MID-ATLANTIC NEPHROLOGY ASSOCIATES,
PA
NOTICE OF PRIVACY PRACTICES
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.
Effective
Date: April 14, 2003
If
you have questions about this Notice, please contact our Privacy
Officer:
Attn:
Privacy Officer
Mid-Atlantic Nephrology Associates, P.A.
1589 Sulphur Spring Road, Suite 109
Baltimore, MD 21227
(410) 536-5400
Compliance Hotline (410) 536-4637
1. OUR PLEDGE REGARDING MEDICAL INFORMATION
We
understand that medical information about you and your health
is personal, and are committed to protecting your medical information.
We create a record of the care and services you receive to provide
you with quality care and to comply with certain legal requirements.
This Notice applies to all of the records of your care generated
or received by us.
We
are required by law to:
Make sure that medical information that identifies you is kept
private, and will be used or disclosed only as described by this
Notice or applicable law;
Make this Notice available to you; and
Follow the terms of the Notice that is currently in effect.
2. CHANGES TO THIS NOTICE
We
reserve the right to change this Notice. We reserve the right
to make the revised or changed Notice effective for medical information
we already have about you as well as any information we receive
in the future. We will post a copy of the current Notice in our
offices and on our website: www.manapa.com.
3. HOW WE MAY USE AND DISCLOSE
MEDICAL INFORMATION ABOUT YOU
The
following categories describe different ways that we use and disclose
your medical information. For each category of uses or disclosures,
we will give some examples. Not every use or disclosure in a category
will be listed.
a. For Treatment. We will use medical
information about you to provide you with medical treatment or
services. We may disclose medical information about you to doctors,
nurses, technicians, medical students, or other office personnel
who are involved in taking care of you. For example, we would
disclose your health information, as necessary, to a home health
agency that provides care to you. We also may disclose medical
information about you to a physician to whom you have been referred
to ensure that the physician has the necessary information to
diagnose or treat you.
b.
For Payment. We will use and disclose medical information
about you so that the treatment and services we provide may be
billed to and payment may be collected from you, an insurance
company, a governmental entity such as Medicare or Medicaid, or
a third party. For example, we may need to give your health plan
information about treatment we provide so your health plan will
pay us or reimburse you for the treatment. We may also 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 or hospital admission. We may also have to send your
information to more than one health plan in circumstances where
it is not clear which health plan has the responsibility to pay
for your care.
c.
For Healthcare Operations. We will use and disclose medical
information about you for our operations. These uses and disclosures
are necessary to run our office and make sure that all of our
patients receive quality care. For example, we may use medical
information to review our treatment and services and to evaluate
the performance of our staff in caring for you. We may also combine
medical information about many patients to decide what additional
services we should offer, what services are not needed, and whether
certain new treatments are effective. We may also disclose information
to doctors, nurses, technicians, medical students, and other office
personnel for review and learning purposes. In addition, we may
use a sign-in sheet at the registration desk where you will be
asked to sign your name and indicate your physician. We may also
call you by name in the waiting room when your physician is ready
to see you.
d.
Treatment Alternatives. We may/will use and disclose your
medical information to tell you about or recommend possible treatment
options or alternatives that may be of interest to you.
e.
Health-Related Benefits and Services. We may/will use and
disclose your medical information to tell you about health-related
benefits or services that may be of interest to you.
f.
Reminders. We may/will use and disclose medical information
about you to contact you in an effort to provide appointment reminders
for medical care.
g.
Research. Under certain circumstances, we will use and
disclose medical information about you for research purposes.
For example, your clinical lab values may be used for clinical
research. Research projects may be conducted with de-identified
patient information, with your written authorization, or with
the approval of a Privacy Board or Institutional Review Board.
De-identified patient information has numerous items removed (i.e.,
your name, address, phone number, etc.) so that the information
may not be used to identify you.
h.
Business Associates. We contract with business associates
to provide some services. Examples may include medical billing
and transcription services. When these services are contracted,
we may/will disclose your health information to our business associate
so that they may perform the job we have asked them to do. To
protect your health information however, we require the business
associate to appropriately safeguard your information.
i.
As Required By Law. We will disclose medical information
about you when required to do so by federal, state, or local law.
j.
To Avert a Serious Threat to Health or Safety. We will
use and disclose medical information about you when necessary
to prevent a serious threat to your health and safety or the health
and safety of the public or another person.
k.
Individuals Involved in Your Care or Payment for Your Care.
We may release medical information about you to a friend or family
member who is involved in your medical care. We may also give
information to someone who helps pay for your care. Except
in emergency situations, you may object to the uses and disclosures
described in this Section k, either in general or to any specific
person or persons to whom your medical information might otherwise
be disclosed.
l.
Special Situations. We will use and disclose medical information
about you:
To facilitate organ and tissue donation.
For specialized governmental functions, including the military
and veterans, national security, criminal corrections and public
benefit purposes.
For Workers’ Compensation or similar programs, as permitted
by law.
For public health activities.
To notify the appropriate government authority if we believe a
patient has been the victim of abuse, neglect, or domestic violence.
For health oversight activities including, for example, audits,
investigations, inspections, and licensure.
For lawsuits and disputes, we will disclose medical information
about you in response to a valid court or administrative order
or in the course of defending ourselves.
For law enforcement purposes when asked to do so by a law enforcement
official.
To coroners, medical examiners, and funeral directors as necessary
to assist them to carry out their duties.
To correctional institutions or law enforcement officials with
respect to inmates.
m.
Written Authorization. Except as described above, we will
disclose your medical information only with your prior written
authorization. You may revoke that authorization, in writing,
at any time, unless we have taken action relying on your prior
authorization or if you signed the authorization as a condition
of obtaining insurance coverage.
4.
YOUR RIGHTS REGARDING MEDICAL
INFORMATION ABOUT YOU
You
have the following rights regarding medical information we maintain
about you:
a.
Right to Inspect and Copy. You have the right to inspect
and copy medical information that may be used to make decisions
about your care. Usually, this includes medical and billing records,
but does not include psychotherapy notes and other mental health
records under certain circumstances.
To
inspect and copy medical information that may be used to make
decisions about you, you must submit your request in writing to
our Privacy Officer. If you request a copy of the information,
we may charge a fee for the costs of copying, mailing, or other
supplies associated with your request.
We
may deny your request to inspect and copy medical information
in certain very limited circumstances, including requests by an
inmate at a correctional institution, requests for information
we obtained from someone else subject to certain confidentiality
agreements, and some requests concerning ongoing research projects.
If you are denied access to medical information for any other
reason, you may request that the denial be reviewed. Another licensed
healthcare professional chosen by us will review your request
and the denial. The person conducting the review will not be the
person who denied your request. We will comply with the outcome
of the review.
b.
Request to Amend. If you feel that medical information
we have about you is incorrect or incomplete, you may ask us to
amend the information. To request an amendment, please submit
a written request to our Privacy Officer with a reason that supports
your request.
We
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,
we may deny your request if you ask us to amend information that:
Was not created by us, unless the person or entity that created
the information is no longer available to make the amendment;
Is not part of the medical information kept by us;
Is not part of the information which you would be permitted to
inspect and copy; or
Is accurate and complete.
If
we deny your request, you may submit a written statement disagreeing
with the denial. We will keep your statement on file and distribute
it with all future disclosures of the information to which it
relates.
c.
Right to an Accounting of Disclosures. You have the right
to request an “accounting of disclosures.” This is
a list of the disclosures of medical information about you, with
exceptions. We do not need to account for disclosures made: (i)
to you; (ii) pursuant to your written authorization; (iii) for
the purpose of carrying out treatment, payment or operations;
(iv) to persons involved in your care, or to notify your family
or friends about your whereabouts; (v) that are incidental to
another permissible use or disclosure; (vi) for national security
or intelligence purposes; (vii who had you in custody at the time
of the disclosure; (viii) as part of a limited data set; (ix)
to a health oversight agency or law enforcement official if they
so request. The accounting will include the date of each disclosure,
the name of the entity or person to whom the disclosure was made
and that person’s address (if known), and a brief description
of the information disclosed together with the purpose of the
disclosure.
To
request this list or accounting of disclosures, you must submit
your request in writing to our Privacy Officer. Your request must
state a time period that may not be longer than six years and
may not include dates before April 14, 2003. Your request should
indicate in what form you want the list (for example: on paper,
electronically). The first list you request within a 12-month
period will be free. For additional lists, we may charge you.
We will notify you of the cost involved, and you may choose to
withdraw or modify your request at that time before any costs
are incurred.
d.
Right to Request Restrictions. You have the right to request
a restriction or limitation on the medical information we use
or disclose about you for treatment, payment or healthcare operations.
You also have the right to request a limit on the medical information
we disclose about you to someone who is involved in your care
or the payment for your care, like a family member or friend.
We
are not required to agree to your request. If we do
agree, we will comply with your request unless the information
is needed to provide you emergency treatment. To request restrictions,
you must make your request in writing to our Privacy Officer.
In your request, you must tell us (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.
e.
Right to Confidential Communications. You have the right
to request to receive communications from us on a confidential
basis by using alternative means for receipt of information or
by receiving the information at alternative locations. All reasonable
requests will be granted. Contact our Privacy Officer if you require
such confidential communications.
f. Right to a Paper Copy of This Notice.
You have the right to a paper copy of this notice by requesting
a paper copy from our Privacy Officer in writing.
5.
COMPLAINTS
If
you believe your privacy rights have been violated, you may file
a complaint with us or with the Secretary of the Department of
Health and Human Services. To file a complaint with us, contact
our Privacy Officer:
Attn:
Privacy Officer
Mid-Atlantic
Nephrology Associates, P.A.
1589 Sulphur Spring Road, Suite 109
Baltimore, MD 21227
(410) 536-5400
Compliance Hotline (410) 536-4637
All complaints must be submitted in writing. You
will not be penalized for filing a complaint.
