HIPAA 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.
This is your Health Information Privacy Notice from Krislan of New England, LLC d/b/a Krislan Ultrasonix. When we say "we," "our" or "us" this refers to Krislan Ultrasonix. This notice is effective April 14, 2003, as amended.
This notice provides you with information about the way in which we protect your medical information or Protected Health Information (PHI) that we have about you. PHI includes individually identifiable information which relates to your past, present or future health, treatment or payment for health care services. This notice explains your rights with respect to PHI.
The Health Insurance Portability and Accountability Act (HIPAA) requires us to:
- keep PHI about you private;
- provide you this notice that explains our legal duties and privacy notices with respect to your PHI;
- and follow the terms of the notice that are currently in effect.
HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION WITHOUT YOUR AUTHORIZATION
The following categories describe different ways that we may use and disclose your PHI without your authorization. Not every use or disclosure will be listed.
For Treatment. We may use your PHI to provide you with medical treatment or services. We may disclose PHI about you to doctors, nurses and other personnel who are involved in your care. We may also disclose medical information about you to people outside of our organization who may be involved in your continuing care.
For Payment. We may use and disclose PHI about you to administer and process payment under your insurance coverage, determine eligibility for coverage, claims or billing information, or to another health care provider for its payment purposes.
For Health Care Operations. We may use and disclose your PHI to make sure you receive quality care. For example, we may use your PHI to review our treatment and services and to evaluate the performance of our staff in caring for you.
Appointment Reminders. We may contact you to remind you that you have an appointment with us.
Other Examples of Situations in Which We May Use and Disclose Your PHI Without Your Authorization. We may use and disclose your PHI to enhance the delivery of care, protect your safety, safeguard public health, ensure that we comply with governmental and accreditation standards and when otherwise required by law. For example, we may disclose your PHI to:
- health care oversight agencies for auditing or licensure;
- government agencies if we suspect abuse or neglect;
- appropriate individuals when we believe it is necessary to avoid a serious threat to health or safety or to prevent serious harm to an individual;
- law enforcement when required or allowed by law;
- workers' compensation claims;
- courts when ordered or by a lawful subpoena;
- disaster relief efforts; and
- the U.S. Food and Drug Administration.
HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION AFTER YOU HAVE HAD AN OPPORTUNITY TO OBJECT
Not every use and disclosure is described, but the following is one example when we must provide you with an opportunity to object to a particular use or disclosure.
Disclosure to Family and Friends. Unless you object, we may provide relevant health information to a family member, friend or other person you indicate is involved in your care and treatment.
USES AND DISCLOSURES THAT REQUIRE YOUR AUTHORIZATION
Except for the uses and disclosures described in the notice and as permitted by law, all other uses and disclosures of your PHI will be made with your written permission. If you provide us with written authorization, you may revoke that authorization at any time unless the disclosure is required to obtain payment for services already provided or we have otherwise relied on the authorization or the law prohibits revocation. Also, in some situations, the law may provide special protection for certain kinds of health information, such as drug and alcohol treatment records and mental health records. When required by law, we will contact you to obtain written authorization to use or disclose that information.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
Right to Inspect and Copy. You have the right to inspect and copy PHI that may be used to make decisions about your care. You must submit your request in writing. If you request a copy of the information, we may charge a fee for the cost of copying, mailing or other supplies associated with your request. We may deny your request to inspect and copy records in certain, very limited circumstances. If you are denied access to your PHI, you may request that the denial be reviewed.
Right to Amend. If you feel that your PHI is incorrect or incomplete, you may ask to amend the information. Your request must be in writing and you must explain why the amendment is needed. However, we may deny your request.
Right to an Accounting of Disclosures. You have the right to request an "accounting of disclosures" of your PHI if any such disclosure was made for any purpose other than for treatment, payment or healthcare operations, or in response to an authorization signed by you. To request this list of accounting disclosures, you must submit your request in writing. Your request must state a time period, which may not be longer than six (6) years and may not include dates before April 14, 2003. We may charge you for the costs of providing the list. 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.
Right to Request Restrictions. You may request restrictions on certain uses and disclosures of your PHI. You have the right to request a limit on the PHI we disclose about you to someone who is involved in your care or the payment for your care, such as a family member or friend. We are not required to agree with your request. To request restrictions, please contact us. In your request, you must detail (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.
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 may request that we only contact you at work or by mail.
Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. To request a copy, call Krislan Ultrasonix at 603-769-3134.
If you believe your privacy rights have been violated, you may file a complaint with us at the address listed below. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services.
Krislan of New England, LLC d/b/a Krislan Ultrasonix