ST. LUKE’S FAMILY HEALTH
NOTICE OF PRIVACY PRACTICES
EFFECTIVE APRIL 14, 2003
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.
We are required by law to maintain the privacy of your health
information and to give you notice of our legal duties and privacy
practices with respect to your protected health information. This
Notice summarizes our duties and your rights concerning your protected
health information. Our duties and your rights are set forth more
fully in 45 C.F.R. part 164. We are required to abide by the terms
of our Notice that is currently in effect.
Uses and Disclosures of Information That We May
Make Without Written Authorization:
We may use or disclose protected
health information for the following purposes without your written
authorization. These examples are
not meant to be exhaustive.
Treatment.
We may use or disclose protected health information
to provide treatment to you. For example, a doctor or staff may
use information in your medical records to diagnose or treat your
condition. Also, we may disclose your information to health care
providers outside our office so that they may help treat you.
Payment.
We may use or disclose protected health information
so that we, or other health care providers, may obtain payment
for treatment provided to you. For example, we may disclose information
from your medical records to your health insurance company to obtain
pre-authorization for treatment or submit a claim for payment.
Healthcare Operations.
We may use or disclose protected health
information for certain health care operations that are necessary
to run our practice and ensure that our patients receive quality
care. For example, we may use information from your medical records
to review the performance or qualifications of physicians and staff,
train staff, or make business decisions affecting our practice.
Required by Law.
We may use or disclose protected health information
to the extent that such use or disclosure is required by law.
Threat to Health or Safety.
We may use or disclose protected
health information to avert a serious threat to your health or
safety or the health and safety of others.
Abuse or Neglect.
We must disclose protected health information
to the appropriate government agency if we believe it is related
to child abuse or neglect, or if we believe that you have been
a victim of abuse, neglect or domestic violence.
Communicable Diseases.
We are required to disclose protected
health information concerning certain communicable diseases to
the appropriate government agency. To the extent authorized by
law, we may also disclose protected health information to a person
who may have been exposed to a communicable disease or may otherwise
be at risk of contracting or spreading the disease or condition.
Public Health Activities.
We may use or disclose protected health information
for certain public health activities, such as reporting information necessary
to prevent or control disease, injury or disability, reporting births and deaths;
or reporting limited information for FDA activities.
Health Oversight Activities.
We may disclose protected health
information to governmental health oversight agencies to help them
perform certain activities authorized by law, such as audits, investigations,
and inspections.
Judicial and Administrative Proceedings.
We may disclose protected
health information in response to an order of a court or administrative
tribunal. We may also disclose protected health information in
response to a subpoena, discovery request or other lawful process
if we receive satisfactory assurances from the person requesting
the information that they have made efforts to inform you of the
request or to obtain a protective order.
Law Enforcement.
We may disclose protected health information,
subject to specific limitations, for certain law enforcement purpose,
including to identify, locate, or catch a suspect, fugitive, material
witness or missing person; to provide information about the victim
of a crime; to alert law enforcement that a person may have died
as a result of a crime; or to report a crime.
National Security.
We may disclose protected health information
to authorized federal officials for national security activities.
Coroners and Funeral Directors.
We may disclose protected health
information to a coroner or medical examiner to identify a deceased
person, determine cause of death, or permit the coroner or medical
examiner to fulfill their legal duties. We may also disclose information
to a funeral director to allow them to carry out their duties.
Organ Donation.
We may use or disclose protected health information
to organ procurement organizations or other entities engaged in
the procurement, banking, or transplantation of cadaveric organs
or tissue.
Research.
We may use or disclose protected health information
for research if approved by an institutional review board or privacy
board and appropriate steps have been taken to protect the information.
Workers’ Compensation.
We may disclose protected health
information as authorized by workers’ compensation laws and
other similar legally established programs.
Appointments and Services.
We may use or disclose protected health
information to contact you to provide appointment reminders, or
to provide information about treatment alternatives or other health
related benefits and services that may be of interest to you.
Marketing.
We may use or disclose protected health information
for limited marketing activities, including face-to-face communications
with you about our services.
Business Associates.
We may disclose protected health information
to our third party business associates who perform activities involving
protected health information for us, e.g., billing or transcription
services. Our contracts with the business associates require them
to protect your health information.
Military.
If you are in the military, we may disclose protected
health information as required by military command authorities.
Inmates or Persons in Police Custody.
If you are an inmate or
in the custody of law enforcement, we may disclose protected health
information if necessary for your health care; for the health and
safety of others; or for the safety or security of the correctional
institution.
Uses and Disclosures of Information That We May
Make Unless You Object.
We may use and disclose protected health
information in the following instances without your written authorization
unless you object.
If you object, please notify the Privacy Contact identified below.
Facility Directories.
Unless you object, we will include your
name, your location in our facility, and your general condition,
in our facility directory. We may disclose the foregoing information
to clergy and to people who ask for you by name.
Persons Involved in your
Health Care.
Unless you object, we may disclose protected health information
to a member of your family,
relative, close friend, or other person identified by you who is
involved in your health care or the payment for your health care.
We will limit the disclosure to the protected health information
relevant to that person’s involvement in your health care
or payment.
Notification.
Unless you object, we may use or
disclose protected health information to notify a family member
or other person
responsible for your care of your location and condition. Among
other things,
we may disclose protected health information to a disaster relief
agency to help notify family members.
Uses and Disclosures of Information That We May
Make With Your Written Authorization.
We will obtain a written
authorization from you before using or disclosing your protected
health information for purposes other
than those summarized above. You may revoke your authorization
by submitting a written notice to the Privacy Contact identified
below.
Your Rights Concerning Your Protected Health
Information.
You have the following rights concerning your protected
health information. To exercise any of these rights, you must submit
a
written request to the Privacy Contact identified below.
Right to Request Additional Restrictions.
Your may request additional
restrictions on the use or disclosure of your protected health
information for treatment, payment or health care operations. We
are not required to agree to a requested restriction. If we agree
to a restriction, we will comply with the restriction unless an
emergency or the law prevents us from complying with the restriction,
or until the restriction is terminated.
Right to Receive Communications by Alternative
Means.
We normally
contact you by telephone or mail at your home address. You may
request that we contact you by some other method or at some other
location. We will not ask you to explain the reason for your request.
We will accommodate reasonable requests. We may require that you
explain how payment will be handles if an alternative means of
communication is used.
Right to Inspect and Copy Records.
You may inspect and obtain
a copy of protected health information that is used to make decisions
about your care or payment for your care. We may charge you a reasonable
cost-based fee for providing the records. We may deny your request
under limited circumstances, e.g., if you seek psychotherapy notes;
information prepared for legal proceedings; or if disclosure may
result in substantial harm to you or others.
Right to Request Amendment to Record.
You may request that your
protected health information be amended. You must explain the reason
for your request in writing. We may deny your request if we did
not create the record unless the originator is not longer available;
if you do not have a right to access the record; or if we determine
that the record is accurate and complete. If we deny your request,
you have the right to submit a statement disagreeing with our decision
and to have the statement attached to the records.
Right to Accounting of Certain Disclosures.
You may receive an
accounting of certain disclosures we have made of your protected
health information after April 14, 2003. We are not required to
account for disclosures for treatment, payment, or health care
operations; to family members or others involved in your health
care or payment; for notification purposes; or pursuant to our
facility directory or your written authorization. You may receive
the first accounting within a 12-month period free of charge. We
may charge a reasonable cost-based fee for all subsequent requests
during that 12-month period.
Right to a Copy of this Notice.
You have the right to obtain
a paper copy of this Notice upon request. You have this right even
if you have agreed to receive the Notice electronically.
Changes to this Notice
We reserve the right to
change the terms of our Notice of Privacy Practices at anytime,
and to make the new Notice provisions effective
for all protected health information that we maintain. If we materially
change our privacy practices, we will prepare a new Notice of Privacy
Practices, which shall be effective for all protected health information
that we maintain. We will post a copy of the current Notice in
our reception area and on our website. You may obtain a copy of
the current Notice in our reception area, or by contacting the
Privacy Contact identified below.
Complaints.
You may complain to the Secretary
of Health and Human Services or to us if you believe your privacy
rights have been violated.
You may file a complaint with us by notifying our Privacy Contact
identified below. All complaints must be in writing. We will
not retaliate against you for filing a complaint.
Privacy Contact.
If you have any questions about
this Notice, or if you want to object to or complain about any
use or disclosure
or exercise any
right as explained above, please contact our Privacy Contact:
Privacy Contact
Carol Johnson
12080 W. McMillan Road
Boise, Idaho 83704
208-375-4955
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