Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU (AS A CLIENT OF NATIONAL HORMONE & HEALTH FOR MEN MANAGEMENT OFFICE, OR patient of the Medical Doctor once required blood work, physical exam and health analysis has been completed AND APPROVED) MAY BE USED AND DISCLOSED, IN ADDITION TO INFORMATION REGARDING HOW TO OBTAIN ACCESS TO YOUR PROTECTED HEALTH INFORMATION. PLEASE READ CAREFULLY.
As an essential part of our commitment to you, National Hormone & Health for Men maintains privacy of certain confidential healthcare information about you, known as Protected Health Information (PHI). Your PHI is information about you or information that could be used to identify you, as it relates to your past and present physical and mental health. State law and the Health Insurance Portability and Accountability Act of 1996 (HIPAA) require us to maintain the confidentiality of all your healthcare records and other individually identifiable health information used by or disclosed to us electronically, on paper or orally. We realize these laws are complicated, but National Hormone & Health for Men is required to provide you with the following important information:
- How we may use and disclose your PHI
- Your privacy rights in your PHI
- Our obligations concerning the use and disclosure of your PHI
In most situations, National Hormone & Health for Men may use this information as described in this notice without your permission or authorization, but there are some situations where we may use it only after we obtain your written authorization for use or disclosure. National Hormone & Health for Men professional and non-professional staff will abide by the terms of the notice.
We respect your privacy and treat all healthcare information about our patients with care under strict policies of confidentiality that we are committed to following at all times.
How National Hormone & Health for Men may use and disclose medical information about you
The following are the ways National Hormone & Health for Men may use and disclose your PHI with examples of each use:
For Treatment: This includes such things as verbal and written information that we obtain about you and use pertaining to your medical condition and treatment provided by us and other medical professionals. For example, we may disclose your PHI to doctors, nurses, technicians or other personnel, including people outside our office who are involved in your medical care.
For Payment: This includes any activities we undertake in order to receive payment for the services we provide to you, including submitting bills to insurance companies (either directly or through a third party billing company), management of billed claims for services rendered, medical necessity determinations and reviews, utilization review, third party financing and collection of outstanding accounts.
For our Administration and Healthcare Operations: This includes activities necessary for our continuing operation such as quality assurance, licensing and training programs to ensure that our personnel meet our standards of care, following established policies and procedures, obtaining legal and financial services, conducting business planning, processing grievances and complaints. We may also create reports that do not individually identify you for data collection purposes.
For Appointment Reminders, Treatment Alternatives and Health Related Benefits and Services: This includes use and disclosure of your PHI to contact you and remind you that you have an appointment with us. We may also tell you about treatment alternatives or health-related benefits and services that may be of interest to you.
As Required by Law: National Hormone & Health for Men is required to use or disclose your PHI as required and limited by law.
To a Family Member, Friend or Other Person Involved in Your Health Care: This includes the use and disclosure of your PHI to family members or close friends if we obtain your agreement to do so, or if given the opportunity to object, you do not. We may also disclose your PHI to 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 disclosure when you allow a family member in the examination room for discussion, evaluation or treatment.
For Public Health Activities: We may use and disclose your PHI for public health activities. These activities usually include disclosures for the purpose of preventing or controlling disease, injury, or disability and reporting instances of disease, injury and vital statistics such as birth or death. Other public health disclosures could be made for the purposes of reporting communicable or sexually transmitted diseases, reporting reactions to medication or problems with products and notifying people of recalls of products they may be using.
To Report a Suspected Case of Abuse, Neglect or Domestic Violence: This includes the use or disclosure of your PHI to a government authority, including a social service or protective services agency, if we reasonably believe you are a victim of abuse, neglect or domestic violence.
For Health Oversight Activities: This includes the use or disclosure of your PHI to a health oversight agency for oversight activities authorized by law, including audits, civil or criminal investigations, inspections, licensure or disciplinary action.
For Legal and Administrative Proceedings: This includes the use and disclosure of your PHI to respond to a court order, a subpoena, discover request, or other lawful process, provided that proper documentation is presented to us.
For Law Enforcement Purposes: This includes the release of your PHI at the request of law enforcement officials for the purpose of: reporting certain types of wounds or physical injuries, responding to a court-ordered warrant, subpoena, or a grand jury subpoena, identifying or locating a suspect, fugitive, material witness or missing person, reporting persons suspected to be victims of crime and reporting crime in emergency situations.
To Coroners, Medical Examiners and Funeral Directors: This includes PHI used or disclosed to a coroner or medical examiner for the purpose of identifying a deceased person or determining cause of death, or to funeral directors as necessary to carry out their duties with respect to the decedent.
For Organ, Eye, or Tissue Donation: If you are an organ donor, we may use or disclose your PHI to organizations that handle organ procurement or other entities engaged in procurement such as banking or transportation of organs, eyes, or tissues to facilitate organ, eye or tissue donation and transplantation.
To Avert a Serious Threat to Health or Safety: This includes the use and disclosure of your PHI, if we believe in good faith, and is consistent with any applicable law and standards of ethical conduct, to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. Disclosures will only be made to someone who may be able to help prevent the threat.
For Specialized Government Functions: This includes the use and disclosure of your PHI if you are military personnel or foreign military personnel. Other use and disclosure may be for national security and intelligence activities, protective services, correctional institutions and law enforcement custodial situations.
For Workers' Compensation: This includes disclosure of your PHI as authorized by and to the extent necessary to comply with law relating to workers' compensation or other similar programs that provide benefits for work-related injuries without regard to fault.
For Disaster Relief Purposes: This includes the use or disclosure of your PHI to a public or private entity authorized by law to assist in disaster relief effort.
Inactive Patient Records: We will retain your records for seven years from your last treatment or examination, at which point you will become an inactive patient in our practice and we may destroy your records at that time. We will do so only in accordance with the law (e.g. in a confidential manner, with a Business Associate agreement prohibiting re-disclosure if necessary).
Collections and Marketing: If we use or disclose your PHI for marketing (i.e. communications that encourage recipients to purchase or use a product or service) or collections purposes, we will do so only in accordance with the law.
Your rights regarding medical information:
You may access your medical information: To access your medical information, you must submit your request to us at our address listed below. If you request copies, we may charge a fee allowed by law. We may deny your request in certain very limited circumstances. For example, we might deny access to psychotherapy notes that may be a part of your record.
Under the HITECH regulation, if we have used e-health records, then we must provide an individual with a copy of his or her PHI in electronic record format. If this electronic transfer occurs, we may only charge for the labor involved.
You may amend or correct your medical information: You may ask us to amend or correct your medical information. Please make your request in writing and submit it to our office address listed below. You must provide a reason that supports your request.
You may request an “accounting of disclosures”: You may request a list of the disclosures we made of medical information about you, other than for treatment, payment or practice operations as described above, and without your written authorization.
You may request restrictions on the use or disclosure of your medical information: You may request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or practice operations. For example, you could ask that we not share information with a family member or friend about 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. You may also request that your health information not be submitted to your health insurance carrier if you intend to pay for your services in full at the time of your treatment.
You may 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. We will try to accommodate all reasonable requests.
You may have a paper copy of this notice: You have the right to a paper copy of this notice.
Breach Notification
The HITECH Act requires that we notify patients whose PHI has been breached. A breach occurs when an unauthorized use or disclosure that comprises the privacy or security of PHI presents a significant risk for financial, reputational or other type of harm to the individual.
National Hormone & Health for Men Business Associate Agreements have been amended per the HITECH law to provide that all HIPAA security safeguards, etc. apply directly to the business associate.
Revisions to the Notice of Privacy Practices
National Hormone & Health for Men reserves the right to change and/or revise this Notice of Privacy Practices. We reserve the right to make the changed notice effective for medical information we already know about you, as well as any information we receive in the future. If we make changes, we will post the changed notice, along with its effective date, in our office. Also, upon request, you will be given a copy of our current notice.
Exercise of privacy rights and complaints
Mail or fax to us your written requests for modifying or canceling a confidential communication, for copies of your records, or for amendments to your record.
You may file a complaint with us by notifying our office of your complaint. You may also file a complaint to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. We will not retaliate against you for filing a complaint.
U.S. Department of Health and Human Services
Office of Civil Rights
200 Independence Ave., S.W.
Washington, DC 20201
Call (877) 696-6775 (toll free)