Notice of Privacy Practices

(Long Form)

Health Insurance Portability and Accountability Act (HIPAA)

 

This notice describes how your medical information may be used and disclosed and how you can get access to this information. Please review it carefully. If you have any questions about this notice, please contact your practitioner at 503.249.7752.

All healthcare providers at Beaumont Health Care Clinic are private practitioners, none of whom do business under the name Beaumont Health Care Clinic.

This Notice of Privacy Practices describes how we, the above named practitioners at Beaumont Health Care Clinic, may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted under the law. It also describes your rights to access and control your protected health information. "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 related healthcare services.

We are required to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice at any time. The new notice will be effective for all protected health information that we maintain at that time. Upon your request, we will provide you with any revised Notice of Privacy Practices, by calling your practitioner and requesting that a revised copy be sent to you in the mail, asking for one at the time of your next appointment or accessing our website www.beaumonthealthcare.com

 

1. Uses and Disclosures of Protected Health Information

The above named practitioners at Beaumont Health Care Clinic will use and disclose your protected health information for treatment, payment and health care operations (TPO).

Your protected health information may be used and disclosed by the your practitioner at Beaumont Health Care Clinic and others outside our clinic that are involved in your care and treatment for the purpose of providing healthcare services to you. Your protected health information may also be used and disclosed to pay your healthcare bills.

Following are examples of the types of uses and disclosures of your protected health care information that we are permitted to make. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by the above named practitioners at Beaumont Health Care Clinic.

Treatment: Your practitioner will use and disclose your protected health information to provide, coordinate or manage your health care and any related services. This includes the coordination or management of your health care with a third party that has already obtained your permission to have access to your protected health information. For example, your practitioner would disclose your protected health information as necessary, to a home health agency that provides care for you. Your practitioner will also disclose protected health information to other health care providers who may be treating you or whom you may be referred, or for consultation purposes. For example, your protected health information may be provided to another health care provider to whom you have been referred to ensure that the health care provider has the necessary information to diagnose or treat you. All protected health information provided will be based on the "minimum amount necessary" and still be able to provide appropriate care.

In addition, your practitioner may disclose your protected health information from time-to-time to another health care provider who, at the request of your practitioner at Beaumont Health Care Clinic, becomes involved in your care by providing assistance with your healthcare diagnosis or treatment.

Payment: Your protected health information will be used, as needed, to obtain payment for your health care services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we recommend for you such as; making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example, obtaining approval for a hospital stay may require that your relevant protected health information be disclosed to the health plan to obtain approval for the hospital admission.

Healthcare Operations: Your practitioner at Beaumont Health Care Clinic may use or disclose, as-needed, your protected health information in order to support her specific business activities. These activities include, but are not limited to, quality assessment activities, training of medical students, licensing, marketing and fundraising activities, and conducting or arranging for other business activities.

For example, your practitioner may disclose your protected health information to medical school students whom see patients at Beaumont Health Care Clinic. In addition, we may also call you by name in the waiting room. We may also use or disclose your protected health information, as necessary, to contact you to remind you of your appointments.

Your practitioner will share your protected health information with third party "business associates" that perform various activities (e.g., billing, transcription services) for the practice. Whenever an arrangement between your practitioner at Beaumont Health Care Clinic and a business associate involves the use or disclosure of your protected health information, your practitioner will have a written contract that contains terms, which will ensure the privacy of your protected health information.

Your practitioner may use or disclose your protected health information, as necessary, to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you. Your practitioner may also use and disclose your protected health information for other marketing activities. For example, your name and address may be used to send you a newsletter about your practitioner's practice and various services offered. We may also send you information about products or services that we believe may be beneficial to you. You may contact your practitioner at any time to request that these materials not be sent to you.

Uses 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 described below. You may revoke this authorization, at any time, in writing, except to the extent that your practitioner has taken an action in reliance on the use or disclosure indicated in the authorization.
 

Other Permitted and Required Uses and Disclosures That May be Made with Your Consent, Authorization or Opportunity to Object

We may use and disclose your protected health information in the following instances. You have the opportunity to agree or object to the use or disclosure of all or part of your protected health information. If you are not present or able to agree or object to the use or disclosure of the protected health information, then your practitioner at Beaumont Health Care Clinic may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the protected health information that is relevant to your health care will be disclosed.

Others Involved in Your Healthcare: Unless you object, your practitioner may disclose to a member of your family, a relative, a close friend or any other person you identify, your protected health information that directly relates to that person's involvement in your health care. If you are unable to agree 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. Your practitioner may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your general condition, location or death. Finally, your practitioner 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.

Emergencies: Your practitioner at Beaumont Health Care Clinic may use or disclose your protected health information in an emergency treatment situation. If this happens, we will try to obtain your consent as soon as reasonably possible after the delivery of treatment.

Communication Barriers: Your practitioner may use and disclose your protected health information, if for any reason you are unable grant consent due to substantial communication barriers and she determines, using professional judgment, that you intend to consent to use or disclosure under the circumstances.
 

Other Permitted and Required Uses and Disclosures that May be Made Without Your Consent, Authorization or Opportunity to Object

Your practitioner at Beaumont Health Care Clinic may use or disclose your protected health information in the following situations without your consent or authorization. These situations include:

Required by Law: Your practitioner may use or disclose your protected health information to the extent that the use or disclosure of is required by law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, as required by law, of any such uses or disclosures.

Public Health: Your practitioner may disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury or disability. We may also disclose your protected health information, if directed by the public health authority, to another government agency that is collaborating with the public health authority.

Communicable Diseases: Your practitioner may disclose your protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.

Health Oversight: Your practitioner may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations and inspections. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.

Abuse or Neglect: Your practitioner may disclose your protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, your practitioner may disclose your protected health information if she believes that you have been a victim of abuse, neglect or domestic violence to the governmental entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.

Food and Drug Administration: Your practitioner may disclose your protected health information to a person or company required by the Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations, track products; to enable product recalls, and to make repairs or replacements, as required.

Legal Proceedings: Your practitioner may disclose protected health information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request or other lawful process.

Law Enforcement: Your practitioner may also disclose protected health information, so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include (1) legal processes as required by law, (2) limited information requests for identification and location purposes, (3) pertaining to victims of a crime, (4) suspicion that death has occurred as a result of criminal conduct, (5) in the event that a crime occurs on the premises of the Beaumont Health Care Clinic, and (6) medical emergency (not on the premises of Beaumont Health Care Clinic) and it is likely that a crime that occurred.

Coroner, Funeral Directors and Organ Donation: Your practitioner may disclose protected health information to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law. Your practitioner may also disclose protected health information to a funeral director, as authorized by law, in order to permit the funeral director to carry out their duties. Your practitioner may disclose such information in reasonable anticipation of death. Protected health information may be used and disclosed for cadaveric organ, eye or tissue donation purposes.

Research: Your practitioner may disclose your protected health information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information.

Criminal Activity: Consistent with applicable federal and state laws, your practitioner may disclose your protected health information, if she believes that the use of disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. Your practitioner may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.

Military Activity and National Security: When the appropriate conditions apply, your practitioner may use or disclose protected health information of individuals who are Armed Forces personnel (1) for activities deemed necessary by appropriate military command authorities, (2) for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits, or (3) to a foreign military authority if you a member of that foreign military services. Your practitioner may also disclose your protected health information to authorized federal officials for conducting national security and intelligence activities, including for the provision of protective services to the President or others legally authorized.

Workers' Compensation: Your protected health information may be disclosed by as authorized to comply with workers' compensation laws and other similar legally-established programs.

Inmates: Your practitioner may use or disclose your protected health information if you are an inmate of a correctional facility and she created or received your protected health information in the course of providing care for you.

Required Uses and Disclosures: Under the law, your practitioner must make disclosures to you when required by the Secretary of the Department of Health and Human Services to investigate or determine compliance with the requirements of Section 164.500et.seq.
 

2. Your Rights

Following is a statement of your rights with respect to your protected health information and brief description of how you may exercise these rights. 

You have the right to inspect and copy your protected health information. This means you may inspect and obtain a copy of protected health information about yourself that is contained in a designated record set for as long as I maintain those records. A "designated record set" contains medical and billing records and any other records that your practitioner uses for making decisions about you.

Under federal law, however, you may not inspect or copy the following records; psychotherapy notes, information compiled in reasonable anticipation of, or use in, a civil, criminal or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information. In some circumstances, you may have a right to have this decision reviewed. Please contact your practitioner 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 you may ask your practitioner at Beaumont Health Care Clinic not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. You may also request that any part of your protected health information not be disclosed 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 you want this restriction to apply. Your request must be in writing.

Your practitioner is not required to agree to a restriction that you may request. If your practitioner believes it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted. If your practitioner does agree to the requested restriction, she may not disclose your protected health information without being in violation of that restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request, in writing, with your practitioner.

You have the right to request to receive confidential communications from your practitioner by alternative means or at an alternative location. Your practitioner will accommodate reasonable requests. Your practitioner 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. Your practitioner will not ask for any explanation from you as to the basis of your request. Please make this request in writing to your practitioner.

You have the right to request that your practitioner amend your protected health information. This means you may request an amendment of your protected health information in a designated record set for as long as your practitioner maintains this information. In certain cases, your practitioner may deny your request for an amendment. If your practitioner denies your request for amendment, you have the right to file a statement of disagreement with your practitioner. She may prepare a rebuttal to your statement and will provide you with a copy of said rebuttal. Any requests for an amendment must be in writing. Please contact your practitioner.

Your have the right to receive an accounting of certain disclosures your practitioner has 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 Practice. It excludes disclosures your practitioner 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 your practitioner, upon request, even if you have agreed to accept this notice electronically.


3. Complaints

You may file a complaint with any of the above name practitioners by notifying her of your complaint. All complaints must be in writing. If you are not satisfied with the resolution of your complaint and believe your privacy rights have been violated by one of the practitioners at Beaumont Health Care Clinic, you may contact the Secretary of Health and Human Services. They can be reached at The Department of Health and Human Services; 200 Independence Ave. SW; Washington, DC 20201. Their phone number is toll free, 1-877-696-6775. Your practitioner will not retaliate against you for filing a complaint.

You may contact any of our practitioners at 503.249.7752 or at http://www.beaumonthealthcare.com/ for further information about the complaint process.