Fort Collins Family Physicians | Notice of Privacy Practices

FORT COLLINS FAMILY PHYSICIANS
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.

Your health information is personal, and we are committed to protecting it. Your health information is also very important to our ability to provide you with quality care, and to comply with certain laws. We are required by law to provide you with this notice explaining our privacy practices and how we may use and disclose your protected health information for treatment, payment, and for health care operations, as well as for other purposes that are permitted or required by law.

Duties of Fort Collins Family Physicians: We are required by law to:

maintain the privacy of your health information, also known as “protected health information” or “PHI;”
provide you with this Notice, and
comply with this Notice.

Fort Collins Family Physicians reserves the right to change our privacy practices and to make any such change applicable to the PHI we obtained about you before the change. If a change in our practices is material, we will revise this Notice to reflect the change. You may obtain a copy of any revised Notice and we will also post any revised Notice in our office and on our website.
HITECH Amendments

HITECH: Fort Collins Family Physicians is required to notify patients whose PHI has been breached. Notification must occur by first class mail within 60 days of the event. A breach occurs when an unauthorized use or disclosure that comprises the privacy or security of PHI poses a significant risk for financial, reputational, or other harm to the individual. In the notification, the practice will explain what happened, including the date of both the breach and it’s discovery, the steps the individual should take to protect themselves from potential harm resulting from the breach, and explain what the practice is doing to investigate the breach, mitigate loses, and to protect against future breaches.

Business Associates: Effective 1-01-2012, Fort Collins Family Physicians Business Associate Agreements have been amended to provide that all HIPAA security administrative safeguards, physical safeguards, technical safeguards and security safeguards apply directly to the business associate.

Cash Patients: HITECH states that if a patient pays in full for their services out of pocket they can demand that the information regarding the service not be disclosed to the patient’s third party payer since no claim is being made against the third party payer.

Access to E-Health Records: HITECH gives individuals the right to access their own e-health record in an electronic format and to direct the practice to send e-health records directly to a third party.

THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND PURPOSES FOR WHICH YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED.

Uses and Disclosures for Treatment, Payment and Health Care Operations. We may use or disclose your PHI to provide treatment to you. For example, we may disclose your PHI to physicians, nurses, and other health care personnel in order to provide, coordinate, or manager you health care and any related services.

We may also use or disclose your PHI for payment-related activities. For example, we may use or disclose your PHI to your insurance carrier in order to get paid for treatment provided to you. We may use your PHI to create the bills that we submit to the insurance company.

We may also use or disclose your PHI for health care operations activities. For example, we may use your PHI to evaluate the quality of care you received from us, or to evaluate the performance of those involved with your care. We may also provide your PHI to our attorneys, accountants and other consultants to make sure we are complying with the laws that affect us. We may also provide your PHI to business associates who perform billing, consulting, transcription, or other services for our office.

Other Uses and Disclosures

Appointment Reminders: We may call to remind you of an appointment with our office.
Mail Correspondence: We may send you information in a sealed manner addressed to you via mail pertaining to your protected health information.
Network System: We may use a shared demographic system with the local area health system in order to standardize patient care.
C. Certain Public Health and Other Government-Requested Uses and Disclosures.
The law allows us to disclose PHI without your further written authorization in the following circumstances:

When Required by Law. We disclose PHI when we are required to do so by federal, state or local law.

For Public Health Activities. For example, we disclose PHI when we report suspected child abuse, the occurrence of certain diseases, or adverse reactions to a drug or medical device.

For Reports About Victims of Abuse, Neglect or Domestic Violence. We will disclose your PHI in these reports only if we are required or authorized by law to do so, or if you otherwise agree.

To Health Oversight Agencies. We will provide PHI as requested to government agencies that have authority to audit or investigate our operations.

For Lawsuits and Disputes. If you are involved in a lawsuit, dispute, or other legal action, we may disclose your PHI in response to a court order, warrant, subpoena or other lawful request, but only if efforts have been made to tell you about the request.
To Law Enforcement. We may release PHI if asked to do so by law: (a) in response to a court order, subpoena, warrant, summons or similar process; (b) to identify or locate a suspect, fugitive, material witness or missing person; (c) about the victim of a crime if, under certain limited circumstances, we are unable to obtain the person's agreement; (d) about a death we believe may be due to criminal conduct; (e) about criminal conduct at our facility; (f) in emergency circumstances, to report a crime, its location or victims, or the identity, description or location of the person who committed the crime, and (g) to a coroner or medical examiner holding an inquest or investigation.

To Avert a Serious Threat to Health or Safety. We may disclose your PHI to someone who can help prevent a serious threat to your health and safety or the health and safety of another person or the public.

For Specialized Government Functions. For example, we may disclose your PHI to authorized federal officials for intelligence and national security activities that are authorized by law, or so that they may provide protective services to the President or foreign heads of state or conduct special investigations authorized by law.

For Treatment Options: We may speak to you about treatment programs or options we think may be of interest to you.

To Workers' Compensation or Similar Programs. We may provide your PHI to these programs in order for you to obtain benefits for work-related injuries or illness.

D. Other Uses and Disclosures of Your Protected Health Information.

Other uses and disclosures of your PHI that are not covered by this Notice or the laws that apply to us will be made only with your written authorization. If you give us written authorization for a use or disclosure of your PHI, you may revoke that authorization, in writing, at any time. If you revoke your authorization we will no longer use or disclose your PHI for the purposes specified in the written authorization, except that we are unable to take back any disclosures we have already made with your permission, and are required to retain certain records of the uses and disclosures made when the authorization was in effect.

Your Rights Related to Your Protected Health Information. Although your health record is the physical property of the facility that created it, you have the following rights:

Request Restrictions. You have the right to ask us to limit how we use and disclose your PHI. For example, you can request that we restrict disclosure of your information to someone involved in your care. Any such request must be submitted in writing to our Privacy Officer. We are not required to agree to your request. If we do agree, we will put it in writing and will abide by the agreement except when you require emergency treatment.
The Right to Choose How We Communicate With You. You have the right to ask that we send information to you at a specific address (for example, at work rather than at home) or in a specific manner (for example, by regular mail, or never by telephone). We must agree to your request as long as it would not be disruptive to our operations to do so. You must make any such request in writing, addressed to our Privacy Officer.
The Right to See and Copy Your PHI. Except for limited circumstances, you may look at and copy your PHI if you ask in writing to do so. Any such request must be addressed to our Privacy Officer. In certain situations we may deny your request, but if we do, we will tell you in writing of the reasons for the denial and explain your right to have the denial reviewed. We may charge you a fee for the costs of physical procurement of the records. HITECH expands the right, giving individuals access to their e-health record in an electric health format.
The Right to a Copy of This Notice.
The Right to Correct or Update Your PHI. If you believe that the PHI we have about you is incomplete or incorrect, you may ask us to amend it. Any such request must be made in writing and must be addressed to our Privacy Officer, and must tell the reason for the amendment, as we may deny the request if no reason is given. We will inform you in writing as to whether the amendment will be made or denied. If we agree to make the amendment, we will ask you who else you would like us to notify of the amendment. We may deny your request if you ask us to amend information that:

(1) was not created by us, unless the person who created the information is no longer available to make the amendment;

(2) is not part of the PHI we keep about you;

(3) is not part of the PHI that you would be allowed to see or copy; or

(4) is determined by us to be accurate and complete.

The Right to Get a List of the Disclosures We Have Made. You have the right to get a list of instances in which we have disclosed your PHI. The list will not include, for example, disclosures we have made for your treatment, payment and health care operations purposes, or those made directly to you or your family or friends. Nor will the list include disclosures we have made with your written authorization, for national security purposes or to law enforcement personnel, disclosure of any limited data set, or disclosures made before April 14, 2003.

Your request for a list of disclosures must be made in writing and be addressed to our Privacy Officer. The list we provide will include disclosures made within the last six years unless you specify a shorter period. The first list you request within a 12-month period will be free. You will be charged our costs for providing any additional lists within the 12-month period.

Complaints. If you believe we have violated your medical information privacy rights, you have the right to file a complaint with our facility or directly to the Secretary of the United States Department of Health and Human Services, 200 Independence Ave S.W. Washington, DC 20201. Phone (877) 696-6775.

Any complaints filed with our office must be in writing within 180 days of the suspected violation and can be sent to: the Privacy Officer Fort Collins Family Physicians 2121 E. Harmony Road Suite 370 Fort Collins, CO 80528. You may also contact our Privacy Officer if you have questions or comments about our privacy practices. Effective Date: This Notice of Privacy Practices became effective on April 14, 2003 and was amended on January 1, 2012.