Notice of Privacy
Practices for Protected Health Information
North Iowa Oral Surgery Associates, P.C.
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This notice describes how medical information about
you may be
used and disclosed and how you can
get access to this information.
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Please
review it carefully!
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With your consent, the practice is permitted by federal privacy
laws to make uses and disclosures
of your health information for purposes of treatment, payment, and
health care operations.
Protected health information is the information we create and obtain
in providing our services to
you. Such information may include documenting your symptoms, examination
and test results,
diagnoses, treatment, and applying for future care or treatment. It
also includes billing
documents for those services.
Example of uses of
your health information for treatment purposes:
A nurse obtains treatment information about you and records it in
a health record. During the
course of your treatment, the doctor determines a need to consult
with another specialist in the
area. The doctor will share the information with such specialist and
obtain input. An employee
may also call to remind you of an upcoming appointment and leave a
message on your answering
machine unless you notify the office that you object to such messages.
Additionally, a postcard
may be mailed to remind you of an upcoming appointment or the need
for you to make an
appointment.
Example of use of your health information
for payment purposes:
We submit a request for payment to your health insurance company.
The health insurance
company may request information from us regarding medical care given.
We will provide
information to them about you and the care given.
Example
of Use of Your Information for Health Care Operations:
We obtain services from our insurers or other business associates
such as quality assessment,
quality improvement, outcome evaluation, protocol and clinical guidelines
development, training
programs, credentialing, medical review, legal services, and insurance.
We will share
information about you with such insurers or other business associates
as necessary to obtain
these services.
Your Health Information Rights
The health record we maintain and billing records are the physical
property of the practice. The
information in it, however, belongs to you. You have a right to:
· Request a restriction on certain uses and disclosures of your
health information by delivering
the request in writing to our office. We are not required to grant
the request but we will
comply with any request granted;
· Request that you be allowed
to inspect and copy your health record and billing record--you
may exercise this right by delivering the request in writing to our
office;
· Appeal a denial of access to your protected health
information except in certain
circumstances;
· Request that your health care record be amended
to correct incomplete or incorrect
information by delivering a written request to our office;
· File a statement of disagreement if your amendment is denied, and
require that the request for
amendment and any denial be attached in all future disclosures of
your protected health
information;
· Obtain an accounting of disclosures of your
health information as required to be maintained
by law by delivering a written request to our office. An accounting
will not include internal
uses of information for treatment, payment, or operations, disclosures
made to you or made
at your request, or disclosures made to family members or friends
in the course of providing
care;
· Request that communication of your health information
be made by alternative means or at
an alternative location by delivering the request in writing to our
office; and,
· Revoke authorizations that you made previously
to use or disclose information except to the
extent information or action has already been taken by delivering
a written revocation to our
office.
If you want to exercise any of the above rights, please contact Office
Manager Korky
Kilborn, in person or in writing, during normal hours. She will provide
you with assistance on the steps to take to exercise your rights.
Our Responsibilities
The practice is required to:
· Maintain the privacy of your health information as required by law;
· Provide you with a notice of
our duties and privacy practices as to the information we collect
and maintain about you;
· Abide by the terms of this Notice;
· Notify you if we cannot accommodate a requested restriction or request;
and
· Accommodate your reasonable requests regarding
methods to communicate health
information with you.
We reserve the right to amend, change, or eliminate provisions in
our privacy practices and
access practices and to enact new provisions regarding the protected
health information we
maintain. If our information practices change, we will amend our Notice.
You are entitled to
receive a revised copy of the Notice by calling and requesting a copy
of our "Notice" or by
visiting our office and picking up a copy.
To
Request Information or File a Complaint
If you have questions, would like additional information, or want
to report a problem regarding
the handling of your information, you may contact Korky Kilborn at
641-424-1656 or
1010 4th St SW, Suite 340
Mason City, IA 50401.
Additionally, if you believe your privacy rights have been violated,
you may file a written
complaint at our office by delivering the written complaint to the
above address. You may also
file a complaint by mailing it or e-mailing it to the Secretary of
Health and Human Services
whose street address and phone number is The U.S. Department of Health
and Human Services
200 Independence Avenue, S.W. Washington, D.C. 20201 Telephone: 202-619-0257
Toll Free: 1-877-696-6775
We cannot, and will not, require you to waive the right to file a
complaint with the Secretary
of Health and Human Services (HHS) as a condition of receiving treatment
from the practice.
We cannot, and will not, retaliate against you for filing a complaint
with the Secretary.
Other Disclosures and Uses
Notification
Unless you object, we may use or disclose your protected health information
to notify, or assist in
notifying, a family member, personal representative, or other person
responsible for your care, about your location, and about your general
condition, or your death.
Communication with Family
Using our best judgment, we may disclose to a family member, other
relative, close personal friend, or any other person you identify,
health information relevant to that person's involvement in your care
or in payment for such care if you do not object or in an emergency.
Food and Drug Administration (FDA)
We may disclose to the FDA your protected health information relating
to adverse events with respect to products and product defects, or
post-marketing surveillance information to enable product recalls,
repairs, or replacements.
Workers Compensation
If you are seeking compensation through Workers Compensation, we may
disclose your protected health information to the extent necessary
to comply with laws relating to Workers Compensation.
Public Health
As required by law, we may disclose your protected health information
to public health or legal
authorities charged with preventing or controlling disease, injury,
or disability.
Abuse & Neglect
We may disclose your protected health information to public authorities
as allowed by law to report abuse
or neglect.
Correctional Institutions
If you are an inmate of a correctional institution, we may disclose
to the institution, or its agents, your protected health information
necessary for your health and the health and safety of other individuals.
Law Enforcement
We may disclose your protected health information for law enforcement
purposes as required by law, such as when required by a court order,
or in cases involving felony prosecutions, or to the extent an individual
is in the custody of law enforcement.
Health
Oversight
Federal law allows us to release your protected health information
to appropriate health oversight
agencies or for health oversight activities.
Judicial/Administrative
Proceedings
We may disclose your protected health information in the course of
any judicial or administrative
proceeding as allowed or required by law, with your consent, or as
directed by a proper court order.
Other Uses
Other uses and disclosures besides those identified in this Notice
will be made only as otherwise
authorized by law or with your written authorization and you may revoke
the authorization as previously
provided.
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