October 1, 2008

HIPAA Notice of Privacy Practices

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.

If you have any questions about this notice, please contact the

Femme Vitale Privacy Officer.

WHAT IS PROTECTED HEALTH INFORMATION?

Protected Health Information includes information transmitted or maintained in any form (electronic means, on paper, or through oral communications) that is created or received by a health care provider, health plan, or health care clearinghouse, or employer.  Protected Health Information 1) relates to the past, present, or future physical or mental health or condition of the patient; the provision of health care to a patient; or the past, present, or future payment for healthcare and 2) identifies the patient or could reasonably be considered information that could be used to identify the patient.   

OUR OBLIGATIONS

We are required by law to

Ÿ  Maintain the privacy of protected health information

Ÿ  Give you this notice of our legal duties and privacy practices regarding health information about you

Ÿ  Follow the terms of our notice that is currently in effect

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION

Described as follows are the ways we may use and disclose health information that identifies you (“Health Information”).  Except for the following purposes, we will use and disclose Health Information only with your written permission.  You may revoke such permission at any time by writing to our practice’s Privacy Officer. 

 

Treatment.  We may use and disclose Health Information for your treatment and to provide you with treatment-related health care services.  For example, we may disclose Health Information to doctors, nurses, technicians, or other personnel, including people outside our office, who are involved in your medical care and need the information to provide you with medical care.

 

Payment.  We may use and disclose Health Information so that we or others may bill and receive payment from you, an insurance company, or a third party for the treatment and services you received.  For example, we may give your health plan information so that they will pay for your treatment. 

 

Health Care Operations.  We may use and disclose Health Information for health care operation purposes.  These uses and disclosures are necessary to make sure that all of our patients receive quality care and to operate and manage our office.  For example, we may use and disclose information to make sure the gynecologic care you receive is of the highest quality.  We also may share information with other entities that have a relationship with you (for example, your health plan) for their health care operation activities.

 

Appointment Reminders, Treatment Alternatives, and Health-Related Benefits and Services.  We may use and disclose Health Information to contact you and to remind you that you have an appointment with us.  We also may use and disclose Health Information to tell you about treatment alternatives or health-related benefits and services that may be of interest to you.

 

Individuals Involved in Your Care or Payment for Your Care.  When appropriate, we may share Health Information with a person who is involved in your medical care or payment for your care, such as your family or a close friend.  We also may notify your family about your location or general condition or disclose such information to an entity assisting in a disaster relief effort.

 

Research.  Under certain circumstances, we may use and disclose Health Information for research.  For example, a research project may involve comparing the health of patients who received one treatment to those who received another for the same condition.  Before we use or disclose Health Information for research, the project will go through a special approval process.  Even without special approval, we may permit researchers to look at records to help them identify patients who may be included in their research project or for other similar purposes, as long as they do not remove or take a copy of any Health Information.   

 

SPECIAL SITUATIONS. 

As Required by Law:  We will disclose Health Information when required to do so by international, federal, state, or local law.

 

To Avert a Serious Threat to Health or Safety.  We may use and disclose Health Information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.  Disclosures, however, will be made only to someone who may be able to help prevent the threat. 

 

Business Associates.  We may disclose Health Information to our business associates that perform functions on our behalf or provide us with services if the information is necessary for such functions or services.  For example, we may use another company to perform billing services on our behalf.  All of our business associates are obligated to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract. 

 

Organ and Tissue Donation.  If you are an organ donor, we may use or release Health Information to organizations that handle organ procurement or other entities engaged in procurement; banking or transportation of organs, eyes, or tissues to facilitate organ, eye, or tissue donation; and transplantation.

 

Military and Veterans.  If you are a member of the armed forces, we may release Health Information as required by military command authorities.  We also may release Health Information to the appropriate foreign military authority if you are a member of a foreign military.

 

Workers’ Compensation.  We may release Health Information for workers’ compensation or similar programs.  These programs provide benefits for work-related injuries or illness.

 

Public Health Risks.  We may disclose Health Information for public health activities.  These activities generally include disclosures to prevent or control disease, injury, or disability; report births and deaths; report child abuse or neglect; report reactions to medications or problems with products; notify people of recalls or products they may be using; inform a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and report to the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence.  We will only make this disclosure if you agree or when required or authorized by law.

 

Health Oversight Activities.  We may disclose Health Information to a health oversight agency for activities authorized by law.  These oversight activities include, for example, audits, investigations, inspections, and licensure.  These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.      

 

Lawsuits and Disputes.  If you are involved in a lawsuit or a dispute, we may disclose Health Information in response to a court or administrative order.  We also may disclose Health Information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

YOUR RIGHTS.  You have the following rights regarding Health Information we have about you:

Right to Inspect and Copy.  You have a right to inspect and copy Health Information that may be used to make decisions about your care or payment for your care.  This includes medical and billing record, other than psychotherapy notes.  To inspect and copy this Health Information, you must make your request, in writing, to the Femme Vitale Privacy Officer.

 

Right to Amend.  If you feel that Health Information we have is incorrect or incomplete, you may ask us to amend the information.  You have the right to request an amendment for as long as the information is kept by and for our office.  To request an amendment, you must make your request, in writing, to the Femme Vitale Privacy Officer.

Right to an Accounting of Disclosures.  You have the right to request a list of certain disclosures we made of Health Information for purposes other than treatment, payment, and health care operations or for which you provided written authorization.  To request an accounting of disclosures, you must make your request, in writing, to the Femme Vitale Privacy Officer.

Right to Request Restrictions.  You have the right to request a restriction or limitation on the Health Information we use or disclose for treatment, payment, or health care operation.  You also have the right to request a limit on the Health Information we disclose to someone involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not share information about a particular diagnosis or treatment with your spouse.  To request a restriction, you must make your request, in writing, to the Femme Vitale Privacy Officer.  We are not required to agree to your request.  If we agree, we will comply with your request unless the information is needed to provide you with emergency treatment.

 

Right to Request Confidential Communication.  You have the right to request that we communicate with your about medical matters in a certain way or at a certain location.  For example, you can ask that we contact you only by mail or at work.  To request confidential communication, you must make your request, in writing, to the Femme Vitale Privacy Officer.  Your request must specify how or where you wish to be contacted.  We will accommodate reasonable requests.  

 

Right to a Paper Copy of This Notice.  You have the right to a paper copy of this notice.  You may ask us to give you a copy of this notice at any time.  Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.  You may obtain a copy of this notice at our web site, www.femmevitale.net.  To obtain a paper copy of this notice, your may make your request to the receptionist or the Femme Vitale Privacy Officer. 

 

CHANGES TO THIS NOTICE

We reserve the right to change this notice and make the new notice apply to Health Information we already have as well as any information we receive in the future.  We will post a copy of our current notice at our office.  The notice will contain the effective date on the first page, in the top right-hand corner.

 

FOR MORE INFORMATION OR TO REPORT A PROBLEM.  For additional information about our privacy policies, you may contact our practice’s Privacy Officer, Susan Cairns, at (269) 982-3366.  If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services.  All complaints must be made in writing.  You will not be penalized for filing a complaint.  The address for the Office of Civil Rights is listed below:

 

Our Office                        Office for Civil Rights

Susan Cairns                    U.S. Department of Health and Human Services

Femme Vitale PLC             200 Independence Avenue, S.W.

Edgewater Center             Room 509F, HHH Building

431 Upton Drive               Washington, D.C.  20201

St Joseph, MI  49085