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.
Regulations issued under Federal law known as the Health Insurance Portability and Accountability Act of 1996, (HIPAA), which became effective on April 14, 2002, require covered entities to provide notice of the uses and disclosures of protected health information, and of the individual?s rights with respect to protected health information.
At Scott L. Gross MD we are committed to treating and using your protected health information responsibly. Each time you visit Scott L. Gross MD, a record, usually referred to as a "medical record" of your visit is made. The medical record is completed to document your evaluation, diagnosis and treatment. The information in the medical record serves many useful purposes. It is a valuable tool to the physician that assists the physician to provide care to the patient.
New York State law requires a physician to maintain a medical record for each patient which accurately reflects the evaluation and treatment of a patient. Unless otherwise provided by law, medical records must be retained for at least six years. Records of minor patients must be retained at least six years, and until the minor patient reaches the age of nineteen.
"Treatment" means The provision, coordination, or management of health care and related services by one or more health care providers, including the coordination or management of health care by a health care provider with a third party; consultation between health care providers relating to a patient; or the referral of a patient for health care from one health care provider to another.
As an example of treatment, information obtained by a physician or other member of the health care team at Scott L. Gross MD will be recorded and used as a tool to help determine the course of medical treatment for the patient. The medical record will document the evaluation, diagnosis and treatment the patient has received, the manner the patient has responded to treatment and the doctor's medical observations and plan of care. When planning the patient's course of treatment, we will often review the medical record and use it as a reference to evaluate the patient's health or condition.
At the patient's request, we will make copies of your records or various reports contained in the record available to subsequent treating physicians or health care professionals who may use the medical records as a reference in the patient's treatment.
"Payment" includes activities that must be undertaken by a health care professional to obtain reimbursement for the provision of health care. Payment also includes programs maintained by health payors involving review of health care services with respect to medical necessity, coverage under a health plan, appropriateness of care, or justification of charges. Payment may also include programs maintained by health payors involving utilization review, including pre-certification and pre-authorization services, concurrent and retrospective review of services.
As an example, prior to providing services to an HMO patient, we may be required by the HMO to provide medical information about the patient to determine whether the HMO will pay for the proposed treatment. If we bill for the services that were provided to the patient, the HMO may require information about the treatment before making payment.
"Health care operations" includes various types of activities, including, but not limited to:
An example of health care operations is quality assessment and improvement activities. We may review information contained in the medical record as part of our ongoing effort to improve the quality and effectiveness of the services that we provide.
Consent As used under the HIPAA Privacy Regulations, the term "consent" refers to obtaining an individual's consent prior to using or disclosing protected health information for treatment, payment or health care operations.
The Final HIPAA regulations were modified in August 2002 so that a covered entity is not required to obtain an individual's consent prior to using or disclosing protected health information for activities involving treatment, payment or health care operations.
Although the HIPAA Privacy Rule does not require consent, state law may require the patient's general consent to disclose health information to parties outside of Scott L. Gross MD, for treatment, payment or health care operations. For example, even prior to the Federal HIPAA Privacy regulations, we have obtained the patient's general consent to submit information to health care payors for payment purposes.
Authorization The term "Authorization" under the HIPAA Privacy regulations is used to refer to obtaining an individual's authorization for uses and disclosures of protected health information not otherwise permitted or required by the HIPAA Privacy regulation. Specifically, except for psychotherapy notes, covered entities are not required to obtain an individual's authorization to use or disclose protected health information for treatment, payment or health care operations.
As an example, an authorization is required prior to the use or disclosure of protected health information for marketing purposes. "Marketing" means "to make a communication about a product or service that encourages a recipient to purchase or use the product or service". However, "marketing" does not include communications by a doctor to an individual about treatment. For example, if a doctor sends a reminder to a patient regarding a scheduled test, the doctor is engaging in a "treatment" communication and does not need the patient's authorization to use the patient's protected health information to send the patient the reminder.
Uses and disclosures for which consent or authorization is not required
HIPAA provides exceptions where protected health information may be used or disclosed without consent or authorization. Generally;
-We may use or disclose protected health information to the extent that the use or disclosure is required by law;
"Health Oversight Activities" We may report information to a health oversight agency for health oversight activities authorized by law, including audits, administrative or licensure. Health oversight activities include oversight of (i) the health care system; (ii) Government benefit programs for which health information is relevant to determine beneficiary eligibility; (iii) Government regulatory programs for which health information is necessary for determining compliance with standards; or (iv) entities subject to civil rights laws for which health information is necessary for determining compliance.
Other uses and disclosures that do not involve treatment, payment or health care operations, and which do not involve any of the exceptions listed above in which HIPAA does not require consent or authorization, will be made only with your written authorization. You may revoke the authorization at any time provided the authorization is in writing, except to the extent that we have already taken action in reliance of your authorization.
"HIV Related Information" New York law, Article 27-F of the Public Health law and regulations of the New York State Department of Health provide protection to the confidentiality of HIV Related Information. A summary of HIV/AIDS Testing, Reporting and Confidentiality of HIV Related Information is found on the website of the New York State Department of Health at http://www.health.state.ny.us/nysdoh/rfa/hiv/full63.htm.
We may contact you to provide appointment reminders or information about treatment alternatives or other health related benefits and services that may be of interest to you.
We may disclose to your family members, other relatives, close personal friends, or any other person that you identify the protected health information directly related to such person's involvement with your health care or payment related to your care. We may use or disclose protected health information to notify, or assist in the notification of (including identifying or locating) a family member, a person responsible for your care concerning your location, general condition, or death.
If you are present and have the capacity to make your own decision, we may disclose protected health information only (1) if we have your agreement to disclose to the third parties involved in your care, (2) we have provided you an opportunity to object and there is no objection; or (3) we reasonably infer under the circumstances, based on the exercise of reasonable judgment, that there is no objection to disclosure.
If you are not present or when the opportunity to agree or object to the use or disclosure cannot practicably be provided due to your incapacity or an emergency circumstance, we may, in the exercise of professional judgment, determine whether the disclosure is in your best interests and if so disclose only the protected health information that is directly relevant to the person's involvement with your care.
1) Right to request restriction of uses and disclosures.
2) Right to request access to protected health information.
3) Amendment of Protected Health Information
4) Accounting of Disclosures of Protected Health Information.
-You have a right to receive an accounting of disclosures of protected health information made by this medical practice for the six years prior to the date of the request, except you do not have the right to an accounting of disclosures:
Scott L. Gross MD is required by law to maintain the privacy of protected health information and to provide individuals with notice of its legal duties and privacy practices with respect to protected health information.
We are required to abide by the terms of the notice currently in effect.
We reserve the right to change the terms of this notice and to make new notice provisions effective for all protected health information. If the notice is revised, the revised notice will be available on request at this office.
If you believe that your privacy rights have been violated you may complain to Scott L. Gross MD by contacting Scott L. Gross MD at 631-424-5678. You may also complain to the Secretary of the United States Department of Health and Human Services. Scott L. Gross MD will not retaliate against any person for filing a complaint.
If you have any questions please contact Scott L. Gross MD at 631-424-5678.
This notice is effective April 14, 2003.