NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
I. OUR PLEDGE REGARDING HEALTH INFORMATION:
We understand that health information about you and your health care is personal. We here at Laura F. Dabney, MD are committed to protecting health information about you. We create a record of the care and services you receive. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by this practice. This notice will tell you about the ways in which our office may use and disclose health information about you. We also describe your rights to the health information kept about you, and describe certain obligations we have regarding the use and disclosure of your health information. We are required by law to:
• Make sure that protected health information (“PHI”) that identifies you is kept private.
• Give you this notice of legal duties and privacy practices with respect to health information.
• Follow the terms of the notice that is currently in effect.
• We can change the terms of this Notice, and such changes will apply to all information about you. The new Notice will be available upon request, in my office.
II. HOW OUR OFFICE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU:
The following categories describe different ways that health information is disclosed. For each category of uses or disclosures it will be explained and some examples will be given. Not every use or disclosure in a category will be listed. However, all of the ways permitted to use and disclose information will fall within one of the categories.
Disclosures for treatment purposes are not limited to the minimum necessary standard. Because coaches, therapist, and other health care providers sometimes need access to the full record and/or full and complete information in order to provide quality care. The word “treatment” includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers and referrals of a patient for health care from one health care provider to another.
Lawsuits and Disputes: If you are involved in a lawsuit, information may be disclosed in response to a court or administrative order. Information may be disclosed about your child in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:
1. Coaching/Initial Intake Notes. “Coaching/intake notes” are kept and any use or disclosure of such notes requires your Authorization unless the use or disclosure is:
a. For use in working with you.
b. For use in training or supervising others to help them improve their skills in group, joint, family, or individual coaching and initial intakes.
c. For use in defending in legal proceedings instituted by you.
d. For use by the Secretary of Health and Human Services to investigate compliance.
e. Required by law and the use or disclosure is limited to the requirements of such law.
f. Required by law for certain health oversight activities pertaining to the originator of the coaching/initial intake notes.
g. Required by a coroner who is performing duties authorized by law.
h. Required to help avert a serious threat to the health and safety of others.
2. Marketing Purposes. As a life coach/Initial Intake Associate your PHI will not be disclosed for marketing purposes.
3. Sale of PHI. As a life coach/ Initial Intake Associate, your PHI in the regular course of business will not be sold.
IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AURTHORIZATION. Subject to certain limitations in the law, disclosure of your PHI without your Authorization for the following reasons:
1. When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law.
2. For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s health or safety.
3. For health oversight activities, including audits and investigations.
4. For judicial and administrative proceedings, including responding to a court or administrative order, although preference is to obtain an Authorization from you before doing so.
5. For law enforcement purposes, including reporting crimes occurring on Laura F. Dabney, MD premises.
6. To coroners or medical examiners, when such individuals are performing duties authorized by law.
7. For research purposes, including studying and comparing the coaching and or intake of patients who received one form of coaching and or intakes versus those who received another form of coaching and or intakes for the same condition.
8. Specialized government functions, including, ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counter-intelligence operations; or, helping to ensure the safety of those working within or housed in correctional institutions.
9. For workers’ compensation purposes. Although preference is to obtain an Authorization from you, your PHI may be provided in order to comply with workers’ compensation laws.
10. Appointment reminders and health related benefits or services. Disclosure of your PHI to contact you to remind you that you have an appointment. Disclosure of your PHI to tell you about treatment alternatives, or other health care services or benefits offered.
V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT.
1. Disclosures to family, friends, or others. Your PHI info may be provided to a family member, friend, or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.
VI. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:
1. The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to request the office not to use or disclose certain PHI for treatment, payment, or health care operations purposes. Agreement to your request may be denied, if it is believe that it would affect your care.
2. The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full.
3. The Right to Choose How PHI is sent to You. You have the right to request contact in a specific way (for example, home or office phone) or to send mail to a different address..
4. The Right to See and Get Copies of Your PHI. Other than “notes,” you have the right to get an electronic or paper copy of your record and other information about you. A copy of your record, or a summary of it, if you agree to receive a summary, will be provided within 30 days of receiving your written request, and there may be a charge for doing so.
5. The Right to Get a List of the Disclosures Made. You have the right to request a list of instances in which disclosures of your PHI for purposes other than payment, or health care operations, or for which you provided an Authorization. Response to your request for an accounting of disclosures will be provided within 60 days of receiving your request. The list will include disclosures made in the last six years unless you request a shorter time. The list will be provided to you at no charge, but if you make more than one request in the same year, a charge of a reasonable cost based fee for each additional request will be incurred.
6. The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that it is corrected. The request may be denied, however you will be notified as to why in writing within 60 days of receiving your request.
7. The Right to Get a Paper or Electronic Copy of this Notice. You have the right get a paper copy of this Notice, and you have the right to get a copy of this notice by e-mail. And, even if you have agreed to receive this Notice via e-mail, you also have the right to request a paper copy of it.
BY CLICKING ON THE CHECKBOX BELOW (or signing the hard copy form) I AM AGREEING THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE ITEMS CONTAINED IN THIS DOCUMENT.
EFFECTIVE DATE OF THIS NOTICE: This notice went into effect on September 20, 2013