Notice of Privacy Practices

"Protected Health Information" is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and to related health care services. This notice describes how medical information about you may be used and disclosed and how you may obtain access to this information. Please review it carefully.

We are required to abide by the terms of this notice. We may change the terms at any time; we will provide you with any revised notices upon your request. The new notice will be effective for all protected health information that we maintain at that time. If you have questions about this notice, contact our physician: Anne C Weaver.

Uses and Disclosures of Protected Health Information

Your protected health information may be used and disclosed by your physician, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health services to you. Your protected health information may also be used and disclosed to obtain payment for your healthcare services and to support the operation of the physicians' practice. We will use and disclose your protected health information to provide, coordinate or manage your health care and any related service including the coordination or management of your health care with a third party that has already obtained your permissions to have access to your protected health information. For example we would disclose your protected health information, as necessary, to a home health agency, specialist or laboratory who is participating in your health care. Your protected health information will be used, as needed, to obtain payment for your health care services. This may include any number of activities required by your health insurance plan including, but not limited to, determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. We may use or disclose, as necessary, your protected health information in order to support the business and quality of your physicians' practices including, but not limited to, quality assessment activities, employee review activities, continuing education activities, and the training of students. For example, we may contact you to remind you of your appointment or call your name in the waiting room or share information with medical students training under us in the office. If you have specific concerns about any of these possibilities, please bring them to the attention of any of our staff or your physician. We will share, as necessary, your protected health information with third party business associates such as billing agencies. Whenever an arrangement has been made between our office and a business associate, we will have a written contract with that entity to ensure the privacy of your protected health information.

Medical Forms

With your specific consent, we will disclose your protected health information to complete medical paperwork for schools, camps, employers, WIC and housing authorities. Other uses and disclosures of your protected health information will be made only with your written authorization unless otherwise permitted or required by law as described below.

Others involved in your healthcare

Unless you object, we may disclose to a member of your family, a relative, a close friend or any person whom you identify, your protected health information that directly relates to that person's involvement in your health care. If you are unable to agree to 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 your protected health information to notify or assist in notifying a family member, personal representative or any other person who is responsible for your care, general condition or death. 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.

We may use or disclose your protected health information in an emergency treatment situation. If this happens, your physician will try to obtain your consent as soon as reasonably practicable after the delivery of treatment. If one of our physicians is required by law to treat you and the physician has attempted to obtain your consent but is unable to obtain your consent, the physician may still use or disclose your protected health information to treat you. Or if the physician is unable to obtain your consent due to substantial communication barriers and the physician believes that you intend to consent, we may use or disclose your protected health information using the physician's best professional judgment.

Other Permitted Uses and Disclosures which may be made without your authorization or the opportunity to object

The following activities may require the physician to use or disclose your protected health information without your consent. Every effort will be made to notify you and to disclose the minimal amount of information necessary for the specific situation: legal documents, public health record for the reporting and treatment of disease, injury or disability, health oversight agencies, instances of abuse or neglect, food and drug administration, legal proceedings, law enforcement, coroners, funeral directors and organ donation, criminal activity, military activity and national security as well as worker's compensation. We may use or disclose your protected health information if you are an inmate of a correctional facility. Under the law we must make disclosures to you and when required by the Secretary of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500 et. Seq.

Use and Disclosures of Protected Health Information Based Upon Your Written Authorization

Other uses and disclosures of your protected health information will be made only with your written authorization unless otherwise permitted or required by law as outlined above. You may revoke this authorization at any time in writing except to the extent that your physician or the practice has taken an action in reliance on the use or disclosure indicated in the authorization.

Our Records

Amherst Family Practice has a computerized medical record so that most of your protected health information is stored locally and protected with passwords and access level authorization. Only employees who have a need to know your protected health information are permitted access to these sections of the chart. Email communication with your physician is accessed through a secure encrypted website.

Your Rights

You have the right to inspect and obtain a copy of protected health information about you that is contained in a designated record for as long as we maintain the protected health information; there may be a charge to you for the copying of said record. This record may include medical and billing records and any other records the practice may use for providing healthcare for you. Under federal law, you may not inspect or copy the following records: psychotherapy notes, information compiled for use in or in reasonable anticipation of a civil, criminal, or administrative action or proceeding, protected health information that is subject to law that prohibits access to protected health information. Depending on the circumstances, a decision to deny access may be reviewable. Please contact us if you have any questions about access to your medical record.

You have the right to request a restriction of your protected health information. This means that you may ask that we not use or disclose any part of your protected health information for the purposes of treatment, payment, or healthcare operations. You may also request that we not disclose any part of your protected health information to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom or what agency you want the restriction to apply.

Your physician is not required to agree to a restriction that you may request. If the physician believes it is in the best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted. You may request a restriction by completing a restriction form.

You have the right to request that you receive confidential communications from us by alternative means or at an alternative location. We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. We will not request an explanation from you regarding the basis for your request.

You have the right to have your physician amend your protected health information. This means you may request an amendment to your protected health information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement; we will provide you with a copy of any such rebuttal.

You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information. This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice of Privacy Practices. It excludes disclosures we may have made to you, to family members or friends involved in your care, or for notification purposes. You have the right to receive specific information regarding these disclosures that occurred after April 14, 2003. The right to receive this information is subject to certain exceptions, restrictions and limitations.

You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice electronically.

Complaints

You may complain to Dr. Weaver or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our physicians of your complaint. We will not retaliate against you for filing a complaint or for requesting information regarding the complaint process.

Acknowledgement of Notice of Privacy Practices

You will be asked to acknowledge receipt of this Notice in writing. Your signature on our "Acknowledgement of Receipt of Notice of Privacy Practices" log will serve as documentation that you have received a copy of this notice. If we update our Notice, the update will be posted in our office. You may request an updated copy at any time.

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