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Notice of Privacy Practices
Effective 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
This Notice of Privacy Practices describes how Zepf Center may use and disclose your protected health information (PHI*) in order to carry out treatment, payment, and health care operations and for other purposes permitted or required by law. If also describes your rights to access and control you PHI.
Zepf Center is required to abide by the terms of this Notice. However, we may modify the terms of this Notice at any time, and the new notice will be effective for all PHI in our possession at the time of the change, and any received thereafter. Upon request, we will provide you with and revised Notice or you can review the Notice posted at each of our locations.
USES AND DISCLOSURES OF HEALTH INFORMATION
Zepf Center uses PHI about you for your treatment, payment and operational purposes. We do not require authorization to use your PHI for these purposes. We may also use or disclose your PHI without your authorization for several other reasons. Subject to certain requirements, we may also give out health information without your authorization for public health reasons, for auditing purposes, for research studies and for emergencies.
Treatment. To provide you with the services you require, the Center may use and disclose your PHI to those professionals, whether on the on the Center's staff or not, so that it may provide, coordinate, plan and manage your services. For example, a doctor treating you for physical conditions may need to know and obtain the results of your latest treatment.
Payment. To get paid for services provided to you, the Center may provide your PHI, directly or through a billing service, to a third party who may be responsible for your care, including insurance companies and health plans. If necessary, the Center may use your PHI in other collection efforts with respect to all persons who may be liable to the center for bills related to your case. For example, the Center may need to provide the Medicare program with information about services that you received from the Center so that the Center can be reimbursed. The Center may also need to tell your insurance plan about treatment you are going to receive so that it can determine whether or not it will cover the treatment expense.
Health Care Operations. To operate in accordance with applicable law and insurance requirements, and to provide quality and efficient care, the Center may need to compile, use and disclose your PHI. For example, the Center may use your PHI to evaluate the performance of the Center's personnel in providing care to you.
In addition to the above-mentioned uses of your PHI related to treatment, payment and health care operations, Zepf Center may also use your PHI for the following purposes:
*PHI is individually identifiable information (including demographic information) relating to your health, to the health care provided to you or to payment for health care.
Appointment Reminders. Zepf Center has the right to use and disclose your PHI to contact you and remind you of appointments. The following appointment reminders may be used by the Center: a) a postcard mailed to you at the address provided to you; and b) telephoning your home and leaving a message on your answering machine or with the individual answering the phone.
Health Related Benefits and Services. Zepf Center may use and disclose PHI to inform you of health related benefits or services that may be of interest to you.
Electronic Prescription Software. Zepf Center is moving to electronic prescription software in order to increase coordination of patient care. Zepf Center will view the prescription history (from other authorized healthcare providers) for the purpose of providing clinical care and enhancing patient safety.
Directory/ Sign-In Log. The Center maintains a sign-in log as its reception desk for individuals seeking care and treatment in the office. The sign-in log is located in the position where staff can readily see who is seeking care in the office. This information may be seen by, and is accessible to, others who are seeking care of services in the Center's office.
Release of Information to Family and Friends. Zepf Center may disclose to a family member, other relative, a close personal friend, or any other person identified by you, your PHI directly relevant to such person's involvement with your care or the payment for your care. The Center may also use or disclose your PHI to notify or assist in the notification (including identifying or locating) a family member, a personal representative, or another person responsible for your care, of your location, general condition or death. However, in both cases, the following conditions will apply:
a) If you are present at or prior to the use or disclosure of your PHI, the Center may use or disclose your PHI if you agree, or if the Center can reasonably infer from the circumstances, based on the exercise of its professional judgment that you do not object to the use or disclosure.
b) If you are not present, the Center will, in the exercise of professional judgment, determine whether the use or disclosure is in your best interests and, if so, disclose only the PHI that is directly relevant to the person's involvement with your care.
OTHER USE AND DISCLOSURES WITH MAY BE PERMITTED OR REQUIRED BY LAW
The Center may also disclose your PHI, without your consent or authorization in the following instances:
Disclosures Required by Law. Zepf Center will use and disclose health when we are required to do so by federal, state, or local law.
De-identified Information. The Center may use and disclose health information that may be related to your care but does not identify you and cannot be used to identify you.
Business Associate. The Center may use and disclose PHI to one or more of its business associates if the Center obtains satisfactory written assurance, in accordance with applicable law, that the business associate will appropriately safeguard your PHI. A business associate is a entity that assists the Center in undertaking some essential function, such as a billing company that assists the office submitting claims for payment to insurance companies.
Public Health Risks. Zepf Center may disclose your PHI to public health authorities that are authorized by law to collect information for the purpose of:
· Maintaining vital records, such as births and deaths;
· Reporting child abuse or neglect;
· Preventing or controlling disease, injury or disability;
· Notifying a person regarding potential exposure to a communicable disease;
. Notifying a person regarding the potential risk for spreading or contracting a disease or condition;
. Reporting reactions to drugs or problems with products or devices;\
. Notifying individuals if a product or device they may be using has been recalled;
. Notifying appropriate government agencies and authorities regarding the potential abuse or neglect of an adult patient
including domestic violence); however, we will only disclose this information if the insured agrees or we are required or authorized by law to disclose this information; and
. Notifying your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance.
Health Oversight Activities. Zepf Center may disclose your PHI to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.
Lawsuits and Similar Proceedings. Zepf Center may use and disclose your PHI in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding.
Personal Representative. The Center may use and disclose PHI: to a person who, under applicable law, has the authority to represent you in making decisions related to your care.
Emergency Situations. The Center may use and disclose PHI: for the purpose of obtaining or rendering emergency treatment to you provided that the Center attempts to obtain you consent as soon as possible; or to a public or private entity authorized by law or by its charter to assist in disaster relief efforts, for the purpose of coordinating your care with such entities in an emergency situation.
Serious Threats to Health or Safety. Zepf Center may use and disclose your PHI when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent or lessen the threat.
Law Enforcement. We may release PHI if asked to do so by a law enforcement official:
- Regarding a crime victim in certain situations, if we are unable to obtain the person's agreement;
- Concerning a death we believe might have resulted from criminal conduct;
- Regarding criminal conduct at our offices;
- In response to a warrant, summons court order, subpoena or similar legal process;
- To identify and/or locate a suspect, material witness, fugitive or missing person; and
- In an emergency, to report a crime (including the location or victim(s) of the crime, or the description, identity or location of the perpetrator).
Military. Zepf Center may use and disclose your PHI if you are a member of United States or foreign military forces (including veterans) and if required by the appropriate military command authorities.
National Security. Zepf Center may use and disclose your PHI to federal officials for intelligence and national security activities authorized by law. We also may disclose your PHI to federal officials in order to protect the President. Other officials or foreign heads of state, or to conduct investigations.
Inmates. Zepf Center may disclose your PHI to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. Disclosure for these purposes would be necessary: (a) for the institution to provide health care services to you, (b) for the safety and security of the institution, and/or (c) to protect your health and safety or the health and safety of other individuals.
Workers' Compensations. Zepf Center may release your PHI for workers' compensation and similar programs.
AUTHORIZATION
Uses and/or disclosures, other than those described above will be made only with your written Authorization.
YOUR RIGHTS
The Right to Inspect and Copy. You have the right to inspect and obtain a copy of your PHI that we maintain and have in our possession, including medical records, and billing records, but not including psychotherapy notes. If you request copies, we will charge you a fee for the costs of copying, mailing, labor and supplies associated with your request. To inspect and copy your PHI, you must submit your request in writing.
Under certain circumstances we may deny your request to inspect and copy your PHI. If you are denied access to medical information, you have a right to have that determination reviewed. A licensed health care professional chosen by the Zepf Center will review your request and the denial. The person conducting the review will not be the person who denied your request. Zepf Center promises to comply with the outcome of the review.
*PHI is individually identifiable information (including demographic information) relating to your health, to the health care provided to you or to payment for health care.
The Right to Amend Your PHI. If you feel that any PHI we have about you is not correct or incomplete, you may ask us to amend the information. You have the right to request and amendment for as long as the information is kept by the Zepf Center. To request an amendment, your request must be made in writing. Additionally, you must provide a reason that supports your request.
Zepf Center reserves the right to deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
· Was not created by Zepf Center, unless the person or entity that created the information is no longer available to make the
amendment;
· Is not part of the medical information kept by or for Zepf Center;
· Is not part of the information which you would by permitted to inspect and
copy; or
. Is accurate and complete.
The Right to an Accounting of Disclosures. An accounting of disclosures is a list of the disclosures we have made, if any, of your PHI.
You have the right to request an accounting of disclosures. This right applies to disclosures for purposes other than those made to carry out treatment, payment and health care operations as described in this notice. It excludes disclosures made to you, or those made for notification purposes.
Your request must be made in writing and state a time period that cannot be longer than six years and cannot include any dates before April 13, 2003. Your request should indicate in what form you want the list (e.g. paper, electronically). We may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
The Right to Receive Communications of PHI by Alternative Means or at Alternative Locations. You have the right to request that Zepf Center communicate with you about your health and related issues in a particular manner or at a certain location. For example, you may ask that we contact you at work rather than at home. We will accommodate all reasonable requests made in writing. Your request to receive PHI by alternative means or at an alternative location must clearly state that your life could be endangered by the disclosure of all or part of your PHI.
The Right to Request Restrictions. You have the right to request a restriction or limitation on the PHI we use or disclose about you for treatment, payment or health care operations as described in this notice. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for you care (like a family member or friend), or for notification purposes as described in this notice.
Zepf Center is not required to agree to your request, however, if we do agree, we will comply with your request until we receive notice from you that you no longer want the restriction to apply (except as required by law or in emergency situations).
*PHI is individually identifiable information (including demographic information) relating to your health, to the health care provided to you or to payment for health care.
Any request for a restriction on our use and disclosure of your PHI must be made in writing. Your request must describe in a clear and concise manner: (a) the information you wish restricted; (b) whether you are requesting to limit Zepf Center's use, disclosure or both; and (c) to whom you want the limits to apply.
The Right to Provide an Authorization for Other Uses and Disclosures.
Zepf Center will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provide to use regarding the use and disclosure of your PHI may be revoked at any time in writing. After you revoke your authorization, except under the following circumstances:
· We have taken action in reliance upon your authorization before we received your written revocation;
. You were required to give us your authorization as a condition of obtaining coverage; or
. If state law gives us the right to contest a claim under your policy.
The Right to Obtain a Paper Copy of This Notice. Upon request; you have a right to a paper copy of this notice, even if you have agreed to accept this notice electronically.
How to Contact Us
If you have any complaints or questions about this Notice or you want to submit a written request to Zepf Center as required in any of the previous sections of this Notice, please call us at 419-841-7701, or write to us at the address below:
Attention: Corporate Privacy Officer
Address: Zepf Center
6605 West Central Ave.
Toledo, Ohio 43617
*PHI is individually identifiable information (including demographic information) relating to your health, to the health care provided to you or to payment for health care.
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