Calvert
Internal Medicine Group
PRIVACY NOTICE
OUR COMMITMENT TO YOUR PRIVACY
Our practice is dedicated to maintaining the privacy of your
personal health information contained in our records. We have established
policies to guard against unnecessary disclosure of your health information in
those records. 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 health information. By federal and state law, we must follow the
terms of the notice of privacy practices that we have in effect at the time.
The terms of this
notice apply to all records containing your protected health information 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.
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. This Privacy Notice is being provided to you
as a requirement of a federal law, the Health Insurance Portability and
Accountability Act (HIPAA). This Privacy Notice describes how we may use and
disclose your protected health information to carry out treatment, payment, or
health care operations and for other purposes that are permitted or required by
law. It also describes your right to access and control your protected health
information. Your “protected health information” means any written or oral
information about you, including demographic data that can be used to identify
you, created or received by your health care provider, which relates to your
past, present, or future physical or mental health or condition.
Uses and Disclosures of Protected Health
Information for Treatment, Payment, and Health Care Operations. We may use your
protected health information for the purposes of providing treatment, obtaining
payment for treatment, and conducting health care operations. Your protected
health information may be used or disclosed only for these purposes unless we
have obtained your authorization or the use or disclosure is permitted or
required by the HIPAA regulations or other law. Disclosures of your protected
health information for the purposes described in this Privacy Notice may be
made in writing, orally, or by electronic means.
1. Treatment. We will use and disclose your protected healthcare information
to provide, coordinate, or manage your health care and related services,
including coordination and management with third parties for treatment
purposes. Here are some examples of how we may use or disclose your protected
health information for treatment:
a. We may disclose your protected health
information to a laboratory to order tests.
b. We may disclose your protected health
information to other physicians who may be treating you or consulting with us
regarding your care.
c. We may disclose your protected health information to those who
may be involved in your care, such as family members or your personal
representative.
2. Payment. We will use your protected health information to obtain payment
for the services we provide to you. We may also disclose your protected health
information to another provider involved in your care for their payment
activities. Here are some examples of how we may use or disclose your protected
health information for payment:
a. We may communicate with your health
insurance company to get approval for the services we render, to verify your
health insurance coverage, to verify that particular services are covered under
your insurance plan, and to demonstrate medical necessity.
b. We may disclose your protected health information to anesthesia
care providers involved in your
care so they can obtain payment for their services.
3. Health
Care Operations. We may use and disclose your protected
health information to facilitate our own health care operations and to provide
quality care to all of our patients. Health care operations include such
activities as: quality assessment and improvement; employee review activities;
conduction or arranging for medical review, legal services, and auditing
functions, including fraud and abuse detection and compliance reviews; business
planning and development; and business management and general administrative
activities. In certain situations, we may also disclose your protected health
information to another provider or health plan for their health care
operations. Here are some examples of how we may use or disclose your protected
health information for health care operations:
a. We may use your protected health
information to review our treatment and services and to evaluate the
performance of our staff in caring for you.
b. We may combine protected health
information about many patients to decide what additional services we should
offer, what services are not needed, and whether certain new treatments are
effective.
c. We may also disclose information to
doctors, nurses, technicians, medical students, and other personnel for review
and learning purposes.
d. We may also use or disclose your protected health information
in the course of maintenance and management of our electronic health
information systems.
4. Other
Uses and Disclosures. As part of the
functions above, we may use or disclose your protected health information to
provide you with appointment reminders, to inform you of treatment
alternatives, or to provide you with information about other health-related
benefits and services which may be of interest to you.
Uses and Disclosures of Protected Health
Information Permitted without Authorization Required or Opportunity for the
Individual to Object
The Federal privacy rules allow us to use or
disclose your protected health information without your authorization and
without your having the opportunity to object to such use or disclosure in
certain circumstances, including:
1. When Required By Law. We will disclose your protected health information when we are
required to do so by federal, state, or local law.
2. For
Public Health Reasons. We may disclose your
protected health information as permitted or required by law for the following
public health reasons:
a. For the prevention, control, or reporting
of disease, injury or disability;
b. For the reporting of vital events such as
birth or death;
c. For public health surveillance,
investigations, or interventions;
d. For purposes related to the quality,
safety, or effectiveness of FDA-regulated products or activities, including:
• Collection and reporting of adverse events,
product defects or problems, or biological product deviations
• Tracking of FDA-regulated products
• Product recalls, repairs, or look back,
• Post-marketing surveillance
e. To notify a person who has been exposed to
a communicable disease or who may be at risk of contracting or spreading a
disease or condition;
f. Under certain limited circumstances, to report to an employer
information about an individual who is a member of the employer’s workforce.
3. To Report Abuse, Neglect, or Domestic
Violence. We may notify government authorities if we
believe a patient is a victim of abuse, neglect, or domestic violence. We will
make this disclosure only when specifically authorized or required by law, or
when the patient agrees to the disclosure.
4. For Health Oversight Activities. We may disclose your protected health information to a health
oversight agency for oversight activities authorized by law, including audits;
civil, administrative, or criminal investigations; inspections; licensure or
disciplinary actions; civil, administrative, or criminal proceedings or
actions; or other activities necessary for appropriate oversight.
5. For Judicial or Administrative
Proceedings. We may disclose your protected health
information in the course of any judicial or administrative proceeding in
response to an order of a court or administrative tribunal as expressly
authorized by such order. We may disclose your protected health information in
response to a subpoena, discovery request, or other lawful process that is not
accompanied by an order of a court of administrative tribunal if we have
received satisfactory assurances that you have been notified of the request or
that an effort has been made to secure a protective order.
6. For Law
Enforcement Purposes. We may disclose your
protected health information to a law enforcement official for law enforcement
purposes, including:
a. Wound or physical injury reporting, as
required by law.
b. In compliance with, and as limited by the
relevant requirements of a court order or court-ordered warrant, a subpoena,
summons, or similar process.
c. Identification or location of a suspect,
fugitive, material witness, or missing person.
d. Under certain limited circumstances when
you are the victim of a crime.
e. Alerting law enforcement of the death of
an individual where there is suspicion that the death may have resulted from
criminal conduct.
f. Reporting criminal conduct that occurred
on the premises of the provider.
g. In an emergency to report a crime.
7. To Coroners, Medical Examiners, and
Funeral Directors. We may disclosed protected health
information to a coroner or medical examiner for the purpose of identifying a
deceased person, determining a cause of death, or other duties as authorized by
law. We may disclose protected health information to funeral directors,
consistent with applicable law, as necessary to carry out their duties with
respect to the decedent. In some cases such disclosures may occur prior to, and
in reasonable anticipation of, the individual’s death.
8. For Organ or Tissue Donation. We may use or disclose protected health information to organ
procurement organizations or other entities engaged in the procurement,
banking, or transplantation of cadaver organs, eyes, or tissue for the purpose
of facilitating donation and transplant.
9. For Research Purposes. We may use or disclose your protected health information for
research purposes when an institutional review board that has reviewed the
research proposal and protocols to safeguard the privacy of your protected
health information has approved such use or disclosure.
10. To Avert a Serious Threat to Health
or Safety. We may, consistent with applicable law and
standards of ethical conduct, use or disclose your protected health information
if we believe, in good faith, that such use or disclosure is necessary to
prevent or lessen a serious and imminent threat to your health and safety or
that of the public.
11. For Specialized Government Functions. We may use or disclose your protected health information, as
authorized or required by law, to facilitate specified government functions
related to military and veterans activities; national security and intelligence
activities; protective services for the President and others; medical
suitability determinations; correctional institutions and other law enforcement
custodial situations.
12. For
Workers’ Compensation. We may use and
disclose your protected heath information, as necessary, to comply with
workers’ compensation laws or similar programs.
Uses and Disclosures of Protected Health
Information Permitted without Authorization Required but with an Opportunity
for the Individual to Object
We may disclose your protected health information to a friend or
family member who is involved in your medical care or payment for care. In
addition, if applicable, we may disclose medical information about you to an
entity assisting in a disaster relief effort so that your family can be
notified about your condition, status and location.
You may object to these disclosures. If you do not object to these
disclosures, or we determine in the exercise of our professional judgment that
it is in your best interest for us to disclose information that is directly relevant
to the person’s involvement with your care, we may disclose your protected
health information.
Uses and Disclosures of Protected Health
Information which You Authorize
Other than the uses and disclosures described above, we will not
use or disclose your protected health information without your written
authorization. Authorizations are for specific uses of your protected health
information, and once you give us authorization, any disclosures we make will
be limited to those consistent with the terms of the authorization. You may
revoke your authorization, by submitting a revocation in writing, at any time,
except to the extent that we have already taken action in reliance upon your
authorization.
Your Rights Regarding Your Protected Health
Information
You have the following rights regarding your
protected health information:
1. The Right
to Request Restriction of Uses and Disclosures. You have the right to request that we not use or disclose
certain parts of your protected health information for the purposes of
treatment, payment, or healthcare operations. You also have the right to
request that we do not disclose your protected health information to friends or
family members who may be involved in your care, or for notification purposes
as described earlier in this notice. Your request must be made in writing and
must state the specific restriction requested and the individuals to whom the
restriction applies.
We are not required to agree to a restriction
you may request. We will notify you if we do not agree to your restriction
request. If we do agree to the restriction request, we will not use or disclose
your protected health information in violation of the agreed upon restriction,
unless necessary for the provision of emergency treatment. We may terminate our
agreement to a restriction if you agree to the termination in writing; if you
agree to the termination orally and the oral agreement is documented, or if we
notify you of
By law, you do not have a right to access
psychotherapy notes; information compiled in reasonable anticipation of, or for
use in, a civil, criminal, or administrative proceeding; and protected health
information which is subject to a law which prohibits access to protected
health information. Depending on the circumstance of your request, you may have
the right to have a decision to deny access reviewed.
We may deny your request to inspect or copy
your protected health information if, in our professional judgment, we
determine that the access requested is likely to endanger you or another
person, or is likely to cause substantial harm to another person referenced
within the protected health information. You have a right to request a review
of a denial of access.
If you request a copy of your information, we
may charge you a fee for the costs of copying, mailing, or other costs incurred
by us as a result of complying with your request.
Requests for access to your protected health information must be
made in writing to the Privacy Officer.
2. The Right to Amend Protected Health Information. You have the right to request that we amend your protected
health information in a designated record set for as long as we maintain that
information. In certain cases we may deny your request. If we deny your request
you will be notified in writing, and you will have the right to file a
statement of disagreement with us. We may prepare a rebuttal to your statement
of disagreement and if we do so we will provide a copy of our rebuttal to you.
Requests for amendment of protected health
information must made in writing to the Privacy Officer, and must include a
reason to support the requested amendments.
3. The Right to Receive an Accounting of
Disclosures of Protected Health Information. You have the right to request an accounting of
disclosures of your protected health information made by us. This right applies to disclosures made by us except for
disclosures: to carry out treatment, payment, or health care operations as
described in this Notice or incidental to such use; to you or your personal
representatives; pursuant to your authorization; for our directory, or other
notification purposes, or to termination of the agreement and the termination
applies only to protected health information created or received by us after
you receive the notice of termination of the restriction. Request for
restrictions must be made in writing to the Compliance Officer
Requests for disclosure of accounting must
specify a time period sought for the accounting, with the maximum time period
being six years prior to the date of the request. We are not required to
provide accounting for disclosures made before April 14, 2003. We will provide
the first disclosure accounting you request during any 12-month period without
charge. Subsequent disclosure accounting request will be subject to a
reasonable cost-based fee.
4. The Right to Request Confidential Communications. You have the right to request that you receive communications of
protected health information from us by alternative means or at alternative
locations. We must accommodate reasonable request of this nature. We may
condition the provision of accommodation by requesting information from you
describing how payment will be handled, or by requesting specification of an
alternative address or alternative form of contact. Requests for confidential
communications must be made in writing to the Compliance Officer.
5. The Right
to Inspect and Copy Protected Health Information. You have the right to inspect and obtain a copy of your
protected health information that is maintained in a designated record set for
as long as we maintain the protected health information. The designated record
set is a collection of records maintained by us, which contains medical and
billing information used in the course of your care, and any other information
used to make decisions about you. Persons involved in your care; or for certain
other disclosures we are permitted to make without your authorization.
6 The Right to Obtain a Paper Copy of this Notice. Upon request, we will provide a paper copy of this notice.
7. Right
to Opt Out of Health Information Exchange. We may participate in health
information exchanges to facilitate the secure exchange of your electronic
health information between and among several healthcare providers or other
healthcare entities for your treatment, payment, or other healthcare operations
purposes. This means we may share information we obtain or create about you
with outside entities (such as hospitals, doctors offices, pharmacies, labs,
and imaging centers) or we may receive information they create or obtain about
you (such as medication history, medical history, lab results, and imaging
studies) so each of us can provide better treatment and coordination of your
healthcare services. Exchange of health
information can provide faster access, better coordination of care and assist
healthcare providers and public health officials in making more informed
treatment decisions. You may “opt-out” of participation in health information
exchanges which Calvert Internal Medicine Group participates in. Even if you “opt-out,” a certain amount of
your information will be retained by the exchange, and your ordering or
referring physicians may access diagnostic information about you, such as reports
of imaging and lab results. You may
“opt-out” and prevent searching of your health information by
non-ordering/non-referring healthcare providers through health information
exchanges which Calvert Internal Medicine Group participates in. Although we believe that sharing health
information among providers of care leads to better healthcare, we want you to
be comfortable with how we share your information. Therefore, if you wish to
“opt-out” of participation in health information exchanges as described, please
sign our “opt-out” form located at any registration desk.
Your Rights Regarding Your Protected Health
Information
We are required by law to maintain the privacy of your health
information and to provide you with this Privacy Notice of our legal duties and
privacy practices with respect to protected health information. We are required
to abide by the terms of the Notice currently in effect. We reserve the right
to change the terms of this Notice and to make any new provisions effective for
all protected health information that we maintain. If we change the Notice, we
will provide a copy of the revised notice through in-person contact.
Your Rights Regarding Your Protected Health
Information
You have the right to express complaints to us and to the Secretary
of the Department of Health and Human Services if you believe that your privacy
rights have been violated. If you wish to complain to us, please do so in
writing, and direct your complaint to the Compliance Officer.
You will
not be penalized for filing a complaint.
Contact Information
For further information about this Notice,
please contact:
Calvert Internal Medicine Group, P.A.
Attn: Compliance Officer
110 Hospital Road #310
Prince Frederick, MD 20678
If you have privacy issues, or if you believe
that your privacy rights have been violated, please contact:
Calvert Internal Medicine Group, P.A.
Attn: Compliance Officer
110 Hospital Road #310
Prince Frederick, MD 20678
Effective Date: This Notice is effective September 28, 2010.
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