Notice of Privacy Practices for Protected Health Information (PHI)
Germantown Pediatric and Family Medicine LLC
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY!
Effective date: January 2021
The Practice of Germantown Pediatric and Family Medicine is required by applicable federal and state laws to maintain the privacy of your health information. Protected health information (PHI) is the information we create and maintain in the course of providing our services to you. Such information may include documentation of your symptoms, examination and test results, diagnoses and treatment protocols. It also may include billing documents for those services. We are permitted by federal privacy law (the Health Insurance Portability & Accountability Act of 1996 (HIPAA), to use and disclose your PHI, without your written authorization, for purposes of treatment, payment, and health care operations. Your Health Information can be used for payment purposes, for treatment purposes, and for health care operation purposes.
Your Health Information Rights
The health and billing records we maintain are the physical property of the Practice. The information in them, however, belongs to you. You have a right to:
- Access your medical records and other information. You may request this by sending to us this request in writing.
- Request changes or amendments to your PHI.
- Request an accounting of disclosures of your PHI.
- Request certain restrictions on the use and disclosure of your PHI.
- Request that you be contacted at different places or via different means by sending this request in writing.
- •Obtain a paper copy of our current Notice of Privacy Practices for PHI ("the Notice");
- •Receive Notification of a breach of your unsecured PHI.
- Revoke any of your prior authorizations to use or disclose information by sending the revocation in writing (except to the extent action has already been taken based on a prior authorization).
The Practice is required to:
- •Maintain the privacy of your health information as required by law;
- •Notify you following a breach of your unsecured PHI;
- •Provide you with a notice (‘Notice’) describing our duties and privacy practices with respect to the information we collect and maintain about you and abide by the terms of the Notice;
- •Notify you if we cannot accommodate a requested restriction or request; and,
- •Accommodate your reasonable requests regarding methods for communicating with you about your health information and comply with your written request to refrain from disclosing your PHI to your health plan if you pay for an item or service we provide you in full and out-of-pocket at the time of service.
We reserve the right to amend, change, or eliminate provisions of our privacy practices and to enact new provisions regarding the PHI we maintain about you. If our information practices change, we will amend our Notice. You are entitled to receive a copy of the revised Notice upon request by phone or by visiting our website or Practice.
Other Uses and Disclosures of your PHI
- We may disclose your PHI to public health or legal authorities charged with preventing or controlling disease, injury, or disability; to report reactions to medications or problems with products; to notify people of recalls; or to notify a person who may have been exposed to a disease or who is at risk for contracting or spreading a disease or condition.
As Required by Law
Law Enforcement and Correctional Institutions.
Health Oversight Federal law may require us to release your PHI to appropriate health oversight agencies .
Judicial/Administrative Proceedings -We may disclose your PHI with your authorization, or as directed by a proper court order.
For Specialized Governmental Functions or Serious Threat
Coroners, Medical Examiners, and Funeral Directors
Other uses and disclosures of your PHI not described in this Notice will only be made with your authorization, unless otherwise permitted or required by law.
To Request Information, Exercise a Patient Right, or File a Complaint
If you have questions, would like additional information, want to exercise a Patient Right described above, or believe your (or someone else’s) privacy rights have been violated, you may contact the Practice’s Privacy Officer at 901-854-5455, or in writing to us at our practice address.
Please note that all complaints must be submitted in writing to the Privacy Officer at the above address. You may also file a complaint with the Secretary of Health and Human Services (HHS), Office for Civil Rights (OCR). Your complaint must be filed in writing, either on paper or electronically, by mail, fax, or e-mail. The address for the Colorado regional office is: Office for Civil Rights, U.S. Department of Health and Human Services, 999 18th Street, Suite 417, Denver, CO 80202; or call (800) 368-1019. More information regarding the steps to file a complaint can be found at: www.hhs.gov/ocr/privacy/hipaa/complaints.
- •We cannot, and will not, require you to waive the right to file a complaint with the Secretary ofHHS as a condition of receiving treatment from the Practice.
- •We cannot, and will not, retaliate against you for filing a complaint with the Secretary of HHS.