NOTICE OF PRIVACY POLICIES AND PRACTICES

 

FOR

Telemedicine For Us

 

DEAR PATIENT:

 

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.

 

INTRODUCTION

 

At Telemedicine For Us, we are committed to treating and using protected health information about you responsibly.  This Notice describes the personal information we collect, and how and when we use or disclose that information.  It also describes your rights as they relate to your protected health information.  This Notice is effective September 23, 2013 and applies to all protected health information as defined by federal regulations.

 

UNDERSTANDING YOUR MEDICAL RECORD / HEALTH INFORMATION

 

Each time you visit Telemedicine For Us a record of your visit is made.  Typically, this record contains information about your visit including your examination, diagnosis, test results, treatment as well as other pertinent healthcare data.  This information, often referred to as your health or medical record, serves as a:

• Basis for planning your care and treatment
• Means of communication with other health professionals involved in your care
• Legal document outlining and describing the care you received
• A tool that you, or another payer (your insurance company) will use to verify that services billed were actually provided
• An education tool for medical health providers
• A source for medical research
• Basis for public health officials who might use this information to assess and/or improve state as well as national healthcare standards
• A source of data for planning and / or marketing
• A tool that we can reference to ensure the highest quality of care and patient satisfaction

 

Understanding what is in your record and how your health information is used helps you to ensure it’s accuracy, determine what entities have access to your health information, and make an informed decision when authorizing the disclosure of this information to other individuals.

 

YOUR RIGHTS

 

You have certain rights under the federal privacy standards. These include:

• The right to request restrictions on the use and disclosure of your protected health information
• The right to receive confidential communications concerning your medical condition and treatment
• The right to inspect and copy your protected health information
• The right to amend or submit corrections to your protected health information
• The right to receive an accounting of how and to whom your protected health information has been disclosed
• The right to receive a printed copy of this notice

 

OUR RESPONSIBILITIES

 

Telemedicine For Us is required to:

• Maintain the privacy of your health information
• Provide you with this Notice as to our legal duties and privacy practices with respect to information we collect and maintain about you
• Abide by the terms of this notice
• Notify you if we are unable to agree to a requested restriction
• Accommodate reasonable requests you may have regarding communication of health information via alternative means and/ locations

 

As permitted by law, we reserve the right to amend or modify our privacy policies and practices. These changes in our policies and practices may be required by changes in federal and state laws and regulations. Whatever the reason for these revisions, we will provide you with a revised notice on your next office visit. The revised policies and practices will be applied to all protected health information that we maintain.

We will not use or disclose your health information without your authorization, except as described in this notice.  We will also discontinue using or disclosing your health information after we have received a written revocation of the authorization according procedures included in the authorization.

 

 

HOW WE MAY USE AND/OR DISCLOSE YOUR HEALTH INFORMATION

 

We will use your health information for treatment.  Your health information may be used by staff members or disclosed to other health care professionals for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. For example: results of laboratory tests and procedures will be available in your medical record to all health professionals who may provide treatment or who may be consulted by staff members.

 

We will use your information for payment.  Your health plan may request and receive information on dates of service, the services provided, and the medical condition being treated in order to pay for the service rendered to you.

 

We will use your information for regular health operations.  Your health information may be used as necessary to support the day-to-day activities and management of Telemedicine For Us For example: information on the services you received may be used to support budgeting and financial reporting, and activities to evaluate and promote quality.

 

Business Associates.  In some instances, we have contracted separate entities to provide services for us.  These “in order to accomplish the tasks that we as associates” require your health information k them to provide.  Some examples of these “business associates” might be a billing service, collection agency, answering services and computer software/hardware provider.

 

Additional Use and/or Disclosures Include:

• Research / Teaching / Training
• Healthcare Oversights
• Public health reporting
• For Health Oversight Activities
• Appointment reminders, Treatment, Alternatives and Health-related Benefits and Services.
• For Organ and Tissue Donation
• For Data Breach Notification Purposes
• To Coroners, Medical Examiners, and Funeral Directors
• For Military and Veterans
• For Workers’ Compensation
• As Required by Law
• Law enforcement
• For Abuse, Neglect, or Domestic Violence
• For Lawsuits and Disputes
• For Inmates or Individuals in Custody
• To Avert a Serious Threat to Health or Safety
  
  

 Uses and Disclosures Where You Have an Opportunity to Object and Opt Out:

 

For Individuals Involved in Your Care or Payment for Your Care. .  Due to the nature of our field, we will use our best judgment when disclosing member, other relatives, or any other person that is involved in your care or that you have authorized to receive this information.  Please inform the practice when you do not wish a family member or other individual to have authorization to receive your information.

• For Disaster Relief
• For Fundraising Activities

 

Written Authorization is required for the Following Uses and Disclosure:

• Uses and disclosures of Protected Health Information for marketing purposes: and
• Disclosures that constitute a sale of your Protected Health Information.

 

FOR MORE INFORMATION OR TO REPORT A PROBLEM

 

If you have complaints, questions or would like additional information regarding this notice or the privacy practices of S.W. Atlanta Nephrology PC please contact:

 

PRIVACY OFFICER

Telemedicine For Us

www.telemedicineforus.org

1-800-820-0918

 

If you believe that your privacy rights have been violated, please contact the aforementioned practice Privacy Official, or, you may file a complaint with the Office for Civil Rights, U.S. Department of Health and Human Services.  There will be no retaliation for filing a complaint with either the practice’s Privacy Official or with the Office for Civil Rights.  The address for the Office for Civil Rights is listed below:

 

OFFICE FOR CIVIL RIGHTS

U.S. Department of Health and Human Services

200 Independence Avenue, S.W.

Room 509F, HHH Building

Washington, D.C., 20201

 

Or call (202) 619-0257 (or (877) 696-6775

 

Or visit the OCR website, www.hhs.gov/ocr/hipaa/ for more information on the options listed above, or for electronic filing options.