Privacy Policy

 

 

Effective Date: December 31, 2018

 

PRAIRIE FIELDS FAMILY MEDICINE, P.C.

NOTICE OF PRIVACY PRACTICES

 

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION

ABOUT YOU MAY BE USED AND DISCLOSED

AND HOW YOU CAN GET ACCESS

TO YOUR MEDICAL INFORMATION.


PLEASE REVIEW THIS NOTICE CAREFULLY.

OUR COMMITMENT TO YOUR PRIVACY

Prairie Fields Family Medicine, P.C. (“PFFM”) is dedicated to maintaining the privacy of your identifiable health information. In conducting our business, we create and maintain identifiable information about you and the treatment and services we provide to you (collectively, your “Information”). We are required by law to maintain the confidentiality of your Information. We also are required by law to provide you with this Notice of Privacy Practices (this “Notice”) setting forth our legal duties and privacy practices concerning your Information. By law, we must follow the terms of the Notice that we have in effect at the time.

This Notice provides you with the following important information:

·            How PFFM may use and disclose your Information;

·            Your privacy rights in your Information; and

·            PFFM’s obligations concerning the use and disclosure of your Information.

The terms of this Notice apply to all records containing your Information that are created and/or retained by PFFM. We reserve the right to revise or amend this Notice. Any revision or amendment of this Notice will be effective for all of your records that PFFM has created or maintained in the past, and for any of your records we may create or maintain in the future. We post a copy of our current Notice in each of our facilities in a prominent location, and you may request a copy of our most current Notice during any visit. The effective date of our Notice will be posted in the upper left-hand corner of the Notice.

WHO WILL FOLLOW THIS NOTICE

The privacy practices of PFFM set forth in this Notice apply to:

·            any health care professional authorized to enter information into your medical records, including members of our medical staff;

·            all departments, units and offices operated by PFFM; and

·            all employees, staff and other personnel of PFFM

All of these individuals and locations will follow the terms of this Notice. In addition, these individuals and locations may share your Information with each other for treatment, payment, or health care operations purposes as described in this Notice.

 

HOW WE MAY USE AND DISCLOSE YOUR IDENTIFIABLE HEALTH INFORMATION

The following categories describe different ways in which we may use and disclose your Information. For each category of uses or disclosures we will explain what we mean and provide examples. Not every use or disclosure in a category will be listed; however, all of the ways we are permitted to use and disclose your Information will fall within one of the categories. Please realize that in some instances Nebraska has special laws concerning the use and disclosure of certain types of health information, such as mental health, substance abuse, and HIV/AIDS information.

·         Treatment. We may use your Information to provide you with health treatment or services. We may disclose your Information to doctors, nurses, technicians, medical students, or other personnel who are involved in taking care of you at PFFM. For example, a doctor treating you for a broken leg may need to know if you have diabetes, because diabetes may slow the healing process. PFFM may share your Information in order to coordinate the different things you need, such as prescriptions, lab work, x-rays and follow-up care. To the extent permitted by law, we may disclose your Information to people outside PFFM who may be involved in your health care (such as family members and friends, home health agencies, and others that provide services that are part of your care), unless you have specifically instructed us not to do so.

·         Payment. We may use and disclose your Information so that the treatment and services you receive from us may be billed to and payment may be collected from you, an insurance company, or a third party. We also may tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment. We also may disclose your Information to other health care providers and health plans for payment activities of those providers and plans. For example, we may provide your Information to a physician who is not on our medical staff so that the physician may bill you or your insurer for services you received from that physician.

·         Health Care Operations. PFFM may use and disclose your Information for certain administrative and operational purposes. These uses and disclosures are necessary for our operations and to make sure that all of our patients receive quality care. For example, we may use your Information to review our treatment and services and to evaluate our performance in caring for you. We may combine health information about some or all of our patients to decide what additional services we should offer, what services may not be needed, and whether certain new treatments are effective. We may also disclose your Information to doctors, nurses, technicians, medical students, and our personnel for review and learning purposes. We may also combine the health information we have with health information from other health care providers to compare how we are doing and see where we can make improvements in the care and services we offer. We may remove information that identifies you from this set of health information (e.g., name, address, social security number) so others may use it to study health care and health care delivery without learning your identity. We also may disclose your Information to certain other individuals and organizations, including physicians, hospitals, and health plans, to assist with health care operations activities of these individuals and organizations. Except for those individuals and organizations described in the section of this Notice entitled “Who Will Follow This Notice,” these individuals and organizations now have (or had in the past) a relationship with you.

The information we disclose about you will relate to this relationship. For example, we may disclose your Information to a hospital if that hospital has treated you in the past, the information we disclose relates to that relationship, and the hospital intends to use your Information for its quality assurance and improvement activities. Similarly, we may share your Information with your health plan for quality assurance and improvement purposes. These are just some of the various uses and disclosures PFFM may engage in as part of routine health care operations.

·         Business Associates. We may disclose your Information to entities that provide services for PFFM. We require these business associates to protect the health information we provide to them.

·         Appointment Reminders. We may use and disclose your Information to contact you as a reminder that you have an appointment for treatment or medical care.

·         Treatment Options. We may use and disclose your Information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.

·         Health-Related Benefits and Services. We may use and disclose your Information to tell you about health-related benefits or services that may be of interest to you.

·         Release of Information to Family/Friends. We may release your Information to a friend or family member who is helping you pay for your health care or who assists in taking care of you. Further, in the event of your death, we may disclose to a member of your family, a relative, a close friend, or any other person you have identified, your Information that directly relates to that person’s involvement in your health care or who has responsibility for payment of your health care, unless such disclosure is inconsistent with your prior expressed preference that is known to us. In addition, we may disclose your Information to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.

·         As Required By Law. We will use and disclose your Information when we are required to do so by federal, state or local law.

USE AND DISCLOSURE OF YOUR INFORMATION IN CERTAIN SPECIAL CIRCUMSTANCES

The following categories describe circumstances in which we may use or disclose your Information:

·         Public Health Risks. We may disclose your Information for state and federal public health activities. These activities generally include the following purposes:

·         to report, prevent or control disease, injury or disability;

·         to report births and deaths;

·         to report child abuse or neglect;

·         to report reactions to medications or problems with products;

·         to notify people of recalls of products they may be using;

·         to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and

·         to notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence.

We will only make these disclosures if you agree or when we are otherwise required or authorized by law to do so.

·         Health Oversight Activities. We may disclose your Information to a state or federal health oversight agency for activities authorized by law. These oversight activities include, for example: investigations, inspections, audits, and surveys; licensure and disciplinary actions; civil, administrative, and criminal procedures or actions; and other activities necessary for the government to monitor government programs, compliance with civil rights laws, and the health care system in general.

·         Lawsuits and Disputes. We may disclose your Information in response to a court or administrative order. We also may disclose your Information in response to a subpoena, discovery request, or other lawful process by another party involved in a legal dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

·         Law Enforcement. We may release your Information if asked to do so by a local, state or federal law enforcement official:

·         in response to a court order, subpoena, warrant, summons or similar process;

·         to identify or locate a suspect, fugitive, material witness, or missing person;

·         about the victim of a crime in certain limited circumstances, if we are unable to obtain the person's agreement;

·         about a death we believe may be the result of criminal conduct;

·         about criminal conduct at any PFFM facility; and

·         in emergency circumstances to report a crime (including the location or victim(s) of the crime, or the description, identity or location of the perpetrator).

·         Coroners, Medical Examiners and Funeral Directors. We may disclose your Information to a coroner or medical examiner to identify a deceased person or determine a cause of death. We may also disclose your Information to funeral directors as necessary to carry out their duties.

·         Organ and Tissue Donation. If you are an organ donor, we may release health information to organizations that handle organ procurement or organ, eye, or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.

·         Research. We may use and disclose your Information for research purposes in certain limited circumstances. For example, a research project may involve comparing the health of all patients who received one medication to those who received another, for the same condition. All research projects are subject to a special approval process. This process evaluates a proposed research project and its use of health information, trying to balance the research needs with patients’ need for privacy of their health information. Before we use or disclose health information for research, the project will have been approved through this research approval process; however, we may disclose your Information to people preparing to conduct a research project (e.g., to help them find patients with specific health needs), so long as the information they review does not leave our premises. We will almost always ask for your specific permission if the researcher will have access to your name, address, or other information that reveals who you are, or will be involved in your care.

·         Serious Threats to Health or Safety. We may use and disclose your Information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat and/or to any specifically identified victims of the threat.

·         Military and Veterans. If you are a member of the armed forces, we may release your Information as required by appropriate military command authorities. We may also release health information about foreign military personnel to the appropriate foreign military authority.

·         National Security and Intelligence Activities. We may disclose your Information to federal officials for intelligence, counter-intelligence, and national security activities authorized by law. We also may disclose your Information to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.

·         Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may disclose your Information to the correctional institution or law enforcement official. Disclosures for these purposes would be necessary: (1) for the institution to provide health care services to you; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.

·         Workers’ Compensation. We may release your Information for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.

·         Employers. We may disclose to your employer your Information obtained in providing medical services to you at the request of your employer for purposes of conducting an evaluation relating to medical surveillance of the workplace or determining whether you have a work-related illness or injury when such medical services are needed by the employer to comply with certain legal requirements.

·         Schools. We may disclose proof of immunizations to a school you attend or will attend if the school is required by state or other law to have such proof prior to admitting you and if we obtain your consent or, if you are a minor, the consent of a parent, guardian or person acting in loco parentis.

BREACH

In the event your unsecured Information has been accessed, acquired, used or disclosed in a manner not permitted by law which compromises its security or privacy, we are required by law to notify you of such breach within sixty (60) days after we have discovered the breach.

YOUR RIGHTS REGARDING YOUR IDENTIFIABLE HEALTH INFORMATION

You have the following rights regarding the Information we maintain about you:

·         Confidential Communications. You have the right to request that we communicate with you about health matters in a certain way or at a certain location. For example, you may ask that we contact you at work or by U.S. Mail. To request that we contact you in a certain way or at a certain location, you must make your request in writing to: Administrator, Prairie Fields Family Medicine, P.C., 350 W. 23rd Street, Suite A, Fremont, NE 68025. We will not ask you the reason for your request, and we will accommodate reasonable requests.

Your written request must specify how or where you wish to be contacted. You must provide us with a mailing address where you can receive correspondence and other communications from us related to payment for the services you have received from us. We reserve the right to contact you by other means and at other locations if you fail to respond to any communication from us that requires a response. We will notify you in accordance with your original request prior to attempting to contact you by other means or at another location.

·         Requesting Restrictions. You have the right to request a restriction in our use or disclosure of your Information for treatment, payment or healthcare operations purposes. You also have the right to request that we limit our disclosure of your Information to persons involved in your health care or the payment for your care, such as family members and friends. PFFM is not required to agree to your request unless the restriction involves the disclosure to a health plan for purposes of carrying out payment or health care operations and such health information pertains solely to a health care item or service for which you paid out-of-pocket in full. NOTE: If we do agree, we will strive to comply with your request unless your Information is needed to provide emergency treatment to you. However, PFFM cannot ensure complete success.

We may terminate our agreement to restrict uses and disclosures of your Information by providing you with written notice of such; provided, however, that our termination shall only be effective with respect to your Information created or received after we have given you notice of termination of the restriction. Further, we may not terminate a restriction that we are required to agree to with respect to disclosures to health plans, which is described above.

To request a restriction, you must make your request in writing to: Administrator, Prairie Fields Family Medicine, P.C., 350 W. 23rd Street, Suite A, Fremont, NE 68025. In your request, you must describe in a clear and concise fashion: (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse. PFFM does not have the authority to bind anyone else to such restrictions.

·         Inspection and Copies. You have the right to inspect and copy your Information that may be used to make decisions about your care, including your medical records and billing records, but not including: psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding; and certain laboratory information restricted by federal law. PFFM will respond to your written request within thirty (30) days, unless state law requires us to respond earlier.

If we maintain your Information electronically, we will provide you with a copy of your medical record in the electronic form and format that you request, if we can readily produce such format. If we cannot readily produce the format you requested, we will produce your electronic health information in at least one readable electronic format as agreed to between you and us.

If your request directs us to transmit the copy of your Information directly to another person, we will provide the copy of your Information to the person you designated, but your request must be made in writing, signed by you, and clearly identify the designated person and where to send the copy of your Information.

To inspect or obtain a copy of your Information that is maintained by or on behalf of PFFM and that may be used to make decisions about you, you must submit your request in writing to Administrator, Prairie Fields Family Medicine, P.C., 350 W. 23rd Street, Suite A, Fremont, NE 68025. PFFM may charge a reasonable fee for the costs of copying, mailing, labor, and supplies associated with your request.

We may deny your request to inspect and copy your Information under certain limited circumstances. For example, you may not be provided with your Information if it is determined that providing such information could cause harm to you or another person. In most cases, if you are denied access to your Information you may request that the denial be reviewed. PFFM’s physicians, in accordance with applicable law, will review your request and the denial. The person conducting the review will not be the person who denied your request. The PFFM department that originally denied you access will comply with the outcome of the review.

·         Amendment. If you feel that your Information maintained by PFFM is incorrect or incomplete, you may ask us to amend it. You have the right to request an amendment for as long as your Information is kept by or for PFFM. To formally request an amendment of your Information that is maintained by, or on behalf of, PFFM, your request must be made in writing and submitted to: Administrator, Prairie Fields Family Medicine, P.C., 350 W. 23rd Street, Suite A, Fremont, NE 68025. In addition, you must provide a reason that supports your request.

PFFM may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, PFFM may deny your request if you ask to amend information that:

·         Is accurate and complete;

·         Was not created by PFFM, unless the person or entity that created the information is no longer available to make the amendment;

·         Is not part of the health information kept by or for PFFM; or

·         Is not part of the information which you would be permitted to inspect and copy.

·         Accounting of Disclosures. You have the right to receive an accounting of certain disclosures we have made, if any, of your Information. This right applies to disclosures made for purposes other than: (i) treatment, payment, and/or health care operations; (ii) disclosures made to you, the patient; (iii) disclosures to a facility directory; (iv) disclosures to family members or friends involved in your care or for notification purposes; (v) pursuant to an authorization we get from you; (vi) for national security or intelligence purposes; (vii) to correctional institution or law enforcement officials; and (ix) as part of a limited data set, in accordance with applicable laws. To request an accounting of disclosures made by PFFM, you must submit your request in writing to: Administrator, Prairie Fields Family Medicine, P.C. 350 W. 23rd Street, Suite A, Fremont, NE 68025. Your request must state a time period that may not be longer than the six (6) years preceding the date of your request. The first list you request within a 12-month period will be free. For additional lists within the same 12-month period, you may be charged for the costs of providing the list. You will be notified of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

·         Right to a Paper Copy of This Notice. You have the right to receive a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time. To obtain a paper copy of this Notice, contact the Administrator, Prairie Fields Family Medicine, P.C. 350 W. 23rd Street, Suite A, Fremont, NE 68025. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy of this Notice.

RIGHT TO FILE A COMPLAINT

If you believe your privacy rights have been violated, you may file a complaint with the Administrator, Prairie Fields Family Medicine, P.C. 350 W. 23rd Street, Suite A, Fremont, NE 68025.

You may also submit a complaint to the Secretary of the Department of Health & Human Services at 200 Independence Ave SW, Washington, DC, 20210 or by calling toll free 1-877-696-6775.

All complaints must be submitted in writing. The Office of Civil Rights of HHS provides information on its website about how to file a complaint: www.hhs.gov/ocr/hipaa/. You will not be penalized for filing a complaint.

RIGHT TO PROVIDE AN AUTHORIZATION FOR OTHER USES AND DISCLOSURES

We may only use and/or disclose your psychotherapy notes (if any) with your prior written authorization, except for certain treatment, payment, or health care operations purposes or as required by law, including to prevent or less a serious and imminent threat to the health and/or safety of a person or the public. We may only use and disclose your Information for marketing purposes with your written authorization, except if the communication is in the form of a face-to-face communication made by us to you or is a promotional gift of nominal value from us to you. We may only sell your Information with your written authorization. Further, any other uses and disclosures of your Information for purposes other than those described in this Notice will be made only with your prior written authorization. Any authorization you provide to us regarding the use and disclosure of your Information may be revoked by you at any time in writing. After you revoke your authorization, we will no longer use or disclose your Information for the reasons set forth in the authorization. Please note, we are required to retain records of your medical care.

If you have any questions about this Notice, please contact us at (402) 721-7077.

 

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