduct, we may
use and disclose protected health information if we, in good faith, believe
that the use or disclosure is necessary to prevent or lessen a serious and
imminent threat to the health or safety of a person or the public or is
necessary for law enforcement authorities to identify or apprehend an
individual.
Note:?
HIV-related information, genetic information, alcohol and/or substance
abuse records, mental health records and other specially protected health
information may enjoy certain special confidentiality protections under
applicable State and Federal law.?Any
disclosures of these types of records will be subject to these special
protections.
OTHER USES OF YOUR HEALTH INFORMATION
�������������� Other
uses and disclosures of protected health information not covered by this notice
or the laws that apply to us will be made only with your permission in a
written authorization.?You have the
right to revoke that authorization at any time, provided that the revocation is
in writing, except to the extent that we already have taken action in reliance
on your authorization.
YOUR RIGHTS
1.����������?You
have the right to request restrictions on our uses and disclosures of protected
health information for treatment, payment and health care operations.?However, we are not required to agree to your
request.?To request a restriction, you
must make your request in writing to the Practice�s Privacy Officer.
2.����������?You
have the right to reasonably request to receive confidential communications of
protected health information by alternative means or at alternative
locations.?To make such a request, you
must submit your request in writing to the Practice�s Privacy Officer.
3.����������?You
have the right to inspect and copy the protected health information contained
in your medical and billing records and in any other Practice records used by
us to make decisions about you, except:?
�������������� (i)
���������� for psychotherapy notes, which
are notes that have been recorded by a mental health professional documenting
or analyzing the contents of conversations during a private counseling session
or a group, joint or family counseling session and that have been
separated from the rest of your medical record;
�������������� (ii)
��������?for information compiled in
reasonable anticipation of, or for use in, a civil, criminal, or administrative
action or proceeding;
�������������� (iii)
�������� for protected health information
involving laboratory tests when your access is restricted by law;
�������������� (iv)
�������� if you are a prison inmate,
obtaining a copy of your information may be restricted if it would jeopardize
your health, safety, security, custody, or rehabilitation or that of other
inmates, or the safety of any officer, employee, or other person at the
correctional institution or person responsible for transporting you;
�������������� (v)
��������?if we obtained or created
protected health information as part of a research study, your access to the
health information may be restricted for as long as the research is in
progress, provided that you agreed to the temporary denial of access when
consenting to participate in the research;
�������������� (vi)
�������� for protected health information
contained in records kept by a Federal agency or contractor when your access is
restricted by law; and
�������������� (vii)?������ for
protected health information obtained from someone other than us under a
promise of confidentiality when the access requested would be reasonably likely
to reveal the source of the information.
�������������� In
order to inspect and copy your health information, you must submit your request
in writing to the Practice�s Privacy Officer.?
If you request a copy of your health information, we may charge you a
fee for the costs of copying and mailing your records, as well as other costs
associated with your request.
�������������� We
may also deny a request for access to protected health information if:
��������������
�������������� ?
������������ ?/span>a licensed health care professional has
determined, in the exercise of professional judgment, that the access requested
is reasonably likely to endanger your life or physical safety or that of
another person;
�������������� ?
������������ the protected health
information makes reference to another person (unless such other person is a
health care provider) and a licensed health care professional has determined,
in the exercise of professional judgment, that the access requested is
reasonably likely to cause substantial harm to such other person; or
�������������� ?
������������ ?/span>the request for access is made by the individual�s
personal representative and a licensed health care professional has determined,
in the exercise of professional judgment, that the provision of access to such
personal representative is reasonably likely to cause substantial harm to you
or another person.
If we deny a request for access for any of the three
reasons described above, then you have the right to have our denial reviewed in
accordance with the requirements of applicable law.
4.����������?You
have the right to request an amendment to your protected health information,
but we may deny your request for amendment, if we determine that the protected
health information or record that is the subject of the request:
�������������� (i)
���������� was not created by us, unless
you provide a reasonable basis to believe that the originator of protected
health information is no longer available to act on the requested amendment;
�������������� (ii)
��������?is not part of your medical or
billing records or other records used to make decisions about you;
�������������� (iii)
�������� is not available for inspection
as set forth above; or
�������������� (iv)
�������� is accurate and complete.
�������������� In
any event, any agreed upon amendment will be included as an addition to, and
not a replacement of, already existing records.?
In order to request an amendment to your health information, you must
submit your request in writing to the Practice�s Privacy Officer, along with a
description of the reason for your request.
5.����������?You
have the right to receive an accounting of disclosures of protected health information
made by us to individuals or entities other than to you for the six years prior
to your request, except for disclosures:
�������������� (i)
���������� to carry out treatment, payment
and health care operations as provided above;
�������������� (ii)
��������?incident to a use or disclosure
otherwise permitted or required by applicable law;
�������������� (iii)
�������� pursuant to a written
authorization obtained from you;��
�������������� (iv)
�������� to persons involved in your care
or for other notification purposes as provided by law;
�������������� (v)
��������?for national security or
intelligence purposes as provided by law;
�������������� (vi)
�������� to correctional institutions or
law enforcement officials as provided by law;
�������������� (vii)
������?as part of a limited data set as
provided by law; or
�������������� (viii)
������ that occurred prior to April 14,
2003.
�������������� To
request an accounting of disclosures of your health information, you must
submit your request in writing to the Practice�s Privacy Officer.?Your request must state a specific time
period for the accounting (e.g., the past three months).?The first accounting you request within a
twelve (12) month period will be free.?
For additional accountings, we may charge you for the costs of providing
the list.?We will notify you of the costs
involved, and you may choose to withdraw or modify your request at that time
before any costs are incurred.
COMPLAINTS.?
�������������� If
you believe that your privacy rights have been violated, you should immediately
contact?the Practice�s Privacy
Officer.?We will not take action against
you for filing a complaint.?You also may
file a complaint with the Secretary of Health and Human Services.
CONTACT PERSON
�������������� If
you have any questions or would like further information about this notice,
please contact the Practice�s Privacy Officer -Dr. Shear.
This notice is effective as of?April 14, 2003.
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