Go to a printable page!

Effective Date of this Notice: April 14, 2003

THE FAMILY DOCTORS

NOTICE OF PRIVACY PRACTICES

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 HEALTH INFORMATION ABOUT YOU (AS A PATIENT OF THIS PRACTICE) MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO YOUR INDIVIDUALY IDENTIFIABLE HEALTH INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.

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 the 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 in 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 to 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 offices 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 QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT:

Lisa Britt, 8383 Millicent Way, Shreveport LA 71115, Telephone 318/797-6661

B. WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION (PHI) IN THE FOLLOWING WAYS:

1. Treatment . Our practice may use your PHI to treat you. For example, we may ask you to have laboratory tests (such as blood or urine 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. We may use your PHI to inform outside consultants and services to help treat you. Many of the people who work for our practice -including, but not limited to, our doctors and nurses -may use or disclose your PHI in order to treat you or to assist others in your treatment. Additionally, we may disclose your PHI to others who may assist in your care, such as your spouse, children or parents.

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, or pay for, your treatment. We also may use and disclose your PHI to obtain payment from third parties that may be responsible for such costs. Also, we may use your PHI to bill you directly for services and items.

3. Health Care Operations . Our practice may use and disclose your PHI to operate our business. As examples of the ways in which we may use and disclose your information for our operations, our practice may use your PHI to evaluate the quality of care you received from us, or to conduct cost-management and business planning activities for our practice. Our practice may call your name aloud in order to acknowledge your presence and begin treatment, payment and healthcare operations (TPO).

4. Appointment Reminders. Our practice may use and disclose your PHI to contact you and remind you of an appointment. If you have an answering machine or voice mail, our practice may leave messages regarding your appointment or we may tell a family member about your appointment.

5. Treatment Options. Our practice may use and disclose your PHI to inform you of potential treatment options or alternatives.

6. Health-Related Benefits and Services. Our practice may use and disclose your PHI to inform you of health-related benefits or services that may be of interest to you.

7. 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 babysitter take their child to our office for treatment of a cold. In this example, the babysitter may have access to this child' s medical information. You or a family member or a financial assistant may have a need to call our office about your bill. We may have to answer questions regarding the services you received.

8. Disclosures Required By Law. Our practice will use and disclose your PHI when we are required to do so by federal, state or local law.

C. USE AND DISCLOSURE OF YOUR PHI IN CERTAIN SPECIAL CIRCUMSTANCES

1. Public Health Risks. Our practice may disclose your PHI to public health authorities that are authorized by law to collect information for the purpose of:

•  maintaining vital records, such as births and deaths .reporting child abuse or neglect
•  preventing or controlling disease, injury or disability
•  notifying a person regarding potential exposure to a communicable disease
•  notifying a person regarding a potential risk for spreading or contracting a disease or condition
•  reporting reactions to drugs or problems with products or devices
•  notifying individuals if a product or device they may be using has been recalled
•  notifying appropriate government agency(ies) and authority(ies) regarding the potential abuse or neglect of an adult patient (including domestic violence); however, we will only disclose this information if the patient agrees or we are required or authorized by law to disclose this information
•  notifying your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance.

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; civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.

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 also may disclose your PHI in response to a discovery request, subpoena, or other lawful process by another party involved in the 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 PHI if asked to do so by a law enforcement official: Regarding a crime victim in certain situations, if we are unable to obtain the person's agreement. Concerning a death we believe has resulted from criminal conduct regarding criminal conduct at our offices. In response to a warrant, summons, court order, subpoena or similar legal process to identify/locate a suspect, material witness, fugitive or missing person. In an emergency, to report a crime (including the location or victim(s) of the crime, or the description, identity or location of the perpetrator).

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 also may 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 transplantation, 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: (a) our use or disclosure was approved by an Institutional Review Board or a Privacy Board; (b) we obtain the oral or written agreement of a researcher that either the information being sought is necessary for the research study; and/or the use or disclosure of your PHI is being used only for the research and/or the researcher will not remove any of your PHI from our practice; (c) the PHI sought by the researcher only relates to decedents and the researcher agrees either orally or in writing that the use or disclosure is necessary for the research and, if we request it, to provide us with proof of death prior to access to the PHI of the decedents.

8. Serious Threats to Health or 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 threat.

9. Military. Our practice may disclose your PHI if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate authorities.

10. National Security. Our practice may disclose your PHI to federal officials.

11. Inmates. Our practice may disclose your PHI to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. Disclosure for these purposes would be necessary: (a) for the institution to provide health care services to you, (b) for the safety and security of the institution, (c) to protect your health and safety or the health and safety of other individuals.

12. Workers' Compensation. Our practice may release your PHI for workers' compensation and similar programs.

D. YOUR RIGHTS REGARDING YOUR PHI

1. Inspect and copy your health record. In order to inspect or obtain a copy of your health record, you must submit a written request to Lisa Britt at the address shown above. The form for your request to inspect or copy your health record is available at our office. If you request a copy of the information, we will charge a fee as permitted by Louisiana law for the costs of copying, mailing or other supplies associated with your request. Your request to inspect and copy your health record can be denied by The Family Doctors in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed.

2. Amendment to your health record . If you feel that medical information maintained by The Family Doctors is incorrect or incomplete, you may ask The Family Doctors to amend the information. You have the right to request an amendment to your health record only during the time the information is kept by, or on behalf of, The Family Doctors. To request an amendment, your request must be made in writing and submitted to Lisa Britt at the address shown above. In addition, you must provide a reason that supports your request. The form for your request for an amendment to your health record is available at our office. We may deny your request for an amendment to your health record if it is not in writing or does not include a reason that supports the request. In addition, we may deny your request if you ask us to amend information that:

•  Was not created by The Family Doctors;
•  Was created by a person or entity that is no longer available to make the amendment;
•  Is not part of the medical information kept by or for this office;
•  Is not part of the information which you would be permitted to inspect and copy; or
•  Is accurate and complete medical information.

If your request for an amendment is denied, you have the right to file a statement of disagreement. The Family Doctors also has the right to prepare a rebuttal to your statement of disagreement and will provide you with a copy of any rebuttal.

3. Request restrictions . You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or healthcare operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could request that we not use or disclose information about a medical procedure that you had. We are not required to agree to your request . If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request restrictions, you must make your request in writing to The Family Doctors at the address listed above. In your request you must tell us (1) what information you want to limit; (2) whether you want to limit the use, disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to your child. The form for your request for a restriction/limitation on medical information disclosed is available at our office.

4. A paper copy of this notice . You have the right to obtain a copy of this notice. You may ask us to give you a copy of the notice at any time. Or you may obtain a copy of this notice at our website: www.famdocs.com .

5. Obtaining an accounting of disclosures of your health information. You have the right to obtain an accounting of disclosures of your health information other than for treatment, payment or healthcare operations. To exercise this right you must submit your request in writing to The Family Doctors at the address listed above. The form for your request for an accounting of disclosures is available at our office. Your request must state a time period that may not be longer than six years and may not include dates prior to April 14, 2003. The first list you request within a 12-month period will be free. For additional lists, we may charge you for the cost of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

6. Request confidential communications . You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask we only contact you at work or by mail. We will accommodate all reasonable requests to the best of our ability. To request confidential communications, you must make your request in writing to The Family Doctors at the address shown above. We will not ask you for the reason for your request. Your request must specify how or where you wish to be contacted.

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 the Department of Health and Human Services. To file a complaint with our practice, contact Lisa Britt, 8383 Millicent Way, Shreveport LA 71115 . All complaints must be submitted in writing.

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 provide 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.

REVISED DATE: APRIL 2, 2003.