PREMIER MEDICAL GROUP OF MISSISSIPPI
NOTICE OF PRIVACY PRACTICES FOR PROTECTED HEALTH INFORMATION
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU MAY GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.
If you have any questions regarding your privacy or any of the information contained in this Notice, please contact our Privacy Officer at 662-289-1800.
We create a record of care and services you receive at our clinic. We need this record in order to provide care. We are required by law to maintain the privacy of your health information and provide you with this Notice. We reserve the right to change this Notice. We reserve the right to make the new Notice effective for all protected health information (PHI) we maintain. A copy of our current Notice will be available and posted at the clinic.
Acknowledgement of Privacy Practices: We will ask you to sign a form that states you have received this Notice. This form does not state that you have read the Notice, only that you have received it.
Requirement for Written Authorization: We will generally obtain your written permission before using your health information or sharing it with others outside our group practice. You may also initiate transfer of your records to another person by completing an authorization form. If you provide us with a written authorization, you may revoke that authorization at any time, except when we have already relied upon it. To revoke an authorization, please call our Privacy Officer at 662-289-1800.
Exceptions to Requirement for Written Authorization: There are some situations when we do not need your written authorization before using your health information or sharing it with others. These situations include treatment, payment, health care operations, an emergency, communication with your caregivers and family, and many other circumstances which are described in detail in this Notice. Premier Medical Group is committed to protect the privacy of your health care information. Some examples of the information we are protecting include: information about your health condition; information about health care services you have received or may receive in the future; geographic information (such as where you live or work); demographic information (such as your race, gender, or marital status); unique numbers that my identify you (such as your social security number, driver’s license, or phone number); other types of information that may identify who you are.
How is this protected health information used?
Premier Medical Group physicians and staff use your medical information and share it with others in order to treat your condition, obtain payment for that treatment, and run the practice’s normal business operations. Here are some specific examples of how we may use this information without your authorization.
Treatment: We may share this information with doctors and nurses that are involved in your care. We may use health information about you to provide you with medical treatment or services. A doctor in our practice may also share this information with another doctor to whom you have been referred for further care. We may also share information to other health care providers to assist them in taking care of you.
Payment: We may use your health information or share it with others for payment purposes. For example, we may share information about you with your insurance company in order to obtain reimbursement after we have treated you. We may also share information with your insurance company to determine whether it will cover your treatment or to obtain pre-approval before providing you with treatment.
Health Care Operations: We may use your health information or share it with others in order to conduct our normal business operations. This may include measuring and improving quality, evaluation performance, conducting training, and getting accreditation certificates, licenses and credentials we need to serve you. We may ask you to use a sign-in sheet at the registration desk. We may also share your health information with another company that performs business services for us, such as billing companies. If so, we will have a written contract to ensure that this company also protects the privacy of your health information.
Caregivers and Family Involved in Your Care: If you do not object, we may share your health information with a family member, relative, or close personal friend who is involved in your care. We may also notify a family member, personal representative, or caregiver about your general condition. In some cases, we may need to share your information with a disaster relief organization that will help us notify these persons. If you do not want us to share information with a family member, relative or close personal friend we will need this request in writing.
Appointment Reminders and Health Related Benefits: We may use PHI to provide appointment reminders or give you information about test results or treatment alternatives, health-related benefits, health education and services that might be of interest to you.
Emergencies: We may disclose your health information if you need emergency treatment or if we are required by law to treat you but are unable to obtain your consent. If this happens, we will try to obtain your consent as soon as we reasonably can after we treat you.
Public Health: We may disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling diseases, injury or disability.
Communicable Diseases: We may disclose your PHI, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.
Law Enforcement: We may disclose your PHI when a law requires that we report information to government agencies and law enforcement personnel about victims of abuse, neglect or domestic violence. We may also disclose PHI, so long as applicable legal requirements are met, for identification and location purposes pertaining to victims of a crime, suspicion that death has occurred as a result of criminal conduct, or in the event that a crime occurs on the premises of the practice. We may also disclose PHI if it is necessary to law enforcement authorities to identify or apprehend an individual.
Legal Proceedings: We may disclose protected health information in the course of any judicial or administrative proceedings in response to an order of the court or administrative tribunal (to the extent such disclosure is expressively authorized), in certain conditions in response to a subpoena, discovery request or other lawful processes.
National Security: We may disclose your PHI to authorized federal officials who are conducting national security and intelligence activities.
Coroner and Organ Donation: We may disclose PHI to a coroner or medical examiner for identification purposes, determining cause of death or to perform other duties authorized by law. We may notify organ procurement organizations to assist them in organ, eye or tissue donation and transplants.
Workers’ Compensation: We may provide PHI in order to comply with workers’ compensation law and other similar legally established programs.
Health Oversight: We may disclose your PHI to a health oversight agency for activities authorized by law, such as audits, investigations and inspections. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs and other government regulatory programs and civil rights laws.
Food and Drug Administration: We may disclose your PHI to a person or company required by the Food and Drug Administration to report adverse events or product defects.
Required Uses and Disclosures: Under the law, we must make disclosures when required by the Secretary of the Department of Health and Human Services to investigate our compliance with the requirements of the federal law.
Research: We may disclose your PHI to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your PHI.
You have the right to ask that we limit how we use and disclose your PHI for the purposes of treatment, payment or healthcare operations. You may also request that any part of your PHI not be disclosed to family members or others who may be involved in your care. Your request must be in writing and state the specific restriction requested and to whom you want the restriction to apply. We will consider your request but are not legally required to accept it. If we accept your request, we will put any limits in writing and abide by them except in emergency situations. You may not limit the uses and disclosures that we are legally required or allowed to make. Please make your request in writing to the Privacy Officer of Premier Medical Group.
You have a right to request that we communicate about your treatment and/or protected health information by alternative means or locations. We are required to accept reasonable requests. We require that you make this request in writing.
In most cases, you have the right to look at or get copies of your PHI that we have. You must make the request in writing using a HIPAA compliant authorization. If we do not have your PHI but we know who does, we will tell you how to get it. If you request copies of your PHI, we will charge you a fee as mandated by the Mississippi State Board of Medical Licensure. This fee may be required in advance of receiving copies of your PHI. Please contact our Privacy Office if you have further questions about access to your medical record.
You have the right to get a list of instances in which we have disclosed your PHI. The list will not include uses or disclosures that you have already consented to, such as those made for treatment, payment, health care operations, health oversight, directly to you, to your family, or in our facility. The list also won’t include uses and disclosures made for national security purposes or law enforcement personnel, or before April 14, 2003.
You have the right to request amendments to your PHI. We require that all requests for amendments be made in writing and provide a reason to support the requested amendment. Under federal law, we may deny this amendment. Please contact the Privacy Officer for more details or to exercise this right.
You have a right to contact the Privacy Officer to request additional information or ask questions. You may contact the Privacy Officer by calling 662-289-1800 or if you think there has been a violation of your privacy rights, you may submit a written complaint to the Department of Health and Human Services. We will not retaliate against you for filing a complaint.
This Notice is effective as of April 1, 2009.