NOTICE OF PRIVACY PRACTICES
Effective: April 14, 2003
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.
Northern Virginia Pulmonary And Critical Care Associates, P.C. (“NVPCCA”) uses and discloses health information about you for treatment, to obtain payment for treatment, for administrative purposes, and to evaluate the quality of care that you receive. Your health information is contained in a medical record that is the physical property of NVPCCA.
How NVPCCA May Use and Disclose Your Health Information
For Treatment. NVPCCA may use or disclose your health information to provide you with medical treatment or services. For example, a health care provider, such as a physician, nurse, or other person providing health services to you, will record information in your record that is related to your treatment. This information is necessary for health care providers to determine what treatment you should receive. Health care providers will also record actions taken by them in the course of your treatment and note how you respond to the actions. NVPCCA may also disclose your health information to or share your health information with other healthcare providers to coordinate your care. This might include, but is not limited to, pharmacies, other physicians and hospitals.
For Payment. NVPCCA may use or disclose your health information to others for purposes of receiving payment for treatment and services that you receive. For example, a bill may be sent to you or a third-party payor, such as an insurance company or health plan. The information on the bill may contain information that identifies you, your diagnosis, and treatment or supplies used in the course of treatment.
For Health Care Operations. NVPCCA may use or disclose health information about you for operational purposes. For example, your health information may be disclosed to members of our medical staff, risk or quality improvement personnel and others to:
- evaluate the performance of our staff;
- assess the quality of care and outcomes in your cases and similar cases;
- learn how to improve our facilities and services; and
- determine how to continually improve the quality and effectiveness of the health care we provide.
Appointments and Information. NVPCCA may use or disclose your health information to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.
Required by Law. NVPCCA may use or disclose information about you as required by law. For example, NVPCCA may disclose information for the following purposes:
- For judicial and administrative proceedings pursuant to legal authority;
- To report information related to victims of abuse, neglect or domestic violence; and to assist law enforcement officials in their law enforcement duties.
Public Health. Your health information may be disclosed for public health activities such as assisting public health authorities or other legal authorities to prevent or control disease, injury, or disability, or for other health oversight activities.
Decedents. Health information may be disclosed to funeral directors or coroners to enable them to carry out their lawful duties.
Organ/Tissue Donation. Your health information may be used or disclosed for cadaveric organ, eye or tissue donation purposes.
Research. NVPCCA may use or disclose your health information for research purposes when an institutional review board or privacy board that has reviewed the research proposal and established protocols to ensure the privacy of your health information has approved the research.
Health and Safety. Your health information may be used or disclosed to avert a serious threat to the health or safety of you or any other person pursuant to applicable law.
Government Functions. Your health information may be disclosed for specialized government functions such as protection of public officials or reporting to various branches of the armed services.
Workers’ Compensation. Your health information may be disclosed in order to comply with laws and regulations related to Workers’ Compensation.
Other Uses. Other uses or disclosures will be made only with your written authorization and you may revoke the authorization except to the extent NVPCCA has taken action in reliance on such.
Your Health Information Rights
You have the right to:
- request a restriction on certain uses and disclosures or your information as provided by 45 CFR 164.522; however, NVPCCA is not required to agree to a requested restriction;
- obtain a paper copy of this Notice of Privacy Practices upon request;
- inspect and obtain a copy of your health record as provided for in 45 CFR 164.524;
- amend your health record as provided in 45 CFR 164.526;
- request communications of your health information by alternative means or at alternative locations;
- revoke your authorization to use or disclose health information except to the extent that action has already been taken; and
- receive an accounting of disclosures made of your health information as provided by 45 CFR 164.528.
You may complain to NVPCCA and to the Department of Health and Human Services if you believe your privacy rights have been violated. You will not be retaliated against for filing a complaint.
Obligations of NVPCCA
NVPCCA is required to:
- maintain the privacy of protected health information;
- provide you with this Notice of its legal duties and privacy practices with respect to your health information;
- abide by the terms of this Notice;
- notify you if we are unable to agree to a requested restriction on how your information is used or disclosed;
- accommodate reasonable requests you may make to communicate health information by alternative means or at alternative locations; and
- obtain your written authorization to use or disclose your health information for reasons other than those listed above and permitted under law.
NVPCCA reserves the right to change its privacy practices, to revise the terms of its Notice of Privacy Practices and to make the new provisions effective for all Protected Health Information it maintains including Protected Health Information it created or received prior to issuing a revised Notice of Privacy Practices. NVPCCA will promptly revise and re-distribute its Notice whenever there is a material change to the uses and disclosures, the rights of individuals, the legal duties of NVPCCA or other privacy practices stated in the Notice. Revised Notices will be made available to you by posting the revised Notice in a prominent location within our office and providing you with a copy of the revised Notice upon request.
If you have any questions or complaints or wish to submit any special requests, please contact:
Northern Virginia Pulmonary And Critical Care Associates, P.C.
3289 Woodburn Road
Annandale, Virginia 22003