Family Practice Physicians
10301 Glacier Highway · Juneau, AK 99801
Revised: November 11, 2013
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.
OUR PLEDGE REGARDING MEDICAL INFORMATION:
We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at Family Practice Physicians. We need this record to provide you with quality care and to comply with certain legal requirements. We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information
Family Practice Physicians is providing you this notice in order to explain the impacts of new federal laws detailing exactly how medical information about you may be used and disclosed. Family Practice Physicians is required by law to abide by the terms of this notice. If you have any questions about it, please contact the Family Practice Physicians Compliance Officer at 789-3418. We will be happy to answer any of your questions or concerns.
TO REPORT A PROBLEM
Family Practice Physicians (FPP) is mandated by Federal and State of Alaska law to maintain the privacy of your confidential information. It is a mandate that we at FPP take very seriously. If you believe your privacy rights have been violated, you can file a complaint with FPP, by contacting Katrina Paddock, Compliance Officer at 789-3418 or with the Secretary of Health and Human Services. You will not be penalized for filing a complaint.
HOW FPP MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
The following describes different ways that we use and disclose medical information. For each use or disclosure we will explain what we mean and try to give some examples. Not every use or disclosure will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the following.
Treatment: FPP may use medical information about you to provide you with medical treatment or services. For example: Information obtained by a nurse, physician, or other member of your healthcare team will be recorded in your record and used to determine the course of treatment that should work best for you. Your physician will record instructions for other members of your healthcare team, who in turn will then record their action and their observations. In that way, the physician will know how you are responding to treatment.
We may also provide your referring or consulting physician with copies of various reports that should assist him or her in treating you.
Payment: We will use your health information for payment. For example: A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures and supplies used.
Health Care Operations: We will use your health information for regular health operations. For example: Members of the medical staff, the risk or quality improvement manager, or members of the quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the healthcare and service we provide.
Marketing: We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services at BRH that may be of interest to you.
Individuals Involved in Your Care or Payment for Your Care: FPP may release medical information about you to a family member or personal representative who is involved in your medical care or who helps pay for your care. FPP may also tell your family or representative your condition. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.
Research: We may disclose information to researchers. An institutional review board must approve the researchers. The board must review the research proposal and establish protocols to ensure the privacy of your health information. Alaska law places restrictions on the type of information that may be released in research related to substance abuse.
As Required By Law: FPP may use or disclose your protected health information for law enforcement purposes as required by law or in response to valid subpoena. For example: To the FDA health information relative to adverse events with a medication.
To Avert a Serious Threat to Health or Safety: FPP may use and disclose medical 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. Any disclosure would be to someone able to help prevent the threat.
Business Associates: There are some services provided by FPP through contracts with other agencies. FPP may disclose your health information to these business associates so that they can perform services for FPP. For example: Transcriptionist or FPP retained attorneys. To protect your health information, however, we require the business associate to appropriately safeguard your information.
Photography, Videotaping and Audio Taping: To document patient care a number of visual or audio means, including photography, videotaping and digital imaging may be used. A separate consent is required should FPP wish to photograph. Federal law also requires that FPP obtain an authorization from you for the release of this media for purposes beyond treatment, payment and healthcare operations.
Organ and Tissue Donation: If you are an organ donor, FPP may release medical information to organizations that handle procurement or transplantation or to an organ donation bank as necessary to facilitate organ or tissue donation and transplantation.
Military and Veterans: If you are a member of the armed forces, FPP may release medical information about you as required by military command authorities.
Workers’ Compensation: FPP may disclose medical information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
Public Health Risks: As required by Federal and State of Alaska Law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, disability, to report births and deaths, to report child and elder abuse or neglect, to report reactions to medications or problems with products, also to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition. State of Alaska Law requires reporting of the birth defects registry, cancer registry, communicable diseases, firearm injuries and blood lead test results.
Finally, we may notify the appropriate government authority if we believe a patient has been a victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.
Health Oversight Activities: FPP may disclose medical information to a health oversight agency for activities authorized by law. For example: Audits, investigations, inspections and licensure.
Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, FPP may disclose medical information about you in response to a court order. We may also disclose medical information about you in response to a subpoena or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
Law Enforcement: FPP may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena or warrant.
Coroners, Medical Examiners and Funeral Directors: FPP may disclose health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or to determine the cause of death. We may disclose health information to funeral directors consistent to carry out their duties.
Inmates: If you are an inmate of a correctional institution or under the custody of a law enforcement official, FPP may release medical information about you to the correctional institution or law enforcement official.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU
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. To do so, you must submit your request in writing to the FPP Medical Records Department. If you request a copy of the information, we may charge a fee for our costs.
FPP may deny your request to inspect and copy in certain limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by FPP will review your request and the denial. We will comply with the outcome of the review.
Right to Amend: If you feel that medical information we have about you is incorrect or incomplete, you have the right to request an amendment. That right exists as long as the information is kept by FPP.
Your request for an amendment must be in writing and submitted to the FPP Medical Records Department. In addition, you must provide a reason that supports your request.
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, FPP may deny your request if you ask us to amend information that:
- Was not created by FPP, unless the person or entity that created the information is no longer available to make the amendment;
- Is not part of the medical information kept by or for FPP;
- Is not part of the information which you would be permitted to inspect and copy; or
- Is accurate and complete.
Right to an Accounting of Disclosures: An “Accounting of Disclosures” is a list of the disclosures FPP made of your medical information. We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
To request this accounting of disclosures, you must submit your request in writing to FPP Medical Records Department. Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. The first list you request within a 12-month period will be free. For additional lists, you may be charged for the cost of providing the list. FPP 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 medical information we use or disclose about you for treatment, payment or health care operations. If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery you had.
FPP is not required to agree to your request. If FPP does agree, we will comply with your request unless the information is needed to provide emergency treatment for you or as required by law.
To request restrictions, you must make your request in writing to FPP Medical Records Department. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both: and (3) to whom you want the limits to apply, for example, disclosures to your spouse.
Right to Request Confidential Communications and the Right to have Information Communicated to you by Alternative Means and/or Location: You have the right to request that FPP communicate with you about medical matters in a certain way. For Example, you can ask that we only contact you at work or by mail. In addition, you may request that confidential information about you be communicated by the means or location of your choice. For example, test results mailed vs. a phone call.
To make such a request, you must submit in writing to FPP Medical Records Department. FPP will accommodate all reasonable requests. Your request must specify how and/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 FPP to give you a copy at any time.
CHANGES TO THIS NOTICE
FPP reserves the right to change this notice. FPP reserves the right to make the revised or changed notice effective for all medical information we have about you. Copies of the current notice will be available at our office. The effective date will be written on the first page of the notice. In addition, each time you check-in for an appointment at our office we will offer you a copy of the current notice.
OTHER USES OF MEDCIAL INFORMATION
Other uses and disclosures of medical information not covered by this notice or the laws that apply to FPP will be made only with your written permission. If you provide FPP permission to use or disclose medical information about you, you may revoke that permission in writing at any time.