Minnesota Provider Notice of Privacy Practices
Center for Reproductive Medicine, P.A.
EFFECTIVE DATE OF THIS NOTICE: December 10, 2012
THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Our Pledge And Legal Duty To Protect Health Information About You.
The privacy of your health information is important to us. We are required by federal and state laws to protect personal health information that we create or receive that identifies you and relates to your past, present or future physical or mental health or condition; the provision of health care to you; or the past, present, future payment for health care furnished to you.
- CRM considers patient privacy its highest priority.
- CRM takes necessary precautions against inappropriate use or disclosure of protected health information whether oral, electronic or paper.
- Except as described in this notice or specifically required or permitted by law, CRM will not use or disclose your protected health information without your specific written authorization.
- CRM employees are expected to access medical information only as necessary to perform their jobs.
- CRM employees who violate these rules and policies are subject to sanctions, including discipline and termination.
- CRM is required to give you this notice and to follow the terms and conditions of this notice.
- CRM will change the terms of this Notice as required by law and will post new Notice provisions effective for all health information that we maintain.
- CRM will make copies of this Notice available to you upon request.
USES AND DISCLOSURES OF YOUR HEALTH INFORMATION
Federal and State laws require CRM to protect your medical information and federal law requires CRM to describe to you how, when and why we use or disclose your health information. When federal and state privacy laws differ, and the state law is more protective of your information or provides you with greater access to your information, then state law will override federal law.
There are a number of purposes for which it may be necessary for us to use or disclose your health information. For some of these purposes, we are required to obtain your consent. In other specific instances, we may be required to obtain your individual authorization. And in a limited number of circumstances, we will be authorized by Law to disclose your health information without your consent or authorization. Following is a description of these uses and disclosures.
A. Uses and Disclosures of Your Health Information for Purposes of Treatment, Payment, and Health Care Operations.
Health Care Treatment. We may use or disclose health information with other doctors, nurses, technicians or other personnel who are involved in taking care of you. For example, we may use or disclose health information about you when you need a prescription, lab work, an x-ray, or other health care services.
Appointment Reminders and Other Contacts. We may use your health information to contact you and/or your spouse/partner with reminders about your appointments, test results, alternative treatments you may want to consider, or other of our services that may be of interest to you.
Payment. We may use or disclose your health information to bill and collect payment for the treatment and services provided to you. The information on, or accompanying the bill, may include information that identifies you, as well as your diagnosis, procedures, and supplies used. We may also talk with the policy-holder of your insurance coverage.
Health Care Operations. We may use or disclose health information about you to allow us to perform business functions. For example, we may use your health information to help us train new staff and conduct quality improvement activities. We may also disclose your information to consultants and other business associates who help us with these functions (for example, billing, computer support and transcription services).
B. Uses and Disclosures Authorized by Law.
Certain types of protected health information may have additional protection under federal or state law. For example, protected health information about HIV/AIDS and genetic testing results is treated differently than other types of protected health information under certain state laws. Additionally, federal assisted alcohol and drug abuse programs are subject to certain special restrictions on the use and disclosure of alcohol and drug abuse treatment information. To the extent applicable, CRM would need to get your written permission before disclosing that information to others. Under other circumstances, we are authorized by Law to use or disclose your health information without obtaining a consent or authorization from you. These may include when the use or disclosure is:
Required by Law. We will disclose your health information when such disclosure is required by federal, state or local laws.
Necessary for public health activities. For example, when reporting to public health authorities the exposure to certain communicable diseases or risks of contracting or spreading a disease or condition.
Public Health Risks. We may disclose information about you for public health activities such as to report births, deaths, medication problems, product recalls, disease exposures, and adult abuse of neglect.
For health oversight activities. We may disclose information to a health oversight agency for activities authorized by law. For example audits, investigations, inspections and licensure.
For judicial and administrative proceedings. For example, when responding to a request for health information contained in a court order.
To avert a serious threat to health or safety. We may use and disclose information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public.
Military and Veterans. If you are a member of the armed forces or separated/discharged from military services, we may disclose health information about you as required by military command authorities or the Department of Veterans Affairs, as may be applicable.
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU
A. Right to Access Your Health Information.
You have the right to inspect and to request a copy of the information contained in clinical, billing and other records that we maintain and use to make decisions about you. To obtain or inspect a copy, submit a written request to CRM. We ask that your request be made in writing. We may charge a reasonable fee. There might be limited situations in which we may deny your request. Under these situations, we will respond to you in writing, stating why we cannot grant your request and describing your rights to request a review of our denial.
B. Right to Request Alternate Methods of Communication.
You have a right to request that CRM communicate with you in certain ways or at a certain location. For example, you may ask that we contact you only at home or only at your place of business. In this situation, you may submit a written request to CRM. However, if this request could result in CRM not being to collect for services provided, CRM reserves the right to require you to provide additional information regarding payment of services.
C. Right to Request an Amendment of Your Protected Health Information.
You have the right to request amendments to the health information CRM created about you and that we maintain and use to make decisions about you. We ask that your request be made in writing and must explain, in as much detail as possible, your reason(s) for the amendment and, when appropriate, provide supporting documentation. Under limited circumstances, we may deny your request. If we deny your request, we will respond to you in writing stating the reasons for the denial. You may file a statement of disagreement with us. You may also ask that any future disclosures of the health information under dispute include your requested amendment and our denial to your request.
D. Accounting of Disclosures
You have the right to ask CRM for a list of the persons or organization to which CRM has disclosed your protected health information. This list would provide you with a summary of certain disclosures CRM has made that you would not be in a position to know about such as:
- disclosures to carry out treatment, payment and health care operations
- disclosures made directly to you or disclosures that you have specifically requested/authorized
- disclosures to persons involved in your care
- disclosures incident to a use or disclosure that is otherwise permitted or required by law
- disclosures made for intelligence purposes or national security
- disclosures made for research approved by our review process under strict federal guidelines
- Your request must be in writing and must state a time period (beginning no earlier than April 14, 2003, when the federal privacy rules went into effect and for no longer than six years.
E. Right to Request Restrictions on Uses and Disclosures of Your Health Information.
You have the right to request that we restrict our use or disclosure of your protected health information. Your request must be made in writing. We are not required to agree to your request for a restriction, and we will notify you of our decision. However, if we do agree, we will comply with our agreement, unless there is an emergency or we are otherwise required to use or disclose the information.
QUESTIONS OR COMPLAINTS
If you want more information about our privacy practices or have questions or concerns, please contact our Privacy Office. If you are concerned that your privacy rights have been violated, you may file a complaint with our Privacy Office. You may also submit a written complaint to the U.S. Department of Health and Human Services Office of Civil Rights. We will provide you with the address to file your complaint with the U.S. Department of Health and Human Services upon request. We support your right to the privacy of your health information. We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.
Privacy Office Contact Information:
Kenneth Palattao Privacy Officer, Center for Reproductive Medicine, P.A.
2828 Chicago Avenue South, Suite 400, Minneapolis, MN 55407