THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. 

This notice is effective as of October 1, 2015

Uses and Disclosure of Health Information

Zepf Center provides health care to our patients, residents, and clients through physicians and other healthcare professionals and businesses. This notice applies to all of our locations (see “Affiliated Entities”), including:

• All employees, physicians, or volunteers, including students in training.
• Any business associate or partner that uses your health information.

Our Pledge to You

We know your medical information is personal and we are committed to protect your privacy. We create a record of your care and services to meet legal requirements and to provide you with the best possible service of integrated care. This notice applies to your medical record that we maintain for services or services that we provide to you at our locations.

We are required by law:

• To keep medical information about you private.
• To give you this notice, explaining our legal duties to protect your privacy.
• To follow the terms of the notice that is currently in effect.
• To notify you if we fail to protect your privacy.

We may change our policies at any time and the changes will apply to current and any new medical information we collect. Before we make a major change in policy, we will change our notice and post it in waiting areas and on our website at www.zepfcenter.com (scroll to bottom of page and click on “Notice of Privacy Practices”). You may request the current notice at any time. When we change our notice, we will offer you a copy of the current notice at your next visit, and we may ask you to acknowledge in writing your receipt of this notice.

TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS

Zepf Center uses and discloses your protected health information for treatment, payment, and health care operations. Some examples of when our office may use or disclose your health care information for these purposes include:

• Sharing test results with other health care providers for confirmation of a diagnosis
• Providing your diagnosis or other information about your health to your insurance provider or our billing service to obtain payment for the health care services we provide
• Reviewing information as part of our quality improvement program

OTHER USES AND DISCLOSURES

Zepf Center may also use or disclose your protected health information, in compliance with guidelines outlined by law, for the following purposes:

• Providing you with information related to your health
• Treatment (sharing your medical information with other health care providers involved in your care, or to a specialist for a referral)
• Payment (sending billing information to your insurance company or Medicare)
• Health Care Operations (comparing patient data to improve treatment standards)
• Health Information Exchange (HIE) (An HIE manages electronic medical information often shared)
• Contacting you regarding appointments, information about Zepf Center or other health-related services
• Incidental uses or disclosures (e.g., listing your name on a sign-in sheet, etc.); Compliance with all laws (including reports of suspected abuse, neglect or violence); Providing certain specified information to law enforcement or correctional institutions; Providing information to a coroner, medical examiner, funeral director or organ procurement organization
• Public health activities when requested by a public health authority or the FDA. Responding to health oversight agencies
• Responding to court or administrative tribunal orders, subpoenas, discovery requests, or other lawful process
• Research activities
• When necessary to avert a serious threat to health or safety
• Military affairs, veterans affairs, national security, intelligence, Department of State, or presidential protective service activities
• To assist in your health care (e.g. pick-up prescriptions or other documents, note follow-up care instructions, etc.)
• Other required reporting (quality data and patient satisfaction reporting)
• Health oversight audits or inspections (Health Department, Independent Review Organizations, or Accreditation Surveys)

AUTHORIZATION FOR OTHER USES

Zepf Center will make other uses and disclosure of your protected health information only after obtaining your written authorization.  If you authorize a use not contained in this notice, you may revoke your authorization at any time by notifying us in writing that you wish to revoke your authorization.

YOUR RIGHTS REGARDING THE PRIVACY OF YOUR HEALTH INFORMATION

Subject to limitations outlined by law, you have certain rights related to use and disclosure of your protected health information, including the right to:

• Request restrictions on certain uses and disclosures. However, Zepf Center is not obligated to agree to requested restrictions
• Receive confidential communications or protected health information
• Inspect and copy your protected health information with some limited exceptions
• Amend your health information
• Receive an accounting of disclosures of your health information
• Obtain a copy of this notice

ZEPF CENTER’S DUTIES REGARDING THE PRIVACY OF YOUR HEALTH INFORMATION

Subject to limitations outlined by law, Zepf Center has certain duties related to your protected health information, including:

• Zepf Center is required by law to maintain the privacy of protected health information and to provide individuals with notice of our legal duties and privacy practices with respect to protected health information
• Zepf Center is required to abide by the terms of the privacy notice that is currently in effect
• Zepf Center reserves the right to change a privacy practice described in this notice and to make such change effective for all protected health information. Revised notices will be posted on our website and available upon request

CONCERNS

If you have questions about your privacy, please call our Privacy Officer:

Walter Wehenkel

Phone number: 419-841-7701 Ext. 6200   email: [email protected]

No individual will be retaliated against for filing a complaint. 

NOTICE OF PRIVACY PRACTICES