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.
If
you have any questions about this Notice, please contact our Privacy Officer:
Cindy Johnson
5855 Bremo Road, Suite 205
Richmond,
VA 23226
(804)
662-6060 ext. 7503
1.
Purpose
We
understand that medical information about you and your health is personal and we
are committed to protecting that information. We create a record of the care and services you receive at
Riverview Physician’s for Women in order to provide you with quality care and
to comply with certain legal requirements.
This Notice of Privacy Practices describes how we may use and
disclose medical information about you, including demographic information, that
may identify you and your related health care services to carry out your
treatment, obtain payment for our services, to perform the daily health care
operations of this practice and for other purposes that are permitted or
required by law. This notice also
describes your rights to access and control your medical information.
We are required to abide by the terms of this Notice of Privacy
Practices.
2.
Written Acknowledgement
You will be asked to sign a written
statement acknowledging that you have received a copy of this notice.
The acknowledgement only serves to create a record that you have received
a copy of the notice.
3.
Changes to this Notice
We may change the terms of our Notice, at any time. The new Notice will be effective for all medical information that we maintain at that time. Upon your request, we will provide you with any revised Notice of Privacy Practices. To request a revised copy, you may call our office and request that a revised copy be sent to you in the mail or you may ask for one at the time of your next appointment.
4.
How We May Use and Disclose
Medical Information about You
The following categories describe the different ways that Riverview
Physician’s for Women may use and disclose your medical information and a few
examples of what we mean. These
examples are not meant to describe every circumstance, but to give you an idea
of the types of uses and disclosures that may be made by our office.
Other uses and disclosures of your medical information that are not
listed or described below will be made only with your written authorization.
You may revoke this authorization, at any time, in writing, but it will
not apply to any actions we have already taken.
For your treatment:
Your medical information may be used and disclosed by us for the
purpose of providing medical treatment to you or for another health care
provider providing medical treatment to you.
For example, a nurse obtains treatment information about you and
documents it in your medical record and the physician has access to that
information. If you require an
x-ray to be taken, the x-ray technician also has access to your medical
information. In addition, your
medical information may be provided to a physician to whom you have been
referred or are otherwise seeing to ensure that the physician has the necessary
information to diagnose or treat you.
To obtain payment for our
services: Your
medical information may be used and disclosed by us to obtain payment for your
health care bills or to assist another health care provider in obtaining payment
for their health care bills. For
example, we may submit requests for payment to your health insurance company for
the medical services that you received. We
may also disclose your medical information as required by your health insurance
plan before it approves or pays for the health care services we recommend for
you.
For our health care
operations: Your
medical information may be used and disclosed by us to support our daily
operations. These health care operation activities include, but are not
limited to, quality assessment activities, employee review activities, training
of medical students, licensing, and conducting or arranging for other business
activities. For example, we may use
the medical information we have to determine where we can make improvements in
the services and care we offer.
For the health care
operations of other health care providers:
We may also use
your medical information to assist another health care provider treating you
with its quality improvement activities,
evaluation of the health care professionals or for fraud and abuse detection or
compliance. For
example, we may disclose your medical information to another physician to assist
in its efforts to make sure it is complying with all rules related to operating
a medical practice.
For appointment reminders:
We may use or
disclose your medical information to contact you to remind you of your
appointment, by mail or by telephone. Our message will include the name of our practice or the name
of our physician as well as the date and time for your appointment or a reminder
that an appointment needs to be scheduled.
To provide you with treatment
alternatives: We
may use or disclose your medical information
to provide you with information about treatment
alternatives or other health-related benefits and services that may be of
interest to you. For example, we
may contact several home health agencies or physical therapy providers to
discuss the services they provide when we have a patient who needs these
services.
To our business associates:
We will share your
medical information with third party “business associates” that perform
various activities (e.g., billing, transcription services) for the practice. Whenever an arrangement between our office and a business
associate involves the use or disclosure of your medical information, we will
have a written agreement that contains terms that will protect the privacy of
your medical information. For
example, Riverview Physician’s for Women may hire a billing company to submit
claims to your health care insurer. Your
medical information will be disclosed to this billing company, but a written
agreement between our office and the billing company will prohibit the billing
company from using your medical information in any way other than what we allow.
For Fundraising Activities: We may use or
disclose your demographic information and the dates that you received treatment
from us in order to contact you for fundraising activities supported by our
office. If you do not want to
receive these materials, please contact our Privacy Officer and request that
these fundraising materials no be sent to you.
Others involved in your
health care:
Unless you object, we may disclose to a member of your family, a
relative, a close friend or any other person you identify, your medical
information that directly relates to that person’s involvement in your health
care. If you are unable to agree or
object to such a disclosure, we may disclose such information as necessary if we
determine that it is in your best interest based on our professional judgment.
We may use or disclose your medical information to notify a family member
or any other person that is responsible for your care of your location and
general health condition. Finally,
we may use or disclose your medical information to an authorized public or
private entity to assist in (1) disaster relief efforts and (2) to coordinate
uses and disclosures to family or other individuals involved in your health
care.
As required by law:
We may use or disclose your medical information to the extent that the
use or disclosure is required by law. The
use or disclosure will be made in compliance with the law and will be limited to
the relevant requirements of the law. You will be notified, as required by law, of any such uses or
disclosures.
For public health activities:
We may disclose your medical information for public health activities and
purposes to a public health authority that is permitted by law to collect or
receive the information. The
disclosure will be made for the purpose of controlling disease, injury or
disability. We may also disclose
your medical information, if directed by the public health authority, to any
other government agency that is collaborating with the public health authority.
As required by the Food and
Drug Administration:
We may disclose your medical information to a person or company required
by the Food and Drug Administration to report adverse events, product defects or
problems, biologic product deviations, or to track products; to enable product
recalls; to make repairs or replacements; or to conduct post marketing
surveillance, as required.
For communicable disease
exposure:
We may disclose your medical information, if authorized by law, to a
person who may have been exposed to a communicable disease or may otherwise be
at risk of contracting or spreading the disease or condition.
To your employer:
We may disclose your medical information concerning a work related
injury or illness to your employer if you are covered under your
employer’s policy in order to conduct an evaluation relating to medical
surveillance of the work place or to evaluate whether you have a work-related
injury, in accordance with the law.
For abuse or neglect:
We may disclose your medical information to a public health authority
that is authorized by law to receive reports of child or adult abuse or neglect.
In addition, we may disclose your medical information if we believe that
you have been a victim of abuse, neglect or domestic violence as may be required
or permitted by Virginia and/or federal law.
For health oversight:
We may disclose your medical information to a health oversight agency for
activities authorized by law. Oversight
agencies seeking this information include government agencies that oversee the
health care system, government benefit programs (such as Medicare or Medicaid),
other government regulatory programs and civil rights laws.
In legal proceedings:
We may disclose your medical information in the course of any judicial or
administrative proceeding, in response to an order of a court or administrative
tribunal (to the extent such disclosure is expressly authorized), and in certain
conditions in response to a subpoena or other lawful request.
For law enforcement:
We may also disclose your medical information, so long as all legal
requirements are met, for law enforcement purposes. Examples of these law enforcement purposes include (1)
information requests for identification and location purposes, (2) pertaining to
victims of a crime, (3) suspicion that death has occurred as a result of
criminal conduct, (4) in the event that a crime occurs on the premises of
Riverview Physician’s for Women, and (5) in an medical emergency where it is
likely that a crime has occurred.
To coroners, to funeral
directors, and for organ donation: We may disclose your
medical information to a coroner or medical examiner for identification
purposes, determining cause of death or for the coroner or medical examiner to
perform other duties authorized by law. We
may also disclose medical information to a funeral director in order to permit
the funeral director to carry out its duties.
We may disclose such information in reasonable anticipation of death.
Your medical information may be used and disclosed for cadaveric organ,
eye or tissue donation purposes.
For research:
We may disclose your medical information to researchers when their
research has been established as required by federal and state law.
Due to criminal activity:
Consistent with applicable federal and state laws, we may disclose your
medical information if we 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. We may also
disclose your medical information if it is necessary for law enforcement
authorities to identify or apprehend an individual.
For military activity and
national security:
When the appropriate conditions apply, we may use or disclose medical
information of individuals who are Armed Forces personnel (1) for activities
deemed necessary by appropriate military command authorities; (2) for the
purpose of a determination by the Department of Veterans Affairs of your
eligibility for benefits; or (3) to foreign military authority if you are a
member of that foreign military services. We
may also disclose your medical information to authorized federal officials for
conducting national security and intelligence activities, including for the
provision of protective services to the President or others legally authorized.
For workers’ compensation:
Your medical information may be disclosed by us as authorized to comply
with workers’ compensation laws and other similar legally established
programs.
Regarding inmates:
We may use or disclose your medical information if you are an inmate of a
correctional facility and your physician created or received your medical
information in the course of providing care to you.
For required uses and
disclosures:
Under the law, we must make disclosures to you and, when required by the
Secretary of the Department of Health and Human Services, to investigate or
determine our compliance with the requirements of the Health Insurance
Portability and Accountability Act and its regulations.
5. Your Rights
Following is a statement of your rights with respect to your
medical information and a brief description of how you may exercise these
rights.
You have the right to inspect
and copy your medical information. You may
inspect and obtain a copy of your medical information that we maintain.
The information may contain medical and billing records and any other
records that we use for making decisions about you.
However, under federal law, you may not inspect or copy the following
records: psychotherapy notes;
information compiled related to a civil, criminal, or administrative action; and
medical information that is subject to law that prohibits access to medical
information in certain circumstances. We
may deny your request to inspect your medical information.
In some circumstances, you may have a right to have this decision
reviewed. Please contact our
Privacy Officer if you have questions about access to your medical record.
You have the right to request
a restriction of your medical information.
This means you may ask us not to use or disclose any part of your medical
information for the purposes of treatment, payment or health care operations.
You may also request that any part of your medical information not be
disclosed to family members or friends who may be involved in your care.
Your request must state the specific restriction requested and to whom
you want the restriction to apply.
We are not required to agree to your request.
If we agree to the requested restriction, we may not use or disclose your
medical information in violation of that restriction unless it is needed to
provide emergency treatment or unless we otherwise notify you that we can no
longer honor your request. With this in mind, please discuss any restriction you wish to
request with your physician. Please
request all restrictions in writing to our Privacy Officer.
You have the right to request
that we accommodate you in communicating confidential medical information.
We will accommodate reasonable requests, but we may condition this
accommodation by asking you for information as to how payment will be handled or
other information necessary to honor your request.
Please make this request in writing to our Privacy Officer.
You may have the right to ask
us to amend your medical information. You may
request an amendment of your medical information as long as we maintain this
information. In certain cases, we
may deny your request for an amendment. If
we deny your request for amendment, you have the right to file a disagreement
with us and we may respond in writing to you.
Please contact our Privacy Officer if you have questions about amending
your medical record.
You have the right to receive
an accounting of certain disclosures we have made, if any, of your medical
information.
This right applies to disclosures for purposes other than treatment,
payment or health care operations as described in this Notice of Privacy
Practices. It excludes disclosures
we may have made pursuant to your authorization (permission), made directly to
you, to family members or friends involved in your care, or for appointment
notification purposes. You have the right to receive specific information regarding
these disclosures that occurred after April 14, 2003. You may request a shorter timeframe. The right to receive this information is subject to certain
exceptions, restrictions and limitations.
You have the right to obtain
a paper copy of this notice from us. If you would like a
paper copy of this notice, please request one from our Privacy Officer or
request one when you are in our offices.
6. Complaints.
You may complain to us if you believe your privacy rights have been
violated by us. To file a
complaint, please contact our Privacy Officer who will be happy to assist you.
You may file a complaint with us by notifying our Privacy Officer of your
complaint. We will not retaliate against you for filing a complaint.
If you do not wish to file a complaint with us, you may contact the
Secretary of Health and Human Services.
7. Privacy Contact.
If you have any questions about this Notice or require additional
information, please contact our Privacy Officer, Cindy Johnson, at (804)
662-6060 ext. 7503 or at 5855 Bremo Road, Suite 205 Richmond, Virginia 23226.
Our Privacy Officer is available during normal business hours to discuss
your privacy questions, concerns or complaints.