THIS NOTICE
DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND
DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE READ IT
CAREFULLY.
NOTICE OF PRIVACY POLICY
Effective January 30, 2005
The following is the privacy
policy (“Privacy Policy”) of Acupuncture & Herbal Works
(“Covered “Entity”) as described in the Health Insurance
Portability and Accountability Act of 1996 and regulations
promulgated thereunder, commonly known as HIPAA. HIPAA
requires Covered Entity by law to maintain the privacy of your
personal health information and to provide you with notice of
Covered Entity’s legal duties and privacy policies with respect
to your personal health information. We are required by
law to abide by the terms of this Privacy Notice.
Your Personal Health Information
We collect personal health information from you through
treatment, payment and related healthcare operations, the
application and enrollment process, and/or healthcare providers
or health plans, or through other means, as applicable.
Your personal health information that is protected by law
broadly includes any information, oral, written or recorded,
that is created or received by certain health care entities,
including health care providers, such as physicians and
hospitals, as well as, health insurance companies or plans. The
law specifically protects health information that contains data,
such as your name, address, social security number, and others,
that could be used to identify you as the individual patient who
is associated with that health information.
Uses or Disclosures of Your
Personal Health Information
Generally, we may not use or
disclose your personal health information without your
permission. Further, once your permission has been
obtained, we
must use or disclose your personal health information in
accordance with the specific terms that permission. The
following are the circumstances under which we are permitted by
law to use or disclose your personal health information.
Without Your Consent
Without your consent, we
may use or disclose your personal health information in order to
provide you with services and the treatment you require or
request, or to collect payment for those services, and to
conduct other related health care operations otherwise permitted
or required by law. Also, we are permitted to disclose
your personal health information within and among our workforce
in order to accomplish these same purposes. However,
even with your permission, we are still required to limit such
uses or disclosures to the minimal amount of personal health
information that is reasonably required to provide those
services or complete those activities.
Examples of treatment activities
include: (a) the
provision, coordination, or management of health care and
related services by health care providers; (b) consultation
between health care providers relating to a patient; or (c) the
referral of a patient for health care from one health care
provider to another.
Examples of payment activities include:
(a) billing and collection activities and related data
processing; (b) actions by a health plan or insurer to obtain
premiums or to determine or fulfill its responsibilities for
coverage and provision of benefits under its health plan or
insurance agreement, determinations of eligibility or coverage,
adjudication or subrogation of health benefit claims; (c)
medical necessity and appropriateness of care reviews,
utilization review activities; and (d) disclosure to consumer
reporting agencies of information relating to collection of
premiums or reimbursement.
Examples of health care
operations include: (a)
development of clinical guidelines; (b) contacting patients with
information about treatment alternatives or communications in
connection with case management or care coordination; (c)
reviewing the qualifications of and training health care
professionals; (d) underwriting and premium rating; (e) medical
review, legal services, and auditing functions; and (f) general
administrative activities such as customer service and data
analysis.
As Required By Law
We may use or disclose your personal health information to the
extent that such use or disclosure is required by law and the
use or disclosure complies with and is limited to the relevant
requirements of such law. Examples of instances in
which we are required to disclose your personal health
information include: (a) public health activities including,
preventing or controlling disease or other injury, public health
surveillance or investigations, reporting adverse events with
respect to food or dietary supplements or product defects or
problems to the Food and Drug Administration, medical
surveillance of the workplace or to evaluate whether the
individual has a work-related illness or injury in order to
comply with Federal or state law; (b) disclosures regarding
victims of abuse, neglect, or domestic violence including,
reporting to social service or protective services agencies; (c)
health oversight activities including, audits, civil,
administrative, or criminal investigations, inspections,
licensure or disciplinary actions, or civil, administrative, or
criminal proceedings or actions, or other activities necessary
for appropriate oversight of government benefit programs; (d)
judicial and administrative proceedings in response to an order
of a court or administrative tribunal, a warrant, subpoena,
discovery request, or other lawful process; (e) law enforcement
purposes for the purpose of identifying or locating a suspect,
fugitive, material witness, or missing person, or reporting
crimes in emergencies, or reporting a death; (f) disclosures
about decedents for purposes of cadaveric donation of organs,
eyes or tissue; (g) for research purposes under certain
conditions; (h) to avert a serious threat to health or safety; (i)
military and veterans activities; (j) national security and
intelligence activities, protective services of the President
and others; (k) medical suitability determinations by entities
that are components of the Department of State; (l) correctional
institutions and other law enforcement custodial situations; (m)
covered entities that are government programs providing public
benefits, and for workers’ compensation.
All Other Situations, With Your Specific Authorization
Except as otherwise permitted or required, as described
above, we may not use or disclose your personal health
information without your written authorization. Further,
we are required to use or disclose your personal health
information consistent with the terms of your authorization.
You may revoke your authorization to use or disclose any
personal health information at any time, except to the extent
that we have taken action in reliance on such authorization, or,
if you provided the authorization as a condition of obtaining
insurance coverage, other law provides the insurer with the
right to contest a claim under the policy.
Miscellaneous Activities, Notice
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. We may contact you to raise
funds for Covered Entity. If we are a group health plan or
health insurance issuer or HMO with respect to a group health
plan, we may disclose your personal health information to be
sponsor of the plan.
Your Rights With
Respect to Your Personal Health Information
Under HIPAA, you have certain rights with respect to your
personal health information. The following is a brief
overview of your rights and our duties with respect to enforcing
those rights.
Right To
Request Restrictions On Use Or Disclosure
You have the right to request
restrictions on certain uses and disclosures of your personal
health information about yourself. You may request
restrictions on the following uses or disclosures: to carry
out treatment, payment, or healthcare operations; (b)
disclosures to family members, relatives, or close personal
friends of personal health information directly relevant to your
care or payment related to your health care, or your location,
general condition, or death; (c) instances in which you are not
present or your permission cannot practicably be obtained due to
your incapacity or an emergency circumstance; (d) permitting
other persons to act on your behalf to pick up filled
prescriptions, medical supplies, X-rays, or other similar forms
of personal health information; or (e) disclosure to a public or
private entity authorized by law or by its charter to assist in
disaster relief efforts.
While we are not required to agree to any requested restriction,
if we agree to a restriction, we are bound not to use or
disclose your personal healthcare information in violation of
such restriction, except in certain emergency situations.
We will not accept a request to restrict uses or disclosures
that are otherwise required by law.
Right To Receive Confidential Communications
You have the right to receive
confidential communications of your personal health information.
We may require written
requests. We may condition the provision of confidential
communications on you providing us with information as to how
payment will be handled and specification of an alternative
address or other method of contact. We may require that a
request contain a statement that disclosure of all or a part of
the information to which the request pertains could endanger
you. We may not
require you to provide an explanation of the basis for your
request as a condition of providing communications to you on a
confidential basis. We must
permit you to request and must accommodate reasonable requests
by you to receive communications of personal health information
from us by alternative means or at alternative locations.
If we are a health care plan, we must permit you to request and
must accommodate reasonable requests by you to receive
communications of personal health information from us by
alternative means or at alternative locations if you clearly
state that the disclosure of all or part of that information
could endanger you.
Right To Inspect And Copy Your Personal Health Information
Your designated record set is a group of records we maintain
that includes
Medical records and billing
records about you, or enrollment, payment, claims adjudication,
and case or medical management records systems, as applicable.
You have the right of
access in order to inspect and obtain a copy your personal
health information contained in your designated record set,
except for (a) psychotherapy notes, (b) information complied
in reasonable anticipation of, or for use in, a civil, criminal,
or administrative action or proceeding, and (c) health
information maintained by us to the extent to which the
provision of access to you would be prohibited by law.
We may require written requests.
We must provide you with
access to your personal health information in the form or format
requested by you, if it is readily producible in such form or
format, or, if not, in a readable hard copy form or such other
form or format. We may provide you with a summary of the
personal health information requested, in lieu of providing
access to the personal health information or may provide an
explanation of the personal health information to which access
has been provided, if you agree in advance to such a summary or
explanation and agree to the fees imposed for such summary or
explanation. We will provide you with access as requested in a
timely manner, including arranging with you a convenient time
and place to inspect or obtain copies of your personal health
information or mailing a copy to you at your request. We
will discuss the scope, format, and other aspects of your
request for access as necessary to facilitate timely access.
If you request a copy of your personal health information or
agree to a summary or explanation of such information, we may
charge a reasonable cost-based fee for copying, postage, if you
request a mailing, and the costs of preparing an explanation or
summary as agreed upon in advance. We reserve the right to deny
you access to and copies of certain personal health information
as permitted or required by law. We will reasonably
attempt to accommodate any request for personal health
information by, to the extent possible, giving you access to
other personal health information after excluding the
information as to which we have a ground to deny access.
Upon denial of a request for access or request for information,
we will provide you with a written denial specifying the legal
basis for denial, a statement of your rights, and a description
of how you may file a complaint with us. If we do not
maintain the information that is the subject of your request for
access but we know where the requested information is
maintained, we will inform you of where to direct your request
for access.
Right To Amend Your Personal Health Information
We will provide you with a copy
of the most recent version of this Privacy Policy at any time
upon your written request sent to Privacy Officer, Acupuncture & Herbal Works, 254 North Main Street, Seneca, PA 16346 or
at the following website address:
http:\\www.thefinerpoint.com.
For any other requests or for further information regarding
the privacy of your personal health information, and for
information regarding the filing of a complaint with us, please
contact our privacy officer at the address, telephone number, or
e-mail address listed above.
