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Notice of Privacy Practices

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Notice of Privacy Practices 

This notice describes how protected medical information about you may be used and disclosed and how you can gain access to this information.

The privacy of your health information is important to us. OBGYN WEST is required by law to maintain the security and confidentiality of your medical information as well as other identifiable information such as your name, address, and telephone number. We are required to extend certain protections to your “Protected Health Information” (PHI), which includes any identifiable information about your past, present, or future health care services or payment for your health care.

We are required by law to provide you with this notice regarding our legal duties and our privacy practices. We are required to abide by the terms of the notice currently in effect. We reserve the right to change our Privacy Practices and the terms of this notice at any time. For example, if privacy laws change, we will change our practices to comply with the law. OBGYN WEST will provide you, at your request, a copy of any revised Notice of Privacy Practices at the time of your appointment, in the mail, or you may view the revised Notice of Privacy Practices, which will be posted on our web site (www.OBGYNWEST.net) and in our offices.

Uses and Disclosures of Your Health Information

OBGYN WEST is permitted to make uses and disclosures of your protected health information. For some of these purposes, we are required to obtain your consent. For others we may be required to obtain your individual authorization. In a limited number of circumstances we will be authorized by law to disclose your protected health information without your consent or authorization.

Following is a description of these uses and disclosures:

• For treatment – We may use or disclose your protected health information to provide and coordinate your care and treatment and any other related services. For example, we will disclose your protected health information as necessary to a health care provider or agency that provides care to you. We may also provide your protected health information to a specialist, laboratory, or pharmacy that is involved in your care by providing assistance with diagnosis or treatment.
• For payment – We may disclose your health information to coordinate claims processing and payment from third party payors. This may include activities such as needed for your health plan to determine eligibility and benefits and utilization review activities. Information on or accompanying the bill may include information that identifies you as well as your diagnosis, procedures and supplies used.
• For health care operations – We may disclose your health information to support the business activities of OBGYN WEST. These activities include but are not limited to, quality assessment activities, employee and health care professional review activities, staff training and other business activities. For example, we may disclose your protected health information by calling you by name in clinic areas. We may also disclose your protected health information to OBGYN WEST business associates that perform activities and conduct health care operations on behalf of OBGYN WEST.

Minnesota Patient Consent for Disclosures

For some disclosures described above we are required by Minnesota law to obtain written consent from you.

Other Uses and Disclosures

OBGYN WEST is permitted or required, under specific circumstances, to use or disclose protected health information without your written authorization. These disclosures include those required by law such as:

1. for public health issues such as the reporting of certain communicable diseases or to the state immunization registry
2. for reporting of abuse or neglect
3. to government agencies authorized to conduct audits or investigations such as the Food and Drug administration for reporting adverse events, or recalls of products
4. for legal proceedings in response to a court order, and in certain circumstances in response to a subpoena, discovery request or other lawful process
5. to law enforcement officials in response to a warrant, for the purpose of identifying or locating a suspect, witness or missing person or to provide information concerning victims of crimes
6. in certain instances to coroners and medical examiners during investigations, funeral directors so that they can carry out their duties, and to organizations that handle organ donations
7. to researchers if certain measures are taken to protect your health information
8. to the extent necessary to avoid a serious health threat to your health or safety or to the health or safety of others
9. to armed forces personnel under certain circumstances and to authorized federal officials for national security and intelligence
10. to your correctional facility to help provide your health care or to provide safety to you or others, if you are an inmate at a correctional facility
11. as required by worker’s compensation laws
12. to the Secretary of the Department of Health and Human Services to investigate or determine compliance with the federal requirements for protected health information.

Other uses and disclosures will be made only with your written authorization, unless otherwise permitted by law and you may revoke such authorization in writing at any time. Your revocation will not affect any uses or disclosures permitted by your authorization while it was in effect.

OBGYN WEST may contact you by telephone or mail to provide test results, appointment reminders, or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Your Rights Regarding Your Medical Information

The health and billing records we maintain are the physical property of OBGYN WEST. You have the following rights regarding your medical information:

Right to Inspect and Copy: You have the right to inspect and copy medical information that may be used to make decisions about your care. (Usually, this includes medical and billing records but does not include psychotherapy notes.)
     To inspect and /or copy medical information about you, contact OBGYN WEST. If you request a copy of the information, we will charge a fee for the costs of copying, mailing or other expenses associated with your request.

Right to Amend: If you feel that medical information OBGYN WEST has about you 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 or for OBGYN WEST.
     To request a change, you must submit it in writing to OBGYN WEST. You must also provide a reason that supports your request. We may deny your request for a change if it is not in writing or does not include a reason to support the request. In addition, we may deny your request to change information if the information:

• was not created by us, unless the person or company that created the information is no longer available to make the amendment
• is not part of the medical information kept by or for us
• is not part of the information which you would be permitted to inspect and copy under the law
• is accurate and complete.

Right to an Accounting of Disclosures: You have the right to ask for an accounting of disclosures. This is a list of the disclosures we made of medical information about you to others, except for purposes of treatment, payment and operations identified earlier.
     To request an accounting of disclosures list, you must submit your request in writing to OBGYN WEST. The requirement that we provide you with information about the times we have disclosed your protected health information applies for six years from the date of the disclosure. This applies to disclosures made on or after April 14, 2003.

Right to Request Restrictions: You have the right to ask that we limit the information we use or disclose about you or treatment, payment or health care operations. You also have the right to ask for a limit on the medical information we provide about you to someone who is involved in your care, like a family member or friend.
     We are not required to agree to your request. If we do agree, we will complete your request unless the information is needed to provide emergency treatment.
     To request restrictions, you must submit your request in writing to OBGYN WEST. In your request, you must tell us what information you want to limit, whether you want to limit our use, disclosure or both and to whom you want the limits to apply, for example disclosures to your spouse.

Right to Ask for Private Communications: Periodically, we may contact you by phone, postcard reminders, or other means to the location identified in our records. You have the right to receive confidential communications of protected health information from us by alternative means or at an alternative location. We will make every effort to accommodate reasonable requests to communicate with you. We will not request an explanation from you related to the basis for the request, however, for our records, we will need your request in writing. It is important that you understand that any payment or payment information may be sent to the original address in our records unless you discuss alternative payment options with our business office.

Right to a Paper Copy of the Complete Notice: You have the right to a paper copy of OBGYN WEST’S complete privacy notice. You may ask us to give you a copy of the privacy notice at any time by requesting a copy from any member of our clinic staff.

Individuals may complain to OBGYN WEST and to the Secretary of the Department of Health and Human Services, without fear of retaliation by the organization, if they believe their privacy rights have been violated. A brief description of how the individual may file a complaint follows:

If you feel we may have violated your privacy rights, or you disagree with a decision we made about access to your protected health information, you may either:

Contact OBGYN WEST Privacy Officer at:

OBGYN WEST
Attn: Privacy Officer, 952-249-2036
250 North Central Ave., Suite 103
Wayzata, MN 55391

or

Secretary of Health and Human Services
1-800-368-1019
Medical Privacy Complaint Division
Office of Civil Rights
U.S. Dept of Health and Human Services
200 Independence Ave. SW
Washington, DC 20201

THIS NOTICE IS FIRST IN EFFECT ON APRIL 14, 2003