HIPAA Privacy Notice – Notice of Privacy Practices


I.  Who We Are

This Notice describes the privacy practices of RA Medical PC.

II. Our Privacy Obligations

We are required by  law to  maintain the  privacy of  your health information (“Protected Health Information” or “PHI”) and  to provide you  with this  Notice of  our  legal  duties and  privacy practices with  respect to  your Protected Health Information. When we  use or disclose your Protected Health Information, we  are required to  abide by the terms of this Notice (or other notice in  effect at  the time of the  use  or disclosure).

Ill. Permissible Uses and Disclosures Without Your Written Authorization

In certain situations, which we  will  describe in  Section IV  below, we must obtain your written authorization in order to use and/or disclose your PHI.  However, we do  not  need any type of  authorization from  you  for the following uses  and disclosures:

A.  Uses and Disclosures for Treatment, Payment and Healthcare Operations. We may use and  disclose PHI,  but  not your “Highly Confidential Information” (defined in Section IV. B below), in order to  treat you  or  evaluate or our “healthcare operations” as  detailed below:

•Treatment. We  use  and  disclose your PHI  to  provide treatment and  other services to  you  — for example, to treat your injury or illness. In addition, 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  also disclose PHI  to other providers involved in  your treatment.

•Healthcare Operations. We  may  use and  disclose your PHI  for  our  healthcare operations, which include internal administration and  planning and various activities that improve the quality and  cost effectiveness of the care that we  deliver to  you.  For example, we may use PHI  to evaluate the  quality and  competence of our physicians, nurses and  other healthcare workers. We  may also disclose PHI  to  your other healthcare providers when such  PHI is required for them  to treat you,  receive payment for services they render to you, or  conduct certain healthcare operations. such  as  quality assessment and  improvement activities, reviewing the quality and competence of  healthcare professionals, or for healthcare fraud and abuse detection or  compliance.

B. Disclosure to Relatives, Close Friends and Other Caregivers. We  may  use or  disclose your PHI to  a family member, other relative, a close personal friend or  any other person identified by you when you  are  present for,  or otherwise available prior to,  the disclosure, if  we (1) obtain your agreement; (2)  provide you  with the opportunity to  object to the disclosure and you do  not  object; or  (3)  reasonably infer that you  do  not object to  the  disclosure. If you  are  not present, or the opportunity to agree or object to  a use  or disclosure cannot practicably be  provided because of  your incapacity or  an  emergency circumstance, we may exercise our professional judgment to determine whether a disclosure is in your best  interests. If we  disclose information to  a family member, other relative or a close personal friend, we  would disclose only information that we  believe is  directly relevant to the  person’s involvement with your healthcare or  payment related to your healthcare. We may also disclose your PHI  in  order to  notify (or  assist in  notifying) such  persons of  your location, general condition or death.

C.  Public Health Activities. We  may disclose your  PHI  for the following public health activities: (1)  to  report health information to  public health authorities for the  purpose of preventing or controlling disease, injury or  disability; (2)  to  report child abuse and  neglect to public  health authorities or  other government authorities authorized by  law to  receive such reports; (3)  to report information about products and  services under the jurisdiction of the  U.  S. Food and  Drug Administration; (4)  to alert a person who  may have  been exposed to a communicable disease or may otherwise be  at  risk of contracting or spreading a disease or condition; and  (5)  to  report information to your employer as required under laws addressing work-related illnesses and  injuries or workplace medical surveillance.

D.  Victims of Abuse, Neglect or Domestic Violence. If  we  reasonably believe you  are a victim of abuse, neglect or domestic violence, we  may disclose your PHI  to a governmental authority, including a social service or protective services agency, authorized by  law to receive reports of such  abuse, neglect, or domestic violence.

E.  Health Oversight Activities. We  may disclose your PHI  to a health oversight agency that oversees the  healthcare system and  is  charged with  responsibility for ensuring compliance with the rules of  government health programs such  as Medicare or  Medicaid.

F. Judicial and Administrative Proceedings. We may disclose your PHI in the  course of  a judicial or administrative proceeding in response to  a legal order or other lawful process.

G. Law Enforcement Officials. We  may disclose your PHI  to  the police or other law enforcement officials as  required or permitted by  law or in  compliance with  a court order or  a grand jury or administrative subpoena.

H.  Decedents. We may disclose your PHI  to a coroner or  medical examiner as authorized by  law.

I. Organ and Tissue Procurement. We  may disclose your PHI to organizations that facilitate organ, eye  or  tissue procurement, banking or transplantation.

J.  Research. We  may use  or disclose your PHI  without your consent or authorization if an  Institutional Review Board or Privacy Board approves a waiver of authorization for disclosure.

K. Health or Safety. We  may use or disclose your PHI  to prevent or lessen a serious and  imminent threat to a person’s or the  public’s health or safety.

L. Specialized Government Functions. We  may use  and disclose your PHI to  units of the government with special functions, such  as  the  U.  S. military or the U.  S. Department of  State under certain circumstances.

M. Workers’ Compensation. We  may disclose your PHI  as  authorized by and  to the extent necessary to comply with state law relating to workers’ compensation or  other similar programs.

N.  As Required by Law. We may use  and disclose your PHI when required to do  so  by any other law  not already referred to  in  the  preceding categories.

IV.Uses and Disclosures Requiring Your Written Authorization

A.  Use or Disclosure with Your Authorization. For any purpose other than the ones described above in  Section Ill, we only may  use  or disclose your PHI  when you  grant us  your written authorization (“Your Authorization”). For instance, you will need  to  execute an  authorization before we  can send your PHI to your life insurance company or to the attorney representing the other party in litigation in  which you  are  involved.

B.  Uses and Disclosures of Your Highly Confidential Information. In  addition, federal and  state law  requires special privacy protections for certain highly confidential information about you (“Highly Confidential Information”). We  will comply with  such  special privacy protections which may cover the subset of your PHI  that:  (1) is maintained in  psychotherapy notes; (2)  is  about mental health and  developmental disabilities services; (3)  is about alcohol and drug abuse prevention,treatment and referral; (4) is about HIV/AIDS testing, diagnosis or treatment; (5)  is about venereal disease(s); (6) is  about genetic testing; (7)  is  about child abuse and  neglect; (8) is about domestic abuse of  an  adult with  a disability; (9)  is  about sexual assault; or  (10)  is  about abortion.

V.  Your Rights Regarding Your Protected Health Information

A.  For Further Information; Complaints. If you  desire further information about your privacy rights, are concerned that we  have violated your privacy rights or disagree with a decision that we  made about access to your PHI,  you may contact our  Patient Relations Department. You  may also file written complaints with the  Director, Office for Civil  Rights of the U.  S. Department of  Health and  Human Services. Upon request, the Patient Relations Department will provide you with the correct address for the  Director. We will  not retaliate against you if you  file a complaint with  us  or the Director.

B.  Right to Request Restrictions. You  may  request restrictions on  our  use  and  disclosure of  your PHI  (1)  for treatment and  healthcare operations; (2)  to  individuals (such as  a family member, other relative, close personal friend or  any other person identified by  you)  involved with  your care or with  payment related to  your care; or  (3) to notify or  assist in  the notification of  such  individuals regarding your location and  general condition. While we  will  consider all  requests for restrictions carefully, we  are  not  required to agree to a requested restriction. If  you  wish  to  request restrictions, please submit a written request to  our  Patient Relations Department. A form  to  request restrictions is  available upon request from the  Patient Relations Department.

C.  Right to Receive Confidential Communications. You may request, and we  will accommodate, any reasonable written request for you to receive your PHI  by alternative means of communication or at   alternative locations.

D.  Right to Revoke Your Authorization. You may revoke Your Authorization, Your Marketing Authorization or any written authorization obtained in  connection with your Highly Confidential Information, except to the extent that we have taken action in  reliance upon it,  by delivering a written revocation statement to the Patient Relations Department identified below. A form of written revocation is  available upon request from the Patient Relations Department.

E. Right to Inspect and Copy Your Health Information. You may request access to your medical record file and billing records maintained by us  in   order to inspect and request copies of the records. Under limited circumstances, we may deny you  access to a portion of your records. If  you desire access to your records, please submit a written request to the Patient Relations Department. You may obtain a record request form from the Patient Relations Department and submit the completed form to the Patient Relations Department. Requests for a   copy of a limited amount of your medical or billing records (e.g., a prescription) maintained by us on- site may be made orally to our local facility. We may,  however, require that you submit a written request to the Patient Relations Department.

F.  Right to Amend Your Records. You have the right to  request that we amend Protected Health Information maintained in  your medical record file or billing records. If  you desire to amend your records, please send a written request for the amendment, including the reason for the amendment, to the Patient Relations Department. You may obtain a form to request an  amendment from the Patient Relations Department. We will comply with your request unless we believe that the information that would be amended is  accurate and  complete or other special circumstances apply.

G. Right to Receive an Accounting of Disclosures. Upon request, you may obtain an  accounting of certain disclosures of your PHI made by us during any period of time prior to the date of your request provided such period does not exceed six years and does not apply to disclosures that occurred prior to April 14,  2003.

H.  Right to Receive Paper Copy of This Notice. Upon request, you may obtain a paper copy of this Notice, even if you have agreed to receive such notice electronically.VI. Effective Date and Duration of This Notice

A. Effective Date. This Notice is effective as of April  14,  2003.

B.  Right to Change Terms of This Notice. We reserve the right to, meaning we  may, change the terms of this Notice at any time. If we change this Notice, we may make the new notice terms effective for all Protected Health Information that we maintain, including any information created or received prior to issuing the new notice. If we change this Notice, we will post the new notice in waiting areas at our facility and on our Internet site. You also may obtain any new notice by contacting the Physician and Patient Relations Department.

VII. Patient Relations Department.You may contact the Patient Relations Department at:

RA Medical PC

153 Eclipse Way

Mooresville, NC 28117