Notice of Privacy Practices April 14, 2003
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review carefully.
Dr. Arthur Davida's practice acts to maintain the privacy of protected health information and provides individuals with the notice of the practice's legal duties and privacy practices regarding protected health information as described in this notice. Our computers are password protected, only the minimum necessary information is displayed. Access to your medical information by our medical staff is limited to the essentials needed to perform their duties. Our claims' submission to the insurance companies has been certified to meet the Federal HIPAA compliance act.
Provision of Notice: The practice will provide its Notice of Privacy Practices to every patient with whom it has a direct treatment relationship on the earliest appointment on or after April 14, 2003. We will post a copy of the Notice in the waiting room. This Notice will also be available on the practice's website www.familydoctor.net.
Effective Date and Changes to Notice: This Notice is effective April 14, 2003. The practice reserves the right to revise this notice whenever there is a material change to the uses or disclosures, the individual's rights, the covered entity's legal duties, or other privacy practices stated in the Notice. If the Notice is revised, it will be available upon request on the date of revision. The revised Notice will be posted in the reception area and made available to all the patients, including those who have previously received the Notice. The patient will then be asked to acknowledge the receipt of the updated Notice. The revised Notice will also be posted on the website www.familydoctor.net.
Complaints: If you believe your privacy rights are being violated, you may file a written complaint, describing the acts or omissions within 180 days of becoming aware of the violation. These letters should be addressed to Dr. Arthur davida 105 S. Third St Bloomingdale, IL 60108. The patient also has the right to contact the US Dept. of Health & Human Services, Office of Civil Rights, 200 Independence Ave S.W. Washington D.C. 20201.
This practice will not take any adverse action against any patient who files a complaint against this practice.
Uses and Disclosures of Protected Health Information
Our office is permitted by federal law to make uses and disclosures of your health information for purposes of Treatment, Payment, and Health Care Operations. Protected health information is the information we create and obtain in providing services to you. It may include documenting your symptoms, examination, test results, diagnoses, treatments, family medical history, personal social history which includes but is not limited to Tobacco, Alcohol, other drug use, allergies, medication lists, history of past surgery, Xray reports, reports of outpatient & inpatient procedures, and letters from specialists who have seen and treated the patient. The patient record may also include old medical records obtained from another provider with the patient's consent. It will also include payment records for services rendered.
An example of how we use your medical information for Treatmnt is that we telephone our patients to confirm their appointments. It is used for payment when we bill your insurance company or provide information to your managed care plan reviewer. For Health Care Operations we at times obtain information about your prescription drug use from your insurance company's pharmacy benefit manager, or from the local pharmacy.
. Request a restriction on certain disclosures of your health information ( These requests may not always be granted, but will be reviewed carefully ). YOUR HEALTH INFORMATION RIGHTS
The health and billing records we maintain are the physical property of our office. The information in it belongs to you. You have the following rights:
. Request a paper copy of the current Notice of Privacy Practices for Protected Health Information.
. Request to inspect and copy your health record and billing record.
. Appeal a denial of access to your protected health information, except in certain circumstances.
. Request that your health care record be amended to correct incomplete and incorrect information. This request may be denied if the information was not created by us, was not part of the health information kept by the office, or is accurate and complete. However, if denied, you will be informed of the reason for the denial, and can submit a statement of disagreement to be kept with your record.
. Request that a communication of your health information be made by alternative means or at an alternative location.
. Obtain an accounting of disclosures of health information ( not including disclosures made at your request or authorizations, or for treatment, payment or operations ).
. Revoke authorizations that you made previously to disclose information by writing our office except to the extent that information or action had already been taken.
. If you wish to exercise any of these rights, please contact Dr. Davida during the office hours.Our responsibilities:
Our office is required to maintain the privacy of your health information as required by law. This is why we are providing you with a Notice of our duties and privacy practices regarding the information we collect and maintain about you.We will notify you if we can not accommodate a requested restriction or request and accommodate your reasonable requests regarding communication of health information.
Uses and Disclosures Not Requiring Authorizations:
As required by law, disclosure of abuse to a minor, disabled person, or of someone over the age of 60 is mandatory. Also, a patient's relative, emergency room personnel, law enforcement or paramedical personnel may have to be contacted and given information in the event of an emergency ( i.e. a threat to health or safety ). We may disclose to the Food and Drug Administration (FDA) health information related to adverse events related to medications, nutritional supplements, or other products.
Disclosure requiring Authorization:
In Illinois, specific written authorization is required to disclose or release information regarding mental health treatment ( except in an emergency ), alcoholism or drug abuse treatment, or AIDS ( acquired Immune Deficiency Syndrome ). The federal HIPAA laws allow us to disclose necessary information required for the purposes of treatment, payment and health care operations.