PRINCE WILLIAM
CARDIOLOGY ASSOCIATES
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 OBTAIN ACCESS TO THIS INFORMATION. Please review it carefully.
Who will follow this notice:
This notice describes the health information policies of
PRINCE WILLIAM CARDIOLOGY ASSOCIATES
Our pledge regarding medical information
We are required by law (HIPAA, Health Insurance Portability & Accountability Act of 1996) to maintain the privacy of “protected health information.” Protected health information includes any identifiable information that we obtain from you or others that relates to your physical or mental health, the health care you have received, or payment for your health care. We may use and disclose your medical records only for each of the following purposes: treatment, payment and health care operations. Any other uses and disclosures will be made only with your written authorization. We must comply with the provisions of this notice, although we reserve the right to change the terms of this notice from time to time and to make the revised notice effective for all protected health information we maintain. You can always request a copy of the most current privacy notice from our office.
How We May Use and Disclose Health Information About You
The following is a summary of ways that we use and disclose health information about you. In order to provide and coordinate your care, your healthcare information will be shared under the following conditions:
To provide treatment. We may use health information about you to provide you with medical treatment and services. Health information about you may be disclosed to doctors, nurses and employees involved in your medical care. Your information can be shared with caregivers in order to coordinate your treatment during hospitalization or episodes of treatment. We may disclose health information to others outside Prince William Cardiology Associates who may be involved in your medical care including family members, referring physician, other physicians, pharmacists, suppliers of medical equipment or other health care professionals.
To obtain payment. We may use and disclose health information about you so that treatment and services rendered through prince william cardiology associates may be billed to and payment may be collected from you or an insurance company.
Healthcare operations. This includes the business aspects of running our practice such as conducting quality assessment and improvement activities, auditing functions, and customer service.
We may use your information to contact you for purposes such as the following:
Military and Veterans. If you are a member of the armed forces, we may release medical information about you as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority.
Worker’s Compensation. We may release medical information about you for programs that provide benefits for work-related injuries or illness, regardless of the state in which the injury occurred.
Health Oversight Activities. We may disclose medical information to federal or state agencies that oversee our activities. These activities are necessary for the government to monitor the health care 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 medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute.
Law Enforcement. We may release medical information if asked to do so by a law enforcement official:
In response to a court order, subpoena, warrant, summons or similar process
Serious Threats. As permitted by applicable law and standards of ethical conduct, we may use and disclose protected health information if we, in good faith, believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
Disaster Relief. When permitted by law, we may coordinate our uses and disclosures of protected health information with public or private entities authorized by law or by charter to assist in disaster relief efforts.
Other Uses of Medical Information
Other uses and disclosures of medical information not covered by this notice or the laws that apply to use will be made with your written permission. If you give us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke permission, thereafter we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You must understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records for the care that we provided to you.
Your Rights Regarding Medical Information About You
You have the following rights with respect to your protected health information which you can exercise by presenting a written request to the Privacy Officer:
Changes to This Notice: We reserve the right to change this notice. We reserve the right 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 copy of the current notice.
COMPLAINTS
If you believe that your privacy rights have been violated, you should contact, in writing, our Privacy Officer named below. You will not be penalized in any way for filing a complaint.
