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THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
This Facility is required by law to provide you with this Notice of Privacy Practices (hereafter: “Notice”) so that you will understand how we may use or share your information from your Designated Record Set. The Designated Record Set includes financial and health information referred to in this Notice as “Protected Health Information” (“PHI”) or simply “health information.” We are required to adhere to the terms outlined in this Notice, to maintain the privacy of your PHI, and to notify affected individuals of a breach of unsecured PHI. If you have any questions about this Notice, please contact our HIPAA Compliance Officer.
Each time you are admitted to our Facility, a record of your stay is made containing health and financial information. Typically, this record contains information about your condition, the treatment we provide, and payment for the treatment. We may use and/or disclose this information to:
Understanding what is in your record and how your health information is used helps you to:
The following categories describe the ways that we use and disclose health information. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall into one of the categories.
For Treatment:
We may use or disclose health information about you to provide you with medical treatment. We may disclose health information about you to Facility personnel who are involved in taking care of you at our Facility. Different departments of a Facility also may share health information about you in order to coordinate your care. We may also disclose health information about you to people outside the Facility who may be involved in your care after you leave the Facility. This may include family members or visiting nurses to provide care in your home.
For Payment:
We may use and disclose health information about you so that the treatment and services you receive at a Facility may be billed to you, an insurance company, or a third party. For example, in order to be paid, we may need to share information with your health plan about services provided to you. 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.
For Health Care Operations:
We may use and disclose health information about you for our day-to-day health care operations. This is necessary to ensure that all residents receive quality care. For example, we may use health information for quality assessment and improvement activities and for developing and evaluating clinical protocols.
We may also combine health information about many residents to help determine what additional services we should offer, what services should be discontinued, and whether certain new treatments are effective. Health information about you may be used for business development and planning, cost management analyses, insurance claims management, risk management activities, and in developing and testing information systems and programs.
Business Associates:
There may be some services provided in our Facility through contracts with business associates. When these services are contracted, we may disclose your health information so that they can perform the job we’ve asked them to do and bill you or your third-party payer for services rendered. To protect your health information, we require the business associate to appropriately safeguard your information.
Treatment Alternatives:
We may use and disclose health information to tell you about possible treatment options or alternatives that may be of interest to you.
Health-Related Benefits and Services and Reminders:
We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.
Individuals Involved in Your Care or Payment for Your Care:
Unless you object, we may disclose health information about you to a friend or family member who is involved in your care. We may also give information to someone who helps pay for your care. In addition, we may disclose health information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location.
As Required By Law:
We will disclose health information about you when required to do so by federal, state, or local law.
To Avert a Serious Threat to Health or Safety:
We may use and disclose health information about you to prevent a serious threat to your health and safety or the health and safety of the public or another person. We would do this only to help prevent the threat.
Organ and Tissue Donation:
If you are an organ donor, we may disclose health information to organizations that handle organ procurement to facilitate donation and transplantation.
Military and Veterans:
If you are a member of the armed forces, we may disclose health information about you as required by military authorities. We may also disclose health information about foreign military personnel to the appropriate foreign military authority.
Research:
Under certain circumstances, we may use and disclose health information about you for research purposes. For example, a research project may involve comparing the health and recovery of all residents who received one medication to those who received another for the same condition. All research projects are subject to a special approval process.
Although your health record is the property of the Facility, the information belongs to you. You have the following rights regarding your health information:
Right to Inspect and Copy:
With some exceptions, you have the right to review and copy your health information. You must submit your request in writing to our HIPAA Compliance Officer. We may charge a fee for the costs of copying, mailing, or other supplies associated with your request.
Right to Amend:
If you feel that health information in your record is incorrect or incomplete, you may ask us to amend the information. You must submit your request in writing to our HIPAA Compliance Officer. In addition, you must provide a reason for your request.
Right to an Accounting of Disclosures:
You have the right to request an "accounting of disclosures." This is a list of certain disclosures we made of your health information, other than those made for purposes such as treatment, payment, or health care operations.
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 must submit your request in writing to our HIPAA Compliance Officer.
Right to Request Alternate Communications:
You have the right to request that we communicate with you about medical matters in a confidential manner or at a specific location.
Right to a Paper Copy of This Notice:
You have the right to a paper copy of this Notice of Privacy Practices even if you have agreed to receive the Notice electronically.
We reserve the right to change this Notice. We will post a copy of the current Notice in the Facility and on the website. The Notice will specify the effective date on the first page.
If you believe your privacy rights have been violated, you may file a complaint with the Facility or with the Secretary of the Department of Health and Human Services. To file a complaint with the Facility, contact our HIPAA Compliance Officer. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
Contact Us
If you wish to contact us regarding the terms in this Notice, please contact:
Name:
Lauren Buchheit, Business Manager
Phone Number:
(636)532-3311
Email:
Lauren@hilltowndental.com