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April 14, 2003
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.
This notice describes information about privacy
practices followed by our employees, staff and other office
personnel.
If you have any questions about this notice, please contact
Leigh Ann Byrd of our
office at (760)568-9831,
39000 Bob Hope Dr. K-301 Rancho Mirage, CA
92270.
YOUR HEALTH INFORMATION
This notice applies to the information and records we have
about your health, health status, and the healthcare and services
you receive at this office.
We are required by law to give you this notice. It will tell
you about the ways in which we may use and disclose health
information about you and describes your rights and our obligations
regarding the use and disclosure of that
information.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT
YOU
For
Treatment
We may use health information about you to provide you with medical
treatment or services. We may disclose health information about you
to doctors, nurses, technicians, office staff or other personnel who
are involved in taking care of you and your
health.
For example, your doctor may be treating you for a heart
condition and may need to know if you have other health problems
that could complicate your treatment. The doctor may use your
medical history to decide what treatment is best for you. The doctor
may also tell another doctor about your condition so that doctor can
help determine the most appropriate care for
you.
Different personnel in our office may share information about
you and disclose information to people who do not work in our office
in order to coordinate your care, such as phoning in prescriptions
to your pharmacy, scheduling lab work and ordering X‑rays. Family
members and other healthcare providers may be part of your medical
care outside this office and may require information about you that
we have.
For
Payment
We may use and disclose health information about you so that the
treatment and services you receive at this office may be billed to
and payment may be collected from you, an insurance company or a
third party. For example, we may need to give your health plan
information about a service you received here so your health plan
will reimburse you for the service. We may also tell your health
plan about a treatment you are going to receive to obtain prior
approval, or to determine whether your plan will cover the
treatment.
For
Healthcare Operations
We may use and disclose health information about you in order to run
the office and make sure that you and our other patients receive
quality care.
For example, we may use your health information to evaluate
the performance of our staff in caring for you. We may also use
health information about all or many of our patients to help us
decide what additional services we should offer, how we can become
more efficient, or whether certain new treatments are
effective.
Appointment
Reminders
We may contact you as a reminder that you have an appointment for
treatment or medical care at the
office.
Treatment
Alternatives
We may tell you about or recommend possible treatment options or
alternatives that may be of interest to
you.
Health‑Related
Products and Services
We may tell you about health‑related products or services that may
be of interest to you.
Please notify us if you do not wish to be contacted for
appointment reminders, or if you do not wish to receive
communications about treatment alternatives or health‑related
products and services. If you advise us in writing (at the address
listed at the top of this Notice) that you do not wish to receive
such communications, we will not use or disclose your information
for these purposes.
You may revoke your Consent at any time by
giving us written notice. Your revocation will be effective when we
receive it, but it will not apply to any uses and disclosures that
occurred before that time.
If you do revoke your Consent, we will not be
permitted to use or disclose information for purposes of treatment,
payment or healthcare operations, and we may therefore have to
discontinue providing you with healthcare treatment and
services.
SPECIAL SITUATIONS
We may use or disclose health information about you without
your permission for the following purposes, subject to all
applicable legal requirements and
limitations:
To Avert a Serious Threat to Health or Safety
We
may use and disclose health information about you when necessary to
prevent a serious threat to your health and safety or the health and
safety of the public or another person.
Required
By Law
We will disclose health information about you when required to do so
by federal, state or local law.
Research
We may use and disclose health information about you for research
projects that are subject to a special approval process. We will ask
you for your permission if the researcher will have access to your
name, address or other information that reveals who you are, or will
be involved in your care at the office.
Organ
and Tissue Donation
If
you are an organ donor, we may release health information to
organizations that handle organ procurement or organ, eye or tissue
transplantation or to an organ donation bank, as necessary to
facilitate such donation and
transplantation.
Military,
Veterans, National Security and Intelligence
If you are or were a member of the armed forces, or part of the
national security or intelligence communities, we may be required by
military command or other government authorities to release health
information about you. We may also release information about foreign
military personnel to the appropriate foreign military
authority.
Workers'
Compensation
We may release health information about you for workers'
compensation or similar programs. These programs provide benefits
for work‑related injuries or illness.
Public
Health Risks
We may disclose health information about you for public health
reasons in order to prevent or control disease, injury or
disability; or report births, deaths, suspected abuse or neglect,
non‑accidental physical injuries, reactions to medications or
problems with products.
Health
Oversight Activities
We may disclose health information to a health oversight agency for
audits, investigations, inspections, or licensing purposes. These
disclosures may be necessary for certain state and federal agencies
to monitor the healthcare 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 about you in response to a court or
administrative order. Subject to all applicable legal requirements,
we may also disclose health information about you in response to a
subpoena.
Law
Enforcement
We may release health information if asked to do so by a law
enforcement official in response to a court order, subpoena,
warrant, summons or similar process, subject to all applicable legal
requirements.
Coroners,
Medical Examiners and Funeral Directors
We may release health information to a coroner or medical examiner.
This may be necessary, for example, to identify a deceased person or
determine the cause of death.
Information
Not Personally Identifiable
We may use or disclose health information about you in a way that
does not personally identify you or reveal who you
are.
Family
and Friends
We may disclose health information about you to your family members
or friends if we obtain your verbal agreement to do so or if we give
you an opportunity to object to such a disclosure and you do not
raise an objection. We may also disclose health information to your
family or friends if we can infer from the circumstances, based on
our professional judgment, that you would not object. For example,
we may assume you agree to our disclosure of your personal health
information to your spouse when you bring your spouse with you into
the exam room during treatment or while treatment is
discussed.
In situations where you are not capable of giving consent
(because you are not present or due to your incapacity or medical
emergency), we may, using our professional judgment, determine that
a disclosure to your family member or friend is in your best
interest. In that situation, we will disclose only health
information relevant to the person's involvement in your care. For
example, we may inform the person who accompanied you to the
emergency room that you suffered a heart attack and provide updates
on your progress and prognosis. We may also use our professional
judgment and experience to make reasonable inferences that it is in
your best interest to allow another person to act on your behalf to
pick up, for example, filled prescriptions, medical supplies, or
X‑rays.
OTHER USES AND DISCLOSURES OF HEALTH
INFORMATION
We will not use or disclose your health information for any
purpose other than those identified in the previous sections without
your specific, written Authorization. We must
obtain your Authorization
separate from any Consent
we may have obtained from you. If you give us Authorization to use or
disclose health information about you, you may revoke that Authorization, in writing,
at any time. If you revoke your Authorization, we will no
longer use or disclose information about you for the reasons covered
by your written Authorization, but we cannot
take back any uses or disclosures already made with your
permission.
If we have HIV or substance abuse
information about you, we cannot release that information without a
special signed, written authorization (different than the Authorization and Consent mentioned above)
from you. In order to disclose these types of records for purposes
of treatment, payment or healthcare operations, we will have to have
both your signed Consent
and a special written Authorization that
complies with the law governing HIV or substance abuse
records.
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT
YOU
You have the following rights regarding health information we
maintain about you:
Right
to Inspect and Copy
You have the right to inspect and copy
your health information, such as medical and billing records, that
we use to make decisions about your care. You must submit a written
request to Leigh Ann Byrd in order to inspect and/or
copy your health information. If you request a copy of the
information, we may charge a fee for the costs of copying, mailing
or other associated supplies. We may deny your request to inspect
and/or copy in certain limited circumstances. If you are denied
access to your health information, you may ask that the denial be
reviewed. If such a review is required by law, we will select a
licensed healthcare professional to review your request and our
denial. The person conducting the review will not be the person who
denied your request, and we will comply with the outcome of the
review.
Right
to Amend
If you believe health information we have about you is incorrect or
incomplete, you may ask us to amend the information. You have the
right to request an amendment as long as the information is kept by
this office.
To request an amendment, complete and submit a Medical Record
Amendment/Correction Form to Leigh Ann Byrd. We may deny your
request for an amendment if it is not in writing or does not include
a reason to support the request. In addition, we may deny your
request if you ask us to amend information
that:
a) We did not create, unless the person or entity that
created the information is no longer available to make the
amendment.
b) Is not part of the health information that we
keep.
c) You would not be permitted to inspect and
copy.
d)
Is accurate and complete.
Right
to an Accounting of Disclosures
You have the right to request an "accounting of disclosures." This
is a list of the disclosures we made of medical information about
you for purposes other than treatment, payment and healthcare
operations. To obtain this list, you must submit your request in
writing to It must state a time period,
which may not be longer than six years and may not include dates
before April 14, 2003. Your request should indicate in what form you
want the list (for example, on paper or electronically). We may
charge you for the costs of providing the list. We will notify you
of the cost involved and you may choose to withdraw or modify your
request at that time before any costs are
incurred.
Right
to Request Restrictions
You have the right to request a
restriction or limitation on the health information we use or
disclose about you for treatment, payment or healthcare operations.
You also have the right to request a limit on the health information
we disclose about you to someone who is involved in your care or the
payment for it, like a family member or friend. For example, you
could ask that we not use or disclose information about a surgery
you had.
We
are Not Required to Agree to Your Request
If we do agree, we will comply with your request unless the
information is needed to provide you emergency
treatment.
To request restrictions, you may complete and submit the Request For Restriction On
Use/Disclosure Of Medical Information to
Right
to Request Confidential Communications
You have the right to request that we communicate with you about
medical matters in a certain way or at a certain location. For
example, you can ask that we only contact you at work or by
mail.
To request confidential communications, you may complete and
submit the Request For
Restriction On Use/Disclosure Of Medical Information And/Or
Confidential Communication to Leigh Ann Byrd. We will not ask
you the reason for your request. We will accommodate all reasonable
requests. Your request must specify how or where you wish to be
contacted.
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 it electronically, you are still entitled to a paper
copy. To obtain such a copy, contact Leigh Ann
Byrd.
CHANGES TO THIS NOTICE
We reserve the right to change this notice, and to make the
revised or changed notice effective for medical information we
already have about you as well as any information we receive in the
future. We will post a summary of the current notice in the office
with its effective date in the top right hand corner. You are
entitled to a copy of the notice currently in
effect.
COMPLAINTS
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. To file a complaint with
our office, contact Leigh Ann Byrd 39000 Bob Hope Dr. K-301 Rancho
Mirage, CA 92270You will not be penalized for filing a
complaint.
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