Allergy Associates, PA
dba
The Allergy, Asthma & Sinus Center
Comprehensive Wellness Center
Notice of Privacy Practices for Protected Health Information
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!
Our office is permitted by federal privacy laws to make
uses and disclosures of your health information for
purposes of treatment, payment, and health care
operations. Protected health information is the
information we create and obtain in providing our services
to you. Such information may include documenting your
symptoms, examination and test results, diagnoses,
treatment, and applying for future care or treatment. It
also includes billing documents for those services.
Examples of uses of your health information for treatment
purposes are:
During the course of your treatment, the physician
determines he/she will need to consult with another
specialist in the area. He/she will share the information
with such specialist and obtain his/her input.
Example of use of your health information for payment
purposes:
We submit requests for payment to your health insurance
company. The health insurance company or business
associate helping us obtain payment requests information
from us regarding your medical care given. We will provide
information to them about you and the care given.
Example of Use of Your Information for Health Care
Operations :
We may obtain services from business associates such as
quality assessment, quality improvement, outcome
evaluation, protocol and clinical guidelines development,
training programs, credentialing, medical review, legal
services, and insurance. We will share information about
you with such business associates as necessary to obtain
these services.
Your Health Information Rights
The health and billing records we maintain are the physical property of the doctor's office. You have the following rights with respect to your Protected Health Information
- Request a restriction on certain uses and disclosures
of your health information by delivering the request in
writing to our office-we are not required to grant the
request but we will comply with any request granted;
- Obtain a paper copy of the Notice of Privacy Practices
for Protected Health Information ("Notice") by making a
request at our office;
- Right to inspect and copy your health record and
billing record-you may exercise this right by delivering
the request in writing to our office using the form we
provide to you upon request; appeal a denial of access
to your protected health information except in certain
circumstances;
- Right to request that your health record be amended to
correct incomplete or incorrect entries by delivering a
written request to our office using the form we provide
to you upon request. We are not required by law to make
such amendments; however, you may file a statement of
disagreement if your amendment is denied, and require
that the request for amendment and any denial be
attached in all future disclosures of your protected
health information;
- Right to receive an accounting of disclosures of your
health information as required to be maintained by law
by delivering a written request to our office using the
form we provide to you upon request. An accounting will
not include internal uses of information for treatment,
payment, or operations, disclosures made to you or made
at your request, or disclosures made to family members
or friends in the course of providing care;
- Right to request that communication of your health
information be made by alternative means or at an
alternative location by delivering the request in
writing to our office.
If you want to exercise any of the above rights, please
contact "Privacy Officer" at Allergy Associates, PA, P.O.
Box 51770, Knoxville, TN 37950 in writing. She will
provide you with assistance on the steps to take to
exercise your rights.
Our Responsibilities
This office is required to:
- Maintain the privacy of your health information as
required by law;
- Provide you with a notice as to our duties and privacy
practices regarding the information we collect and
maintain about you;
- Abide by the terms of this Notice;
- Notify you if we cannot accommodate a requested
restriction or request;
- Accommodate your reasonable requests regarding methods
to communicate health information with you; and
- Accommodate your request for an accounting of
disclosures.
We reserve the right to amend, change, or eliminate
provisions in our privacy practices and access practices
and to enact new provisions regarding the protected health
information we maintain. If our information practices
change, we will amend our Notice. You are entitled to
receive a revised copy of the Notice by calling and
requesting a copy of our "Notice" or by visiting our
office and picking up a copy.
To Request Information or File
a Complaint
If you have questions, would like additional information,
or want to report a problem regarding the handling of your
information, you may contact our Privacy Officer.
Additionally, if you believe your privacy rights have been
violated, you may file a written complaint at our office
by delivering the written complaint to our Privacy
Officer. You may also file a complaint by mailing it to
the Secretary of Health and Human Services whose street
address is 200 Independence Avenue, S.W., Washington, D.C.
20201.
- We cannot, and will not, require you to waive the
right to file a complaint with the Secretary of Health
and Human Services (HHS) as a condition of receiving
treatment from the office.
- We cannot, and will not, retaliate against you for
filing a complaint with the Secretary of Health and
Human Services.
Following is a List of Other Uses and Disclosures Allowed
by the Privacy Rule
Patient Contact
We may contact you to provide appointment reminders,
information about treatment alternatives, or information
about other health-related benefits and services that may
be of interest to you.
Notification - Opportunity to Agree or
Object
Unless you object we may use or disclose your protected
health information to notify, or assist in notifying, a
family member, personal representative, or other person
responsible for your care, about your location, and about
your general condition, or your death.
Communication with Family - Using our
best judgment, we may disclose to a family member, other
relative, close personal friend, or any other person you
identify, health information relevant to that person's
involvement in your care or in payment for such care if
you do not object or in an emergency.
We may use and disclose your protected health information
to assist in disaster relief efforts.
Opportunity to Agree or Object
Not Required
Controlling Disease - As required by
law, we may disclose your protected health information to
public health or legal authorities charged with preventing
or controlling disease, injury, or disability.
Child Abuse & Neglect - We may
disclose protected health information to public
authorities as allowed by law to report child abuse or
neglect.
Food and Drug Administration (FDA) - We
may disclose to the FDA your protected health information
relating to adverse events with respect to food,
supplements, products and product defects, or
post-marketing surveillance information to enable product
recalls, repairs, or replacements.
Victims Of Abuse, Neglect, Or Domestic Violence
- We can disclose protected health information to
governmental authorities to the extent the disclosure is
authorized by statute or regulation and in the exercise of
professional judgment the doctor believes the disclosure
is necessary to prevent serious harm to the individual or
other potential victim.
Oversight Agencies - Federal law allows
us to release your protected health information to
appropriate health oversight agencies or for health
oversight activities such as audits, civil, administrative
or criminal investigations; inspections; licensures or
disciplinary actions, and for similar reasons related to
the administration of healthcare.
Judicial/Administrative Proceedings - We
may disclose your protected health information in the
course of a judicial or administrative proceeding as
allowed or required by law, or as directed by a proper
court order or administrative tribunal, provided that the
protected health information released is expressly
authorized by such order, or in response to a subpoena,
discovery request or other lawful process.
Law Enforcement - We may disclose your protected health information for law enforcement purposes as required by law, such as when required by court order, including laws that require reporting of certain types of wounds or other physical injury.
Coroners, Medical Examiners And Funeral Directors
- We may disclose your protected health information to
funeral directors or coroners consistent with applicable
law to allow them to carry out their duties.
Organ Procurement Organizations -
Consistent with applicable law, we may disclose your
protected health information to organ procurement
organizations or other entities engaged in the
procurement, banking, or transplantation of organs, eyes,
or tissue for the purpose of donation and transplant.
Research - We may disclose 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.
Threat To Health And Safety - To avert a
serious threat to health or safety, we may disclose your
protected health information consistent with applicable
law to prevent or lessen a serious, imminent threat to the
health or safety of a person or the public.
For Specialized Governmental Functions -
We may disclose your protected health information for
specialized government functions as authorized by law such
as to Armed Forces personnel, for national security
purposes, or to public assistance program personnel.
Correctional Institutions - If you are
an inmate of a correctional institution, we may disclose
to the institution or it's agents the protected health
information necessary for your health and the health and
safety of other individuals.
Workers Compensation - If you are
seeking compensation through Workers Compensation, we may
disclose your protected health information to the extent
necessary to comply with laws relating to Workers
Compensation.
Other Uses and Disclosures
Other uses and disclosures besides those identified in
this Notice will be made only as otherwise authorized by
law or with your written authorization which you may
revoke except to the extent information or action has
already been taken.
Website
If we maintain a website that provides information about
our entity, this Notice will be on our website at
www.comprehensivesleepwellness.com
Effective Date: April 14, 2003