Binghamton Gynecology and Fertility & The Endometriosis Center would like to assure you that we take the confidentiality of your medical records very seriously. Please review the following notice about the “HIPAA” (Health Insurance Portability and Accountability Act) guidelines.
Binghamton Gynecology - Notice of Privacy Practice
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
EFFECTIVE APRIL 14, 2003
At Binghamton Gynecology we take the confidentiality of your medical records very seriously. The following privacy practices will detail the steps we take to protect and if necessary disclose your private health information. A federal regulation, known as the “HIPAA, Health Insurance Portability and Accountability Act of 1996, Privacy Rule”, requires that we provide detailed notice in writing of our privacy practices. The HIPAA Privacy Rule requires us to address many specific things in this notice. If you have any questions about this notice, please contact our Office Manager/Privacy Officer, Becky Bridges, at 607.797.7070, Binghamton Gynecology 200 Plaza Drive, Vestal NY 13850.
WHO WILL FOLLOW THIS NOTICE
This notice describes information about privacy practices followed by all our employees, physicians, practitioners, staff and other office personnel, at Binghamton Gynecology.
OUR COMMITMENT TO PROTECTING HEALTH INFORMATION ABOUT YOU
In this Notice, we describe the ways that we may use and disclose health information about our patients. The HIPAA Privacy Rule requires that we protect the privacy of health information that identifies a patient, or where there is a reasonable basis to believe the information can be used to identify a patient. This information is called “protected health information” or “PHI”. This notice describes your rights as our patient and our obligations regarding the use and disclosure of PHI. We are required by law to: Maintain the privacy of PHI about you; Give you this Notice of our legal duties with respect to your PHI; Comply with the terms of our Notice of Privacy Practices that is currently in effect. We reserve the right to make changes to this Notice and to make such changes effective for all PHI we may already have about you. If and when this Notice is changed, we will post a copy in our office in a prominent location. We will also provide you with a copy of the revised Notice upon your request made to our Privacy Officer.
YOUR HEALTH INFORMATION
This notice applies to the information and records we have about your health, health status, and the healthcare and services you receive at this office. We are required by law to give you this notice upon request. It will tell you about the ways in which we may use and disclose health information about you and describes your rights and our obligations regarding the use and disclosure of that information.
HOW WE MAY USE AND DISCLOSE PROTECTED HEALTH INFORMAITON WE HAVE ON FILE ABOUT YOU.
The following categories describe the different ways we may use and disclose PHI for treatment, payment, or healthcare operations. The examples included with each category.
FOR TREATMENT. We may use health information about you to provide you with medical treatment or services. We may disclose health information about you to doctors, nurses, technicians, office staff or other personnel who are involved in taking care of you and your health.
FOR PAYMENT. We may use and disclose health information about you so that the treatment and services at this office may be billed to you and payment may be collected from you, and insurance company or a third party.
FOR HEALTHCARE OPERATIONS. We may use and disclose health information about you in order to run the office and make sure that you and other patients receive quality care. This may include, but not limited to, appointment reminders, treatment alternatives and discussing health-related products and services that we discuss with you. Health Care Operations also include, but not limited to, doing things that allow us to improve the quality of care we provide and to reduce health care cost, teaching and evaluating office staff performance.
Health Care Operations also include contacting you for various reasons such as appointment reminders and verbal discussions regarding treatment alternatives or other health-related services. Please notify us if you do not wish to be contacted for appointment reminders, or if you do not wish to receive communications about treatment alternatives or health-related services. If you advise us in writing that you do not wish to receive such communication, we will not use or disclose your information for these purposes. You may revoke your Consent at anytime by giving us written notice. Your revocation will be effective when we receive it, but it will not apply to any uses and disclosures that occurred before that time.
SPECIAL SITUATIONS
We may use or disclose health information about you without your permission for the following purposes, subject to all applicable legal requirements and limitations;
TO AVERT A SERIOUS TREAT TO HEALTH OR SAFETY. We may use and disclose health information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
REQUIRED BY LAW. We will disclose information about you when required by federal, state or local law.
RESEARCH. We may use and disclose health information about you for research projects that are subject to a special approval process. We will ask you for your permission if the researcher will have access to your name or other demographic information.
ORGAN AND TISSUE DONATION. If you are an organ donor, we may release health information as necessary to facilitate such donations and transplantation.
MILITARY, VETERANS, NATIONAL SECURITY AND INTELLIGENCE. If you are a member of the armed forces we may be required by military command or other government authorities to release health information about you.
WORKERS’ COMPENSATION. We may release information about you for workers’ compensation or similar programs.
PUBLIC HEALTH RISKS. We may disclose information about you for public health reasons in order to prevent or control disease, injury or disability; or report births, deaths, suspected abuse or neglect, non-accidental physical injuries, reactions to medications or problems with products.
HEALTH OVERSIGHT ACTIVITIES. We may disclose information to a health oversight agency for audits, investigations, inspections, or licensing purpose.
LAWSUITS AND DISPUTES. If you are involved in a lawsuit or a dispute, we may disclose health information about you in response to a court or administrative order. We may also disclose health information about you in response to a subpoena.
CORONERS, MEDICAL EXAMINERS AND FUNERAL DIRECTORS. We may disclose information to the afore mentioned officials or their representatives.
INFORMATION NOT PERSONALLY IDENTIFIABLE. We may disclose information about you in a way that does not personally identify you or reveal who you are.
FAMILY AND FRIENDS. We may disclose health information about you to your family members (including spouses, parents, and friends) if we obtain your written agreement to do so or if we give you an opportunity to object to such a disclosure and you do not raise any objection. In situations where you are not capable of giving consent, we may, using our professional judgment, determine that a disclosure to your family member if in your best interest to allow another person to act on your behalf to pick up, for example, prescriptions, medical supplies etc.
OTHER USES AND DISCLOSURES OF HEALTH INFORMATION
We will not use or disclose your health information for any purpose other than those identified in the above section without your specific written AUTHORIZATION. We must obtain your authorization separate from any consent we may have obtained from you. If you give us authorization to use or disclose health information about you, you may revoke that authorization, in writing at any time. If you revoke your authorization we will no longer use or disclose information about you for the reasons covered by your written authorization, but we cannot take back any uses or disclosures already made with your permission. This includes, but not limited to, applications for medical/life insurance policies, transferring of records and disability.
If we have HIV or substance abuse information about you, we cannot release that information without a special signed, written authorization (different from the authorization and consent mentioned above) from you.
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU
Under Federal Law you have the following rights regarding health information we maintain about you.
RIGHT TO INSPECT AND COPY. You have the right to inspect and receive a copy of your health information that we use to make decisions about your care. You must submit a written request to our office in order to inspect and/or copy your health information. You will be charged a fee for the copying and mailing of these records. We may deny your request to inspect and/or copy in certain limited circumstances. If you are denied access you may ask that the denial be reviewed. The person conducting the review will not be the person who denied your request.
RIGHT TO AMEND. If you believe information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment as long as this office keeps the information. To request and amendment, complete and submit a Medical Record Amendment/Correction form to our designated privacy officer. 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: We did not create; Is not part of the health information that we keep; Is accurate and complete.
RIGHT TO ACCOUNTING OF DISCLOSURES. You have the right to request an “accounting of disclosures”. This is a list of the disclosures we made of medical information about you for purposes other that treatment, payment and health care operations. To obtain this list you must submit a request in writing to our privacy officer. It must state a time period and may not include dates prior to April 14, 2003. We may charge you for this list.
RIGHT TO REQUEST RESTRICTIONS. You have the right to request a restriction or limitation on the health information we use or disclose about you. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care like a family member or friend. We are not required to agree to your request. If we do agree to your request, we are required to comply with our agreement except in certain cases, including where the information is needed to treat you in the case of an emergency. To request restrictions, you must make your request in writing to our Privacy Officer. In your request, please include; The information you want to restrict; How you want to restrict the information; And to whom you want those restrictions to apply.
RIGHT TO REQUEST CONFIDENTIAL COMMUNICATIONS. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.
To request confidential communication, you may complete and submit the Request for Restriction on Use/Disclosure of Medical Information to our privacy officer. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
RIGHT TO A PAPER COPY OF THIS NOTICE. You have the right to a paper copy of this notice. To obtain such copy, contact our privacy officer.
CHANGES TO THIS NOTICE
We reserve the right to change this notice, and 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 summary of the current notice in the office with its effective date. You are entitled to a copy of the notice currently in effect.
QUESTIONS AND COMPLAINTS
If you have any questions about this Notice, please contact our Privacy Officer at 607.797.7070 or by mail at Binghamton Gynecology, 200 Plaza Drive, Vestal NY 13850
If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services. To file a complaint with our office, contact Becky Bridges, Office Manager/Privacy Officer.
You will not be penalized for filing a complaint.
This notice was published and first became effective on April 14, 2003
