Notice of Privacy Practices

SUMMARY OF NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW MEDICAL/ PROTECTED HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY

By law, we are required to provide you with our Notice of Privacy Practices. This notice describes how your medical information may be used and disclosed by us. It also tells you how you can obtain access to this information.

  1. The right to inspect and copy your information;
  2. The right to request corrections to your information;
  3. The right to request that your information be restricted;
  4. The right to request confidential communications;
  5. The right to report disclosure to you information; and
  6. The right to a paper copy of this Notice.

We want to assure you that your medical/protected health information is secure with us. This Notice contains information about how we will insure that your information remains private. If you have any questions about this Notice, our contact person is listed below.

Effective Date: April 14, 2003

Contact Person: Office Manager

Phone Number: 203-756-6422

We are required to protect the privacy of your medical/health information about you and that can be identified with you. This is called "protected health information" or "PHI" for short. We respect the privacy and confidentiality of your protected health information. This Notice of Privacy Practices ("Notice") describes the ways in which we may use and disclose your medical/protected health information and how you can get access to this information. Your health information is contained in your medical and billing records maintained by this organization. It includes demographic information and information that related to your present, past, or future physical or mental health and relate healthcare services. This Notice applies to uses and disclosures we may make of all your protected health information whether created by us in our practice or received by us in another healthcare provider. This notice applies to both of are office locations.

A. OUR LEGAL DUTY TO PROTECT YOUR HEALTH INFORMATION

We are required by law to:

  1. Maintain the privacy of your protected health information that we have created in our practice or received from another health care provider whether it is about your past, present, or future health care condition
  2. Maintain the privacy of your protected health information regarding payment for your healthcare
  3. Notify you about how we protect your protected health information
  4. Explain how, when and why we use and disclose protected health information about you
  5. Abide by the terms of this Notice, as currently in effect
  6. Notify you if we are unable to agree to a requested restriction on how your protected health information is used or disclosed
  7. Accommodate reasonable request that you make to communicate health information by alternative means or at alternative locations
  8. Obtain your written authorization to use or disclose your protected health information for reasons other than those listed below and permitted by law.

We know that your protected health information is personal. We are committed to protecting you information. So as to provide you with good care and to insure that we follow all legal requirements, we document (in a medical record) the care and services that we provide to you. This notice applies to those records.

CHANGES TO THIS NOTICE

We reserve the right to change the terms of this Notice of Privacy Practices and to make the new provisions effective for all protect health information we already about you as well as any protected health information we create or receive In the future. If we make any changes, we will:

  1. Post the revised notice in our office(s), which will contain the new effective date;
  2. Make copies of the revised Notice available to you on request either at our offices or through contact person listed in the Notice; and
  3. Post the revised Notice on our website: www.planetgi.com

B. WE MAY USE AND DISCLOSE PROTECTED HEALTH INFORMATION ABOUT YOU TO PROVDE TREATMENT TO YOU, TO OBTAIN PAYMENT FOR SERVICES RENDERED TO YOU, AND FOR YOUR HEALTHCARE OPERATIONS.

We may use and disclose your protected health information for purposes of healthcare treatment, payment and health care operations as described below.

1. For Treatment:
We may use and disclose your protected health information to provide you with medical treatment and services and to coordinate or manage your healthcare and related services. We may use and disclose your protected health information to doctors and nurses and other personnel who may use your PHI, as well as others that maybe involved in your care, both within our office and with other health care providers involved in your care. We may disclose information to people outside our practice who may be involved in you care, such as your family members, clergy or others who participate in your care. All information is recorded in your medical record. It is necessary for health care providers to determine what treatment you should receive. Healthcare providers will also take actions taken by them in the course of your treatment and note your reactions. We may also disclose your protected health information to providers or facilities who may be involved in your care after you leave are facility or our care.

Examples of how we will disclose information for treatment may include sharing information about you with referring physicians, your primary care physician or family physician, a specialist, hospitals, ambulatory care centers, pharmacies, and visiting nurses.

2. For Payment:
We may use and disclose your protected health information so we can bill and receive payment for the treatment and services you receive form us. For billing and payment purposes, we may disclose your protected health information to an insurance company or managed care company, Medicare, Medicaid, or any other third party payer. The information on the bill may contain information that identifies your diagnosis, treatment and supplies used in the course of the treatment. We may inform an insurance appropriate approvals and/or to confirm coverage for your treatment. Examples of how we will disclose information for payment include: (a) We may contact your health plan to confirm your coverage; (b) We may contact your health plan for pre-certification of a service; (c) We may contact any other organization who provide you with medical services to obtain payment information; (d) We may provide information to any other health care provider who requests information necessary for them to collect payment; (e) We may share information with other billing departments of other providers; (f) We may share information with collection departments; (g) we may share information with agents of health plans (third party administrations) who are involved in the payment of a claim; and/or (h) We may share information with consumer reporting agencies (credit bureaus)

3. For Healthcare Operations:
We may use and disclose your protected health information in performing business activities that we call "healthcare operations". This includes internal operations, such as for general administrative activities and to monitor the quality of care you receive at our facility. This type of use is necessary for us to run our practice and to be sure that our patients are receiving quality care.

Examples of how we will disclose information as it related to healthcare operations include the following:

  1. We may use or disclose your protected health information to review and improve the quality of care you receive;
  2. We may use or disclose you protected health information to doctors, nurses, residents, or other medical staff for education and training purposes;
  3. We may use or disclose you protected health information for planning for services, such as when we assess certain services that we may want to offer in the future;
  4. We may use or disclose your protected health information to evaluate the performances of our employees;
  5. We may use or disclose your protected health information to our attorneys, consultants accountants, and business associates;
  6. We may combine information about several patients to determine if we should offer new services;
  7. We may combine information about several patients to determine if we new treatments are effective;
  8. We may use protected health information to identify groups of patients who have similar heath problems to give them information about treatment alternatives, presentations, or new procedures;
  9. We may use or disclose protected health information to train students, residents other healthcare providers or no-healthcare providers (such as billing personnel);
  10. We may use or disclose your protected health information to organizations that assess the quality of care we provide to our patients (such as government agencies or accrediting bodies);
  11. We may use and disclose and disclose your protected health information to our transcription service;
  12. We may use and disclose protected health information to assist others who may be reviewing our activities such as accountants, lawyers, consultants, risk managers, and other who assist us in complying with the state and federal laws;
  13. We use and disclose protected health information in the process of selling our business or merging with other healthcare entities, or giving control to someone else.
  14. We may use and disclose protected health information in the process of reviewing for healthcare fraud and abuse detection and compliance;
  15. We may use and disclose protected health information when we develop internal protocols;
  16. We may make incidental disclosures to staff members of other practices when we treat you in the office space that we share with them;
  17. In the process of using your protected health information in the course of treatment, payment and healthcare operations, we may make incidental disclosures. We will take reasonable steps to limit incidental disclosures.

Practice-specific examples: We may disclose information as it relates to healthcare operations when we: (a) Leave messages on your answering machine, (b) Leave messages at your place of employment, (c) send you follow-up letters; (d) Call to remind you of an appointment, and (e) Call you by name when you are in our practice.

C. OTHER USES AND DISCLOSURES WE MAY MAKE WITHOUT YOUR WRITTEN AUTHORIZATION OR CONSENT

Under the Health Insurance Portability and Accountability Act Privacy Regulations, we may use and disclose your protected health information in which you do not have to give authorization or otherwise have an opportunity to agree or object. "Use" refers to our internal utilization of your protected health information. Specifically, "use" under the privacy regulations means: "�with respect to individually identifiable health information, the sharing, employment, application, utilization, examination, or analysis of such information within and entity that maintains such information." Disclosure refers to the provisions of information by us to parties outside of our organization. Specifically disclosure means: "�the release, transfer, provision of access to or divulging in any other manner, of information outside of the entity holding the information." We may make the following uses and disclosures of your protected health information without obtaining a written Authorization from you in situations such as:

1. Those Required by Law:
We may disclose your protected health information when required to do so by law. For example, when a disclosure is required by federal, state or local law or other judicial or administrative proceeding.

2. Public Health Risk:
We may disclose your protected health information for public health activities. For example, we may disclose protected health information about you if you have been exposed to a communicable disease or may otherwise be at risk of spreading a disease. Other examples may include reports about injuries or disability, reports of births and deaths, reports of child abuse and/or neglect, and reports regarding recall of products.

3. Persons Involved in Your Care or Payment for Your Care:
Unless you object, we may disclose protected health information about you to a family member, a close personal friend or neighbor or other person(s) you identify, including clergy, who are involved in your care. These disclosures are limited to information relevant to the person's involvement in your care or in arranging payment for your care.

4. Reporting Victims of Abuse, Neglect or Domestic Violence:
If we 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 authorized by law or if we agree to the report.

5. Health Oversight Activities:
We may disclose your protected health information to a health oversight agency for activities authorized by law. A health oversight agency is a state or federal agency that oversees the healthcare system. Some of the activities may include, for example, audits, investigations, inspections and license actions.

6. Judicial and Administrative Proceedings:
We may disclose your protected health information in response to a court or administrative order. We also may disclose information in response to a subpoena, discovery request, or other lawful process.

7. Law Enforcement:
We may disclose your protected health information for certain law enforcement purposes, including, for example, to file reports required by law or to report emergencies to suspicious deaths; to comply with a court order, warrant, or other legal process; to identify or locate a suspect or missing person; or to answer certain requests for information concerning crimes.

8. Coroners, Medical Examiners, Funeral Directors, Organ Procurement Organizations:
We may disclose your protected health information to a coroner, medical examiner, funeral director and, if you are an organ donor, to an organization involved in the donation of organs and tissue to enable them to carry out their lawful duties.

9. Research
Your protected health information may be used for research purposes, but only if: (1) the privacy aspects of the research have been reviewed and approved by a special Privacy Board or Institutional Review Board and the Board can legally waive patient authorizations otherwise required by the Privacy Rule; (2) the researcher is collecting information for a research proposal; (3) the research occurs after your death; or (4) if you give written authorization for the use or disclosure of your information.

10. To Avert a Serious Threat to Health or Safety:
When necessary to prevent a serious threat to your health or safety or the health or safety of the public or another person, we may use or disclose your protected health information to someone able to help lesson or prevent the threatened harm.

11. 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 you if you are a member of a foreign military as required by the appropriate foreign military authority.

12. National Security and Intelligence Activities; Protective Services for the President and Others:
We may disclose protected health information to authorized federal officials conducting national security and intelligence activities or as needed to provide protection to the President of the United States, certain other persons or foreign heads of states or to conduct special investigations.

13. Inmates/Law Enforcement Custody:
If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may disclose your protected health information to the institution or official for certain purposes including your own health and safety as well as that of others.

14. Worker's Compensation:
We may use or disclose your protected health information to comply with laws and regulations relating to workers' compensation or similar programs.

15. Disaster Relief:
We may disclose protected health information about you to an organization assisting in a disaster relief effort.

16. Appointment Reminders:
We may use or disclose protected health information to remind you about appointments.

17. Treatment Alternatives and Health-Related Benefits and Services:
We may use or disclose your protected health information to inform you about treatment alternatives and health-related benefits and services that may be of interest to you.

18. Business Associates:
We may disclose your protected health information to our business associates under a Business Associate Agreement. Some of these business associates may include, for example: our attorney, our consultants, our transcriptionists, and our accountant.

D. ANY OTHER USE OR DISCLOSURE OF YOUR PROTECTED HEALTH INFORMATION REQUIRES YOUR WRITTEN AUTHORIZATION

Under circumstances other than those listed above, we will request that you provide us with a written authorization before we use and disclose your protected health information to anyone. If you sign an authorization allowing us to disclose protected health information about you in a specific situation, you can later revoke (cancel) your authorization in writing. If you cancel your authorization in writing, we will not disclose your protected health information about you after we receive your cancellation, except for disclosures which were already being processed or made before we received your cancellation.

E. YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION

You have the following rights regarding your protected health information:

1. The Right to Access to Personal Protected health information:
You have the right to inspect and, upon written request, obtain a copy of your protected health information except under certain limited circumstances. Under state law, if the [covered entity] makes a copy of your medical record, we will not charge more than it is permitted by the current rate allowed by state law. We may deny your request to inspect or receive copies in certain limited circumstances. If you are denied access to protected health information, in some cases you will have the right to request review of the denial. This review would be performed by a licensed healthcare professional designated by [covered entity] who did not participate in the original decision to deny access.

2. The Right to Request Restrictions:
You have the right to request that we restrict the way we use or disclose your protected health information for treatment, payment or healthcare operations. However, we are not required to agree to such a restriction. If we do agree to the restriction, we will honor that restriction except in the event of an emergency and will only disclose the restricted information to the extent necessary for your treatment.

3. The Right to Request Confidential Communications:
You have the right to request that we communicate with you concerning your health matters in a certain manner or at a certain location. For example, you can request that we contact you only at a certain phone number. We will accommodate your reasonable requests.

4. The Right to Request an Amendment:
You have the right to request that we amend or modify your protected health information. Your request must be made in writing and must state the reason for the requested amendment. We may deny your request for amendment if the information: (a) was not created by us, unless you provide reasonable information that the originator of the information is no longer available to act on your request; (b) is not part of the protected heath information maintained by us; (c) is information to which you have a right of access; or (d) is already accurate and complete, as determined by us. If we deny your request for amendment, we will give you a written denial notice, including the reasons for the denial and explain to you that you have the right to submit a written statement disagreeing with the denial. Your letter of disagreement will be attached to your medical record.

5. The right to An Accounting of Disclosures:
You have the right to request an accounting (a report) of certain disclosures of your protected health information. This is a listing of disclosures made by us or by others on our behalf, but does not include disclosures made for treatment, payment, healthcare operations, nor certain other exceptions. You must submit your request in writing and you must state the time period for which you would like the accounting. The accounting will include the disclosure date, the name, address (if known) of the person or entity that received the information, a brief description of information disclosed; and a brief statement of the purpose of the disclosure. The first accounting provided within a 12-month period will be free. For further requests, we may charge you our costs for completing the accounting.

6. The 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. [In addition, you may obtain a copy of this Notice at our website, [www.planetgi.com]

F. COMPLAINTS

  1. If you believe that your privacy rights have been violated, you may file a complaint in writing with us or with the government:
    Office of Civil Rights
    U.S. Department of Health and Human Services
    200 Independence Avenue, S.W., Room 509F
    HHH Building
    Washington, DC 20201
  2. To file a complaint with us, you should contact the individual mentioned on page one of this notice. A phone number is also provided on page one.
  3. You will not be retaliated against for filing a complaint.

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