NOTICE
OF PRIVACY PRACTICES
AS
REQUIRED BY THE HEALTH INSURANCE
PORTABILITY
AND ACCOUNTABILITY
ACT
OF 1996
(EFFECTIVE
OCTOBER 29, 2002)
NVSDC
IS REQUIRED BY LAW TO MAINTAIN THE PRIVACY OF YOUR PROTECTED
HEALTH INFORMATION AND TO
PROVIDE
YOU WITH A WRITTEN STATEMENT OF OUR PRIVACY PRACTICES.
THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE
USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS
INFORMATION.
PLEASE
REVIEW IT CAREFULLY .
ROUTINE
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
NVSDC
may disclose any information you provide to other Physicians,
Healthcare Providers, Insurance Companies and /or representatives
of any of the entities for the purpose of your ongoing
medical treatment . This may include information
relating to your current diagnosis, past history, and
treatment by other providers. Entities with which this
information may be exchanged may include laboratories,
testing facilities and providers of home equipment or
home care services.
NVSDC
may disclose any information you provide to other Physicians,
Healthcare Providers, Insurance Companies and/or representatives
of any of these entities for the purpose of obtaining
payment or authorization of payment for services
that are either provided by us directly or requested by
us, on your behalf, from other Healthcare Providers. This
may include such identifying information as date of birth,
insurance policy and identification numbers, employer,
information relating to your diagnosis or symptoms, past
treatment history and treatment plan. Entities may include
insurance company claim representatives, case managers
and other physicians or healthcare providers and their
staff.
NVSDC
may disclose any information you provide for the purpose
of healthcare operations. This may include information
pertaining to your diagnosis or condition, medical treatment
and insurance coverage. Entities and/or their representatives
with which this information may be exchanged may include
public health officials, auditors, law enforcement officials.
NVSDC
may use information that you provide for the purpose
of contacting the patient or an authorized or legal representative
of the patient . Reasons for contact may be to provide
information pertaining to treatment options, test results,
appointments and billing issues. This contact may be via
telephone, mail or electronic exchange. It is understood
that a reasonable attempt will be made on behalf of the
provider to either confirm identity of the patient prior
to disclosing information or to address correspondence
in a manner such that the patient is identified as the
sole intended recipient of the information.
PERSONAL
ACCESS TO AND OTHER AUTHORIZED NON-ROUTINE DISCLOSURES
OF YOUR PROTECTED HEALTH INFORMATION.
Non-routine
uses and disclosures of your protected health information
may be made only with your written authorization .
This may include requests for information from insurance
companies other than your current payor, attorneys, social
security/disability entities and yourself. This
authorization may be made for a specific purpose or time
frame and may be revoked in writing by you or your legal
representative at any time.
You
have the right to obtain copies of medical records pertaining
to your treatment provided by NVSDC including an accounting
of disclosures of your information. Requests for copies
of your medical records must be made in writing and must
include specific items, treatment dates and/or procedures.
These records, by state law, are subject to a charge of
$0.50/page for the first 50 pages and $0.25/page for every
page thereafter in addition to a $10.00 Search and Retrieval
fee per request. NVSDC is legally prohibited from disclosing
to you any medical information regarding treatment made
to you by other Healthcare Providers.
Please
note that the situational examples given above for both
routine and non-routine disclosures of your information
are neither exclusive nor all inclusive .
PATIENT
RIGHT TO RESTRICTION OF DISCLOSURES AND RIGHT TO REQUEST
AMENDMENTS TO PERSONAL INFORMATION
You
have the right to request restrictions on certain uses
and disclosures as outlined above. Requests must be made
in writing and directed to the HIPAA Compliance Office
for NVSDC. Such requests will be reviewed and considered;
however, NVSDC is not required or bound by any regulation
to agree to requested restrictions.
You
have the right to request amendments to your protected
health information. Any such request must be made in writing
and must provide specific reason(s) to support the requested
amendment. NVSDC reserves the right to deny such requests
in the event that the protected medical information is
deemed to be true, complete and accurate as determined
by your Medical Provider. In the event of a denial of
an amendment, NVSDC is required to notify you in writing
as to the reason(s) for the denial. You may, in turn,
make a statement of disagreement in writing, which will
be added to your permanent record.
PROCEDURE
FOR COMPLAINTS
In
the event that you believe that your medical privacy has
been compromised, you must contact our HIPAA Compliance
Officer at 703-391-8804. All formal disagreements or complaints
must be made in writing, stating specific reason(s) for
the complaint, and directed to the attention of:
HIPAA
Compliance Officer, NVSDC
C/O
Pulmonary and Critical Care Specialists of Northern Virginia
3650
Joseph Siewick Drive, Suite 307
Fairfax,
VA 22033-1719
You
may, in addition, contact the Secretary of Health and
Human Services. Individuals will not be retaliated against
for filing complaints.
NVSDC
reserves the right to change the terms of the notice of
privacy practices and make new provisions effective for
all protected health information that we maintain. Should
our privacy practices change, you will be provided with
a revised notice.
Additional
copies of this notice may be obtained upon request.
