Provided by Integrated Medical Group (IMG) (http://www.intmedgroup.com/)
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. Our staff is committed to protecting your health information, which is a right you have and one detailed in the federal Health Insurance Portability and Accountability Act (HIPAA) of 1996. Listed on the back of this brochure are all the organizations and providers utilizing this Notice of Privacy Practices.
Effective: April 14, 2003
If you have any questions or requests, please contact our office at 937-431-3779 or 4172 Indian Ripple Road Suite A, Beavercreek, OH 45440.
TABLE OF CONTENTS
1) We must protect your health information.
2) We may use and disclose your protected health information (PHI) as follows:
a. We may use and disclose your PHI to provide health care treatment to you.
b. We may use and disclose your PHI to get payment for services.
c. We may use and disclose your PHI for health care operations.
d. We may use and disclose PHI in other situations without your permission.
e. You can object to certain uses and disclosures.
f. We may contact you to remind you of an appointment.
g. We may contact you with information about treatment, services, products or health care providers.
3) You have several rights regarding PHI.
a. You have the right to ask that we restrict the uses and disclosures of your PHI.
b. You have the right to ask for different ways to communicate with you.
c. You have the right to see and copy your PHI.
d. You have the right to ask for changes to your PHI.
e. You have the right to a list of certain people or organizations who have obtained your PHI from us.
f. You have a right to a copy of this Notice.
4) You may have additional rights under other laws.
5) Effective date of this Notice
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1) WE MUST PROTECT HEALTH INFORMATION ABOUT YOU
We must protect the privacy of your protected health information or "PHI" for short. This Notice explains the ways that we will use your PHI. It also explains the ways that we will share, or disclose, PHI about you. In addition, we may make other uses and disclosures that occur as a result of the permitted uses and disclosures described in this Notice.
We must follow this Notice. We may change this Notice. We may make the changes apply to all PHI that we already have if we:
- Post the new notice in our offices;
- Make copies of the new notice available if someone asks for it (at our office); and
- Post the new notice on our website: www.intmedgroup.com
2) WE MAY USE AND DISCLOSE YOUR PHI
a. We may use and disclose your PHI to provide health care treatment to you:
We may use and disclose your PHI to provide, coordinate or manage your health care and related services. This may include sharing information with other health care providers about your treatment and coordinating and managing your health care with others. For example, we may use and disclose your PHI when you need medicine, lab work, an x-ray, or other health care services. We also may use and disclose your PHI when we send you to another health care provider.
b. We may use and disclose your PHI to obtain payment for services:
Generally, we may use and give your PHI to others to bill and collect payment for services. Before we provide scheduled services, we may share information with your health plan(s) so that we can ask whether your plan or policy will pay for the service. We may also share PHI with:
- Billing departments;
- Collection departments or agencies;
- Insurance companies, health plans and their agents who provide coverage;
- Hospital departments that review your care to see if the care and the costs were appropriate
- Government agencies to try to get you qualified for benefits;
- Consumer reporting agencies (such as credit bureaus); and
- Other departments, agencies and/or companies to obtain payment.
c. We may use and disclose your PHI for health care operations:
We may use and disclose PHI to perform business activities, which we call "health care operations." These "health care operations" allow us to improve the quality of care we provide and reduce health care costs. Examples of the way we may use or disclose your PHI for "health care operations" include:
- Reviewing and improving the quality, efficiency and cost of care that we provide to you and others. For example, we may use your PHI to develop ways to help our health care providers and staff in deciding what medical treatment should be given to others.
- Improving health care and lowering costs for groups of people who have similar health problems and to help manage and coordinate the care for these groups of people. We may use PHI to identify groups of people with similar health problems to give them information about treatment choices, classes, or new procedures.
- Reviewing and evaluating the skills, qualifications, and performance of health care providers taking care of you.
- Training students, health care providers or other professionals (for example, billing clerks or assistants) to help them practice or improve their skills.
- Working with outside organizations that assess the quality of the care that we and others provide. These organizations might include government agencies or accrediting bodies such as the Joint Commission on Accreditation of Healthcare Organizations.
- Working with outside organizations, such as the National Cancer Data Base for quality assurance and data aggregation service.
- Working with outside organizations that evaluate, certify or license health care providers, staff or facilities in a given field or specialty. For example, we may use or disclose PHI so that one of our nurses may become certified as an expert in a certain field of nursing, such as pediatric nursing.
- Helping people who review our activities. For example, PHI may be seen by doctors reviewing the services provided to you, and by accountants, lawyers, and others who help us in following the law.
- Planning for our future and raising money for our organization.
- Managing our business and performing general administrative activities related to our organization and the services we provide.
- Solving problems or complaints within our organization.
- Reviewing activities and using or disclosing PHI in the event that we sell our business or property, or give control of our business or property to someone else.
- Complying with this Notice and with the law.
d. We may use and disclose PHI in other situations without your permission:
We may use and/or disclose PHI about you without your permission. Those situations include when the use and/or disclosure:
- is required by law.
- is needed for public health activities.
- is about the abuse or neglect of a child or disabled adult.
- is for health oversight activities.
- is for legal proceedings.
- is for police or other law enforcement purposes.
- relates to a person who has died.
- relates to organ, eye or tissue donation.
- relates to medical research. In certain situations, we may share your PHI for medical research.
- is to prevent a serious threat to health or safety.
- relates to special government purposes.
- relates to someone who is in jail, prison or police custody.
e. You can object to certain uses and disclosures:
Unless you tell us not to, we may use or share your PHI as follows:
- If you are a patient in one of our hospitals, we may share your name, your room number, and your condition in our patient directory with church or religious leaders and with people who ask for you by name. We also may share information about any church or other religious memberships with religious leaders.
- We may share your PHI with a family member, friend or other person identified by you. We may share information directly related to that person's involvement in your care or payment for your care. We also may share PHI needed to let these people know where you are, your general condition or your death.
- We may share your PHI with a public or private agency (for example, American Red Cross) for disaster relief purposes. Even if you ask us not to, we may share your PHI, if we need to for an emergency.
If you do not want us to use or disclose your PHI in the above situations, please tell the person who registered you or call the Institute for Integrated Health Solutions (dba: Integrated Medical Group) office. If you ask not to be included in the patient directory, you will not receive any cards or flowers that are sent to the facility for you. Also, we will not tell callers or visitors that you are here.
f. We may contact you to remind you of an appointment:
We may use and/or disclose PHI to contact you to remind you about an appointment you have for treatment or medical care.
g. We may contact you with information about treatment, services, products or health care providers:
We may use and/or disclose PHI to manage or coordinate your health care. This may include telling you about treatments, services, products and/or other health care providers. We may also use and/or disclose PHI to give you gifts of a small value.
** ANY OTHER USE OR DISCLOSURE OF PHI ABOUT YOU REQUIRES YOUR WRITTEN PERMISSION**
In any situations other than those listed above, we will ask for your written permission before we use or disclose your PHI. If you sign a written authorization allowing us to disclose PHI about you in a specific situation, you can later cancel your authorization in writing. We will not disclose PHI about you after we receive your cancellation, except for disclosures that were made before we got your cancellation.
3) YOU HAVE SEVERAL RIGHTS REGARDING YOUR PHI
a. You have the right to ask us to restrict the uses and disclosures of your PHI:
You have the right to ask that we restrict the use and disclosure of your PHI. You must ask us in writing. We do not have to agree to your request. Even if we agree to your request, in certain situations your restrictions may not be followed. You may ask for a restriction by filling out a form that you can get from the registration desk or your caregiver. We will write to you to tell you if your request was granted.
b. You have the right to ask for different ways to communicate with you:
You have the right to ask how and where we contact you about PHI. For example, you may ask that we contact you at your work address or phone number instead of contacting you at home. If your request is reasonable, then we must do what you ask, if we can. In order for us to do this, you must give us information about how payment, if any, will be handled. You also must give us another address or other way to reach you.
c. You have the right to see and copy your PHI:
You have the right to see and get a copy of your PHI. You must ask us in writing by filling out a form that you may get from our Department of Health Information Services or the registration desk. We may charge you a fee to do this. There are some situations where we do not have to do what you ask.
d. You have the right to ask for changes to your PHI:
You have the right to ask us to make changes to your PHI. You must ask us in writing by filling out a form that you can get from the Department of Health Information Systems or the registration desk. You must tell us why you want us to make the change. We do not have to make the change.
e. You have the right to a list of certain people or organizations who have gotten your PHI from us:
If you ask in writing, you can get a list of certain of our disclosures of your PHI. You may ask for disclosures made in the last six (6) years. We cannot give you a list of any disclosures made before April 14, 2003. We must give you a list of only certain disclosures. If you ask for a list of disclosures more than once in 12 months, we can charge you a reasonable fee. You may ask for a listing of disclosures by filling out a form that you can get from our Department of Health Information Services or the registration desk.
f. You have the right to a copy of this Notice:
You can get a copy of this Notice anytime by asking the Institute for Integrated Health Solutions office.
4. YOU MAY HAVE ADDITIONAL RIGHTS UNDER OTHER LAWS
Some Ohio laws give greater protection of privacy than federal laws. We must follow both federal and state law. A copy of Ohio HIPPA privacy notice can be obtained at www.publichealth.columbus.gov/Asset/iu_files/HIPAA_Privacy_Notice.pdf
5. EFFECTIVE DATE OF THIS NOTICE
This Notice of Privacy Practices is effective on April 14, 2003. This Notice also applies to all persons providing health care service at Institute for Integrated Health Solutions (dba: Integrated Medical Group), LLC even if they are not our employees or our agents. These persons provide care along with IMG as part of an “organized health care arrangement” under the laws that protect the privacy of your healthcare information. All of these healthcare providers are referred to as "we" in this Notice. For more information, please contact our office at 937-431-3779 or 4172 Indian Ripple Road Suite A, Beavercreek, OH 45440