Effective Date: August 15, 2014
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU AS A PATIENT OF THIS PRACTICE MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION. PLEASE REVIEW IT CAREFULLY.
We understand the importance of privacy and are committed to maintaining the confidentiality of your medical information. We make a record of the medical care we provide and may receive such records from others. We use these records to provide or enable other health care providers to provide quality medical care, to obtain payment for services provided to you directly or as allowed by your health plan, and to enable us to meet our professional and legal obligations to operate this medical practice properly. We are required by law to maintain the privacy of protected health information, to provide individuals with notice of our legal duties and privacy practices with respect to protected health information, and to notify affected individuals following a breach of unsecured protected health information. This Notice describes how we may use and disclose your medical information. It also describes your rights and our legal obligations with respect to your medical information. If you have any questions about this Notice, please contact our Privacy Officer: Margaret “Migs” Muldrow, MD.
This medical practice collects health information about you and stores it in an electronic health record/personal health record. This is your medical record. The medical record is the property of this medical practice, but the information in the medical record belongs to you. The law permits us to use or disclose your health information for the following purposes:
- Treatment. We use medical information about you to provide your medical care. We disclose medical information to our employees and others who are involved in providing the care you need. For example, we may share your medical information with other physicians or other health care providers who will provide services that we do not provide, a pharmacist who needs it to dispense a prescription to you, or a laboratory that performs a test. We may also disclose medical information to members of your family or others who can help you when you are sick, injured, or after you die. We may also ask you to have laboratory tests (such as blood or urine tests) and we may use the results to help us reach a diagnosis.
- Payment. We use and disclose medical information about you to obtain payment for the services we provide. For example, we give your health plan the information it requires before it will pay us. We may also disclose information to other health care providers to assist them in obtaining payment for services they have provided to you. We may also disclose your medical information to obtain payment from third parties who may be responsible for such costs, such as family members.
- Health Care Operations. We may use and disclose medical information about you to operate this medical practice. For example, we may use and disclose this information to review and improve the quality of care we provide, or the competence and qualifications of our professional staff. Or we may use and disclose this information to get your health plan to authorize services or referrals. We may also use and disclose this information as necessary for medical reviews, legal services, and audits, including fraud and abuse detection and compliance programs, business planning, and management. We may also share your medical information with our “business associates,” such as our billing service, who perform administrative services for us. We have a written contract with each of these business associates that contains terms requiring them and their subcontractors to protect the confidentiality and security of your protected health information. We may also share your information with other health care providers, health care clearinghouses, or health plans that have a relationship with you when they request this information to help them with their quality assessment and improvement activities, their patient-safety activities, their population-based efforts to improve health or reduce health care costs, their protocol development, case management or care-coordination activities, their review of competence, qualifications and performance of health care professionals, their training programs, their accreditation, certification or licensing activities, or their health care fraud and abuse detection and compliance efforts. We may also share medical information about you with other health care providers, health care clearinghouses, and health plans that participate with us in “organized health care arrangements” (OHCAs) for any of the OHCAs’ health care operations. OHCAs include hospitals, physician organizations, health plans, and other entities which collectively provide health care services. A listing of the OHCAs we participate in is available from the Privacy Officer.
- Appointment Reminders. We may use and disclose medical information, including your home address or the address you wish to place on file for communication, your phone number, and your email address to contact you and remind you about appointments. If you are not home, we may leave this information on your answering machine or in a message left with the person answering the phone.
- Treatment Options. Our practice may use and disclose your medical information to inform you of potential treatment options or alternatives.
- Health-Related Benefits and Services. Our practice may use and disclose your medical information to inform you of health-related benefits or services that may be of interest to you.
- Sign In Sheet. We may use and disclose medical information about you by having you sign in when you arrive at our office. We may also call out your first name when we are ready to see you.
- Notification and Communication with Family. We may disclose your health information to notify or to assist in notifying a family member, your personal representative, or another person responsible for your care about your location, your general condition or, unless you had instructed us otherwise, the event of your death. In the event of a disaster, we may disclose information to a relief organization so that they may coordinate these notification efforts. We may also disclose information to someone who is involved with your care or helps pay for your care. If you are able and available to agree or object, we will give you the opportunity to object prior to making these disclosures, although we may disclose this information in a disaster even over your objection if we believe it is necessary to respond to the emergency circumstances. If you are unable or unavailable to agree or object, our health professionals will use their best judgment in communication with your family and others.
- Marketing. Provided we do not receive any payment for making these communications, we may contact you to give you information about products or services related to your treatment, case management or care coordination, or to direct or recommend other treatments, therapies, health care providers, or settings of care that may be of interest to you. We may similarly describe products or services provided by this practice and tell you which health plans this practice participates in. We may also encourage you to maintain a healthy lifestyle and get recommended tests, participate in a disease management program, provide you with small gifts, tell you about government-sponsored health programs, or encourage you to purchase a product or service when we see you, for which we may be paid. We may receive compensation which covers our cost of reminding you to take and refill your medication, or otherwise communicate about a drug or biologic that is currently prescribed for you. We will not otherwise use or disclose your medical information for marketing purposes or accept any payment for other marketing communications without your prior written authorization. The authorization will disclose whether we receive any compensation for any marketing activity you authorize, and we will stop any future marketing activity to the extent you revoke that authorization. Our practice will also obtain written authorization before adding your name to our opt-in cosmetic emailing list. If you provide us with consent to add your full name and email to the cosmetic emailing list, we may contact you via the email you provide to us to communicate upcoming cosmetic promotions, general dermatologic information, and general Denver Dermatology Center office information, including but not limited to out of office dates and information on events. You may opt out of these emails at any time.
- Sale of Health Information. We will not sell your health information without your prior written authorization. The authorization will disclose that we will receive compensation for your health information if you authorize us to sell it, and we will stop any future sales of your information to the extent that you revoke that authorization.
- Required by Law. As required by law, we will use and disclose your health information, but we will limit our use or disclosure to the relevant requirements of the law. When the law requires us to report abuse, neglect or domestic violence, or respond to judicial or administrative proceedings or to law enforcement officials, we will further comply with the requirement set forth below concerning those activities.
- Public Health or Safety. We may, and are sometimes required by law, to disclose your health information to public health authorities for purposes related to: maintaining vital records, such as births and deaths; notifying a person regarding a potential risk for spreading or contracting a disease or condition; notifying individuals if a product or device they may be using has been recalled; notifying your employer under limited circumstances related primarily to workplace injury or illness, or medical surveillance; preventing or controlling disease, injury, or disability; reporting child, elder, or dependent adult abuse or neglect; reporting domestic violence; reporting to the Food and Drug Administration problems with products or devices and reactions to medications; and reporting disease or infection exposure. When we report suspected elder or dependent adult abuse or domestic violence, we will inform you or your personal representative promptly unless, in our best professional judgment, we believe the notification would place you at risk of serious harm or would require informing a personal representative we believe is responsible for the abuse or harm.
- Health Oversight Activities. We may, and are sometimes required by law, to disclose your health information to health oversight agencies during the course of audits, investigations, inspections, surveys, licensure and disciplinary actions, other civil, administrative and criminal procedures or actions, or other activities necessary for the government to monitor government programs, subject to the limitations imposed by law.
- Lawsuits and Similar Proceedings. Our practice may use and disclose your medical information in response to a court or administrative order if you are involved in a lawsuit or similar proceeding. We may also disclose your medical information in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.
- Judicial and Administrative Proceedings. We may, and are sometimes required by law, to disclose your health information in the course of any administrative or judicial proceeding to the extent expressly authorized by a court or administrative order. We may also disclose information about you in response to a subpoena, discovery request, or other lawful process if reasonable efforts have been made to notify you of the request and you have not objected, or if your objections have been resolved by a court or administrative order.
- Law Enforcement. We may, and are sometimes required by law, to disclose your health information to a law enforcement official for purposes such as: reporting a crime; identifying or locating a suspect, fugitive, material witness, or missing person; complying with a court order, summons, warrant, or grand jury subpoena; regarding a crime victim in certain situations, if we are unable to obtain the person’s agreement; concerning a death we believe has resulted from criminal conduct; regarding criminal conduct in our office; and other law enforcement purposes.
- Coroners. We may, and are often required by law, to disclose your health information to coroners or medical examiners in connection with their investigations of deaths or to identify the deceased individual. If necessary, we also may release information in order for funeral directors to perform their jobs.
- Organ or Tissue Donation. We may disclose your health information to organizations involved in procuring, banking, or transplanting eyes, organs, and tissues.
- Public Safety. We may, and are sometimes required by law, to disclose your health information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of yourself, a particular person, or the general public.
- National Security. Our practice may disclose your medical information to federal officers for intelligence and national security activities authorized by law. We may also disclose your medical information to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.
- Inmates. Our practice may disclose your medical information to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. Disclosure for these purposes would be necessary: (a) for the institution to provide health care services to you, (b) for the safety and security of the institution, and/or (c) to protect your health and safety or the health and safety of other individuals.
- Proof of Immunization. We will disclose proof of immunization to a school that is required to have it before admitting a student when you have agreed to the disclosure on behalf of yourself or your dependent.
- Specialized Government Functions. We may disclose your health information for military or national security purposes, or to correctional institutions or to law enforcement officers that have you in their lawful custody.
- Workers Compensation. We may disclose your health information as necessary to comply with workers’ compensation laws. For example, to the extent your care is covered by workers’ compensation, we will make periodic reports to your employer about your condition. We are also required by law to report cases of occupational injury or occupational illness to the employer or workers’ compensation insurer.
- Change of Ownership. In the event that this medical practice is sold or merged with another organization, your health information/record will become the property of the new owner, although you will maintain the right to request that copies of your health information be transferred to another physician or medical group.
- Breach Notification. In the case of a breach of unsecured protected health information, we will notify you as required by law. If you have provided us with a current e-mail address, we may use e-mail to communicate information related to the breach. In some circumstances our business associate may provide the notification. We may also provide notification by other methods as appropriate. [Note: Only use e-mail notification if you are certain it will not contain PHI and it will not disclose inappropriate information. For example, if your e-mail address is “digestivediseaseassociates.com” an e-mail sent with this address could, if intercepted, identify the patient and their condition.]
- Psychotherapy Notes. We will not use or disclose your psychotherapy notes without your prior written authorization except for the following: 1) use by the originator of the notes for your treatment, 2) for the training of our staff, students, and other trainees, 3) to defend ourselves if you sue us or bring some other legal proceeding, 4) if the law requires us to disclose the information to you or the Secretary of HHS, or for some other reason, 5) in response to health oversight activities concerning your psychotherapist, 6) to avert a serious and imminent threat to health or safety, or 7) to the coroner or medical examiner after you die. To the extent you revoke an authorization to use or disclose your psychotherapy notes, we will stop using or disclosing these notes.
- Research. Our practice may use and disclose your medical information for research purposes in certain limited circumstances. We will obtain your written authorization to use your medical information for research purposes except when: (a) our use or disclosure was approved by an Institutional Review Board or a Privacy Board; (b) we obtain the oral or written agreement of a researcher that (i) the information being sought is necessary for the research study, (ii) the use or disclosure of your medical information is being used only for the research, and (iii) the researcher will not remove any of your medical information from our practice; or (c) the medical information sought by the researcher only relates to the decedents and the researcher agrees either orally or in writing that the use or disclosure is necessary for the research and, if we request it, to provide us with proof of death prior to access to the medical information of the decedents.
- Fundraising. We may use or disclose your demographic information in order to contact you for our fundraising activities. For example, we may use the dates that you received treatment, the department of service, your treating physician, outcome information, and health insurance status to identify individuals that may be interested in participating in fundraising activities. If you do not want to receive these materials, notify the Privacy Officer listed at the top of this Notice of Privacy Practices and we will stop any further fundraising communications. Similarly, you should notify the Privacy Officer if you decide that you want to start receiving these solicitations again.
B. WHEN THIS MEDICAL PRACTICE MAY NOT USE OR DISCLOSE YOUR HEALTH INFORMATION
Except as described in this Notice of Privacy Practices, this medical practice will, consistent with its legal obligations, not use or disclose health information that identifies you without your written authorization. If you do authorize this medical practice to use or disclose your health information for another purpose, you may revoke your authorization in writing at any time.
C. YOUR HEALTH INFORMATION RIGHTS
- Right to Request Special Privacy Protections. You have the right to request restrictions on certain uses and disclosures of your health information by a written request specifying which information you want to limit; whether you are requesting to limit our practice’s use, disclosure, or both; and to whom you want the limits to apply. You have the right to request that we restrict our disclosure of your medical information to only certain individuals involved in your care, including medical doctors to whom you are referred and other medical doctors necessary to diagnose or treat your condition, as well as their staff, or the payment for your care, such as family members and friends. If you tell us not to disclose information to your commercial health plan concerning health care items or services for which you paid for in full out-of-pocket, we will abide by your request, unless we must disclose the information for treatment or legal reasons. We reserve the right to accept or reject any other request, and will notify you of our decision; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you. Please note: we may contact you using any and all of the contact information you provide to us in your medical record, including but not limited to: mobile phone, home phone, email, and home address. We may leave a voice mail with confidential health information on any of the mail boxes for any of the phone numbers that you provide to us. We also may mail confidential health information to any of the addresses that you provide to us.
- Right to Request Confidential Communications. You have the right to request that you receive your health information in a specific way or at a specific location, such as a specific email address or mailing address. For example, you may ask that we send information to a particular e-mail account or to your work address. We will comply with all reasonable requests submitted in writing which specify how or where you wish to receive these communications. Please note: we may contact you using any and all of the contact information you provide to us in your medical record, including but not limited to: mobile phone, home phone, email, and home address. We may leave a voice mail with confidential health information on any of the mail boxes for any of the phone numbers that you provide to us. We may also mail confidential health information to any of the addresses that you provide to us.
- Right to Inspect and Copy. You have the right to inspect and copy your health information, with limited exceptions. To access your medical information, you must submit a written request detailing what information you want access to, whether you want to inspect it or get a copy of it, and if you want a copy, your preferred form and format. We will provide copies in your requested form and format if it is readily producible, or we will provide you with an alternative format you find acceptable, or if we can’t agree and we maintain the record in an electronic format, your choice of a readable electronic or hard copy format. We will also send a copy to any other person you designate in writing. We will charge a reasonable fee which covers our costs for labor, supplies, postage, and if requested and agreed to in advance, the cost of preparing an explanation or summary. We may deny your request under limited circumstances. If we deny your request to access your child’s records or the records of an incapacitated adult you are representing because we believe allowing access would be reasonably likely to cause substantial harm to the patient, you will have a right to appeal our decision. If we deny your request to access your psychotherapy notes, you will have the right to have them transferred to another mental health professional.
- Right to Amend or Supplement. You have a right to request that we amend your health information that you believe is incorrect or incomplete for as long as the information is kept by or for our practice. You must make a request to amend in writing and include the reasons you believe the information is inaccurate or incomplete. We are not required to change your health information, and will provide you with information about this medical practice’s denial and how you can disagree with the denial. We may deny your request if we do not have the information, if we did not create the information (unless the person or entity that created the information is no longer available to make the amendment), if you would not be permitted to inspect or copy the information at issue, if the information is accurate and complete as is, or if the information is not part of the medical information kept by or for the practice. If we deny your request, you may submit a written statement of your disagreement with that decision and we may, in turn, prepare a written rebuttal. All information related to any request to amend will be maintained and disclosed in conjunction with any subsequent disclosure of the disputed information.
- Right to an Accounting of Disclosures. You have a right to receive an “accounting of disclosures” of your health information made by this medical practice, except that this medical practice does not have to account for the disclosures provided to you or pursuant to your written authorization, or as described in paragraphs 1 (treatment), 2 (payment), 3(health care operations), 8 (notification and communication with family), and 23 (specialized government functions) of Section A of this Notice of Privacy Practices, or disclosures for purposes of research or public health, which exclude direct patient identifiers, or which are incident to a use or disclosure otherwise permitted or authorized by law, or the disclosures to a health oversight agency or law enforcement official to the extent this medical practice has received notice from that agency or official that providing this accounting would be reasonably likely to impede their activities. In order to obtain an “accounting of disclosures,” you must submit your request to us in writing. All requests for an “accounting of disclosures” must state a time period, which may not be longer than six (6) years from the date of disclosure and may not include dates before April 14, 2003. The first list you request within a 12 month period is free of charge, but our practice may charge you for additional lists within the same 12 month period. Our practice will notify you of the costs involved with additional requests and you may withdraw your request before you incur any costs.
- Right to a Paper or Electronic Copy of this Notice. You have a right to notice of our legal duties and privacy practices with respect to your health information, including a right to a paper copy of this Notice of Privacy Practices, even if you have previously requested its receipt by e-mail.
- Right to Provide an Authorization for Other Uses and Disclosures. Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization that you provide to us regarding the use and disclosure of your medical information may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your medical information for the reasons described in the authorization. Please note, we are required to retain records of your care.
If you would like to have a more detailed explanation of these rights or if you would like to exercise one or more of these rights, contact our Privacy Officer listed at the top of this Notice of Privacy Practices.
D. CHANGES TO THIS NOTICE OF PRIVACY PRACTICES
We reserve the right to amend this Notice of Privacy Practices at any time in the future. Untilsuch amendment is made, we are required by law to comply with the terms of this Notice currently in effect. After an amendment is made, the revised Notice of Privacy Practices will apply to all protected health information that we maintain, regardless of when it was created or received. We will keep a copy of the current Notice posted in our reception area and a copy will be available at each appointment. We will also post the current Notice on our website.
If you believe that your privacy rights have been violated, you may file a complaint with our practice or with the Security of the Department of Health and Human Services. To file a complaint with our practice, contact our office directly. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
Welcome to our office. We want your experience to be a good one.
From time to time, you will be asked to update your personal and insurance information, including presenting us with a copy of your insurance card. It is important that we have accurate and current information so that we can contact you in an emergency, give you the results of any test, handle prescription refills, and bill your insurance correctly.
OPTIONS FOR PAYING FOR YOUR CARE
If you do not have insurance, we do not accept your insurance, medical services are not covered by your insurance, or you do not wish to use your insurance, feel free to ask for a discounted cash rate for medical care. Please note that we cannot accept cash from Medicare or Medicaid patients unless the service is deemed to be “not medically necessary.”
If you have insurance and would like us to bill this insurance for covered medical services, we are happy to help! Please understand insurance billing requirements and our office payment policy. Your insurance is a contract between you, your employer, and the insurance company. It is your responsibility to ensure that the insurance information we have for you is correct, to understand your coverage, to obtain the necessary referrals and authorizations for care, and to pay your copay at the time of service. If your insurance plan requires you to provide a referral to see a specialty physician, you are fully responsible for requesting that your primary care physician send this referral directly to your insurance company. If your insurance company does not receive your referral before your visit to our office, you will be financially responsible for the full payment from your visit. These are insurance requirements. Failure to comply with these requirements could result in penalties and/or expulsion from your insurance plan. We will do everything we can to assist you in meeting these insurance requirements.
Filing insurance claims is a courtesy and all charges are your responsibility from the date the services are rendered. If you would like us to bill your insurance for medical services, we will ask that you supply us with a Visa, MasterCard, or HSA debit card at the time of service. We will file your claim with your insurance carrier in a timely manner. Payment of all billed services is expected within 60 days. Once payment is received by your insurance company, the remaining balance will automatically be charged to your credit or debit card on file. If your insurance company fails to pay within the 60 days, it will become your responsibility to pay your account in full. For all charges to your credit or debit card on file, we will provide you with a courtesy phone call, charge the card, and mail you a receipt.
We sell cosmetic products in the office as a service to you.
All cosmetic services require a 48 hour notice for cancellation. In the event that we do not receive a 48 hour notice, you will be charged a 50% cancellation fee. We will ask that you supply us with a credit card to place on your file to secure your appointment, and will provide you with a courtesy phone call, charge this card, and mail you a receipt if you cancel outside of the 48 hour window before your appointment.
We accept cash (exact amount), checks, Visa, MasterCard, and HSA debit cards (when appropriate). Payment for cash discounted medical services, copays, cosmetic products, cosmetic services, and procedures are due in full at the time of service.