Donald A. deGrange, M.D., L.L.C.
NOTICE OF HEALTHCARE INFORMATION 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.
We are committed to treating and using protected healthcare information about you responsibly. This notice describes the personal information we collect, and how and when we use or disclose that information. It also describes your rights as they relate to your protected healthcare information. This notice is effective April 1, 2003, and applies to all protected healthcare information as defined by federal regulations.
Understanding your health record/information
Each time you visit Donald A. deGrange M.D., L.L.C. a record of your visit is made. Typically, this record contains symptoms, examination and test results, diagnoses, treatment, and a plan for your future care or treatment. This information, referred to as your medical record serves as a:
- Basis for planning your care and treatment
- Means of communication among the many health professionals who contribute to your care
- Legal document describing the care you received
- Means by which you or a third-party payer can verify that services billed were actually provided
- A tool in educating health professions
- A source of data for medical research
- A source of information for public health officials charged with improving the health of this state and the nation
- A tool with which we can assess and continually work to improve the care we render and the outcomes we achieve
Understanding what is in your record and how your healthcare information is used helps you to: ensure its accuracy, better understand who, what, when, where, and why others may access your healthcare information, and make more informed decisions when authorizing disclosure to others.
Your healthcare information rights
Although your healthcare record is the physical property of Donald A. deGrange, M.D., L.L.C., the information belongs to you.
You have the right to:
- Obtain a paper copy of this notice of information practices upon request
- Inspect and copy your health record as provided for in 45 CFR 164.524
- Amend your health record as provided in 45 CFR 164.528
- Obtain an accounting of disclosures of your health information as provided in 45 CFR 164.528
- Request communications of your health information by alternative means or at alternative locations
- Request a restriction on certain uses and disclosures of your information as provided by 45 CFR 164.522
- Revoke your authorization to use or disclose healthcare information except to the extent that action has already been taken
Donald A. deGrange, M.D., L.L.C. is required to:
- Maintain the privacy of your healthcare information
- Provide you with this notice as to our legal duties and privacy practices with respect to information we collect and maintain about you
- Abide by the terms of this notice
- Notify you if we are unable to agree to a requested restriction
- Accommodate reasonable requests you may have to communicate healthcare information by alternative means or at alternative locations
We reserve the right to change our practices and to make the new provisions effective for all protected healthcare information we maintain. Should our information practices change, we will change this notice and make the new notice available upon request. You may request a copy of our notice at any time.
We will not use or disclose your healthcare information without your authorization, except as described in this notice. We will also discontinue to use or disclose your healthcare information after we have received a written revocation of the authorization according to the procedures included in the authorization.
For more information or to report a problem
If you have questions and would like additional information, you may contact the practice’s Privacy Officer at (314)251-3990. If you believe your privacy rights have been violated, you can file a complaint with the practice’s Privacy Officer, or with the Office for Civil Rights, U.S. Department of Health and Human Services at:
Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F, HHH Building
Washington, D.C. 20201
Uses and disclosures of healthcare information
We use and disclose health information about you for treatment, payment and healthcare operations. For example:
Treatment: We may use or disclose your healthcare information to a physician or other healthcare provider providing treatment to you.
Payment: A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include information that identifies you, as well as, your diagnosis, procedures, and supplies used.
Healthcare Operations: Members of the medical staff, the risk or quality improvement manager, or members of the quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality an effectiveness of the healthcare and service we provide.
Business associates: There are some services provided in our organization through contacts with business associates. Examples include physician services in the emergency department and radiology, certain laboratory tests, and a copy service we use when making copies of your healthcare record. When these services are contracted, we may disclose your healthcare information to our business associate so that they can perform the job we’ve asked them to do and bill you or your third-party payer for services rendered. To protect your healthcare information, however, we require the business associate to appropriately safeguard your information.
Notification of family: We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location, and general condition. Healthcare professionals, using their best judgment, may disclose to a family member, other relative, close personal friend or any other person you identify, healthcare information relevant to that person’s involvement in your care or payment related to your care.
Research: We may disclose information to researchers when their research has been approved by an institutional review board which has reviewed the research proposal and established protocols to ensure the privacy of your healthcare information.
Food and Drug Administration (FDA): We may disclose to the FDA healthcare information relative to adverse events with respect to food, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.
Workers compensation: We may disclose healthcare information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.
Public health: As required by law, we may disclose our healthcare information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.
Law enforcement: We may disclose healthcare information for law enforcement purposes as required by law or in response to a valid subpoena. Should you be an inmate of a correctional institution, we may disclose to the institution or agents thereof healthcare information necessary for your health and the health and safety of other individuals.
Federal law makes provision for your healthcare information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes I good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public.
Notice of Healthcare Information Practices: April 1, 2003