Franklin Primary Care - Franklin Internal Medicine and Family Practice

FRANKLIN INTERNAL MEDICINE & FAMILY PRACTICE CENTER, PLLC

NOTICE OF HIPAA PRIVACY PRACTICES

As required by the Privacy Regulations Created as a Result of the Health Insurance Portability and Accountability Act of 1996.

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU (AS A PATIENT OF THIS PRACTICE) MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO YOUR INDIVIDUALLY PROTECTED HEALTH INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.

A. OUR COMMITMENT TO YOUR PRIVACY

Our practice is dedicated to maintaining the privacy of your protected health information. In conducting our business, we will create records regarding you and the confidentiality of health information that identifies you. We also are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your protected health information. By federal and state law, we must follow the terms of the notice of privacy practices that we have in effect at the time.

We realize that these laws are complicated, but we must provide you with the following important information:

How we may use and disclose your protected health information
Your privacy rights in your protected health information
Our obligations concerning the use and disclosure of your protected health information

The terms of this notice apply to all records containing your protected health information that are created or retained by our practice. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to t his notice will be effective for all of your records that our practice has created or maintained in the past, or for any of your records that we may create or maintain in the future. Our practice will post a copy of our current Notice in our office in a visible location at all times, and you may request a copy of our most current Notice at any time.

B. IF YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT OUR PRACTICE PRIVACY CONTACT:

Office Manager
100 Covey Dr., Ste 103
Franklin, TN. 37067
615-794-5354

C. WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION IN THE FOLLOWING WAYS

The following categories describe the different ways in which we may use and disclose your protected health information:

1. Treatment. We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your healthcare with another provider. For example, we would disclose your protected health information, as necessary to a home health agency that provides care to you. We will also disclose protected health information to other physicians who may be treating you. For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you Many of the people who work for our practice - including, but not limited to, our doctors, medical assistants, nurses and other office personnel - may use or disclose your protected health information with your spouse, children, parents or other family members in order to treat you or assist in your care.

2. Payment. Our practice may use and disclose your protected health information in order to bill and collect payment for the services and items you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment. We also may use and disclose your protected health information to obtain payment from third parties that may be responsible for such costs, such as family members. Also we may use your protected health information to bill you directly for services and items. We may disclose your protected health information to other health care providers and entities to assist in their billing and collection efforts. We may call your home about a bill and leave a message about this on your voice mail or answering machine.

3. Health Care Operations. Our practice may use and disclose your protected health information to operate our business. These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students and conducting or arranging for other business activities. We will share your protected health information with third party "business associates" that perform various activities (for example, billing or transcription services) for our practice. Whenever an arrangement between our office and a business associate involves the use or disclosure of your protected health information, we will have a written contract that contains terms that will protect the privacy of your protected health information.

4. Appointment Reminders. Our practice may use and disclose your protected health information to contact you and remind you of an appointment. This appointment information may be left on a voice mail or answering machine or mail-out postcard reminders.

5. Treatment Options. Our practice may use and disclose your protected health information to inform you and to enable us to inform you of treatment options or alternatives

6. Release of Information to Family/Friends. Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your protected health information that directly relates to that person's involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death. Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.

7. Health-Related Benefits and Services. Our practice may use and disclose your protected health information to inform you or enable us to inform you of health-related benefits or services that may be of interest to you.

8. Disclosure Required by Law. Our practice will use and disclose your protected health information when we are required to do so by federal, state or local law. For example, if you contract tuberculosis we will inform the county health department.

9. Electronic Communications. Our practice routinely uses fax machines to transmit your protected health information as needed for treatment, payment, or healthcare operations. An example of this practice is that our office commonly faxes information to insurance companies after you have authorized its release. We use a message on the front page of each fax to explain that the transmission contains confidential material. This message asks for the material to be returned to us if the wrong person received the fax. We may find it necessary to record your protected health information on your answering machine or voice mail to properly care for you in a timely fashion. For example, we may leave a message to call our office if an alarming lab value is discovered. We may use cordless phones or cell phones to communicate with you in regards to protected health information without encrypting the message to prevent interception of these wireless transmissions. Such calls are often made when we are returning calls to you on your request after hours. We may on occasion use e-mail that may or may not be encrypted to communicate with appropriate parties in regards to your care and transmissions will include your protected health information. One example of this would be communicating information about your condition to another MD involved in your care via e-mail. Our practice reserves the right to utilize the internet to provide each patient access to information that will include his or her protected health information to enhance accessibility of this information to them. Future uses of this medium of information exchange could include sharing protected health information with other healthcare professionals to improve information transfer at the time of a referral. Our general policy will be to use our judgment to select reasonable available measures to keep your protected health information secure in the electronic environment.

10. Audible Communications. Our practice is located in a structure that does not afford full privacy at all times and places in regards to the spoken word being overheard by someone unintended. Our policy is to conduct ourselves in such a way as to minimize this unintended disclosure of your protected health information.

11. Mailing of Information. Our practice may use the US Postal Service to transport your protected health information from one location to another to conduct treatment, payment, or healthcare operations. An example of this use is mailing to you a letter explaining the results of your laboratory tests.

D. USE AND DISCLOSURE OF YOUR PROTECTED HEALTH INFORMATION IN CERTAIN SPECIAL CIRCUMSTANCES

The following categories describe unique scenarios in which we may use or disclose your protected health information:

1. Public Health Risks. Our practice may disclose your protected health information to public health authorities that are authorized by law to collect information for the purpose of:
Maintaining vital records, such as births and deaths
Reporting child abuse or neglect
Preventing or controlling disease, injury or disability
Notifying a person regarding potential exposure to a communicable disease
Notifying a person regarding a potential risk for spreading or contracting a disease or condition.
Reporting reactions to drugs or problems with products or devices
Notifying individuals if a product or device they may be using has been recalled
Notifying appropriate government agency(ies) and authority(ies) regarding the potential abuse or neglect of an adult patient (including domestic violence); however, we will only disclose this information if the patient agrees or we are required or authorized by law to disclose this information.
Notifying your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance.

2. Health Oversight Activities. Our practice may disclose your protected health information to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.

3. Lawsuits and Similar Proceedings. Our practice may use and disclose you protected health information in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding. We also may disclose your protected health information in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested:

4. Law Enforcement. We may release your protected health information if asked to do so by a law enforcement official:

Regarding a crime victim in certain situations, if we are unable to obtain the personÕs agreement
Concerning a death we believe has resulted from a criminal conduct
Regarding criminal conduct at our offices
In response to a warrant, summons, court order, subpoena or similar legal process
To identify/locate a suspect, material witness, fugitive or missing person
In an emergency, to report a crime (including the location or victim(s) of the crime, or the description, identity or location of the perpetrator)

5. Deceased Patients. Our practice may release your protected health information to a medical examiner or coroner to identify a deceased individual or to identify the cause of death. If necessary, we also may release information in order for funeral directors to perform their jobs.

6. Organ and Tissue Donation. Our practice may release you protected health information to organizations that handle whole cadaver, organ, eye, or tissue procurement for transplantation or medical study (including organ donation banks and medical schools) as necessary to facilitate donation if you are a donor.

7. Research. Our practice may use and disclose your protected health information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information.

8. Serious Threats to Health or Safety. Our practice may use and disclose your protected health information when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.

9. Military. Our practice may disclose your protected health information if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate authorities.

10. National Security. Our practice may disclose your protected health information to federal officials for intelligence and national security activities authorized by law. We also may disclose your protected health information to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.

11. Inmates. Our practice may disclose your protected health information to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. Disclosure for these purposes would be necessary: (a) for the institution to provide health care services to you, (b) for the safety and security of the institution, and/or (c) to protect your health and safety or the health and safety of other individuals.

12. Worker's Compensation. Our practice may release your protected health information for workers' compensation and similar programs.

13. Students in the Health Professions. Our practice may disclose your protected health information to a student working with us in our offices as part of their training.

14. After Hours Contacts. Not all doctors who take emergency calls during the hours our office is closed will be partners in Franklin Internal Medicine & Family Practice Center. Not all information obtained in on-call phone conversations is entered into a record. Some information is transmitted by the alternate physician to us for inclusion in your medical record at our practice. If a doctor not involved with our practice serves your needs on our behalf in that situation, our practice will have ascertained that he or she will deal with your protected health information according to policies much like those of our practice. Their policies will be outlined in a separate but similar Notice of Privacy Practices (NPP). You will have the same rights regarding your protected health information under that alternate NPP as are stated here. We can assist you in obtaining a copy of the NPP of any other physician caring for you in this setting at your request.

E. YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION

You have the following rights regarding the protected health information that we maintain about you:

1. Confidential Communications. You have the right to request that our practice communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home, rather than at work. In order to request a confidential communication, you must make a written request to the Practice Privacy Contact at 100 Cover Dr., Suite 103, Franklin, TN. 37067 specifying the requested method of contact, or the location where you wish to be contacted. Our practice will accommodate reasonable requests. You do not need to give a reason for your request.

2. Requesting Restrictions. You have the right to request a restriction in our use or disclosure of your protected health information for treatment, payment or health care operations. Additionally, you have the right to request that we restrict our disclosure of your protected health information to only certain individuals involved in your care or the payment for your care, such as family members and friends. We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you. In order to request a restriction in our use or disclosure of your protected health information, you must make your request in writing to the Practice Privacy Contact. Your request must describe in a clear and concise fashion:
(a) the information you wish restricted;
(b) whether you are requesting to limit our practice's use, disclosure or both; and
(c) to whom you want the limits to apply.

3. Inspection and Copies. You have the right to inspect and obtain a copy of the protected health information that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes. You must submit your request in writing to the Practice Privacy Contact in order to inspect and/or obtain a copy of your protected health information. Our practice may charge a fee for the costs of copying, mailing, labor and supplies associated with your request. Our practice may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial. Another licensed health care professional chosen by us will conduct reviews.

4. Amendment. You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our practice. To request an amendment, your request must be made in writing and submitted to the Practice Privacy Contact. You must provide a reason that supports your request for amendment. Our practice will deny your request if you fail to submit your request (and the reason supporting your request) in writing. Also, we may deny your request if you ask us to amend information that is in our opinion: (a) accurate and complete; (b) not part of the protected health information kept by or for the practice; (c) not part of the protected health information which you would be permitted to inspect and copy; or (d) not created by our practice, unless the individual or entity that created the information is not available to amend the information.

5. Accounting of Disclosures. All of our patients have the right to request an Òaccounting of disclosures." An Òaccounting of disclosures" is a list of certain non-routing disclosures our practice has made of your protected health information for non-treatment, non-payment or non operations purposes. Use of your protected health information as part of the routine patient care in our practice is not required to be documented. For example, the doctor-sharing information with the medical assistant or another physician; or the billing department using your information to file your insurance claim. In order to obtain an accounting of disclosures, you must submit your request in writing to the Practice Privacy Contact. All requests for an Òaccounting of disclosures" must state a time period, which may not be longer than six (6) years from the date of disclosure and may not include dates before April 14, 2003. The first list you request within a 12-month period is free of charge, but our practice may charge you for additional lists within the same 12 month period. Our practice will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs.

6. Right to a Paper Copy of This Notice. You are entitled to receive a paper copy of our notice of privacy practices. You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this notice, contact the Practice Privacy Contact.

7. Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services. (HHS general phone number 202-619-0257; Office for Civil Rights phone number 800-368-1019). To file a complaint with our practice, contact the Practice Privacy Contact. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

8. Right to Provide an Authorization for Other Uses and Disclosures. Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your protected health information may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your protected health information for the reasons described in the authorization. Please note, we are required to retain records of your care.

Again, if you have any questions regarding this notice of our health information privacy policies, please contact the Practice Privacy Contact at 615-794-5354.

Effective Date: 14 April 2003

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