HIPAA Notice of Privacy Practices
CNOS, PC
Effective Date: April 14, 2003
Updated: April 22, 2011
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED
AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW CAREFULLY
CNOS makes every effort to comply with HIPAA. If you have any questions about this notice, please contact Christine Robeson, Compliance Officer at (605) 217-4808.
During your treatment at CNOS, doctors, nurses, and other caregivers may gather information about your medical history and your current health. This notice explains how that information may be used and shared with others. It also explains your privacy rights regarding this kind of information. The terms of this notice apply to health information created or received by CNOS. We are required by law to make sure that medical information that identifies you is kept private, give you this notice of our legal duties and privacy practices with respect to medical information about you and follow the terms of the notice that is currently in effect.
Your medical information may be used and disclosed for the following purposes:
Treatment
We may use your information to provide, coordinate and manage your care and treatment. For example, a CNOS physician may share your medical information with another physician for a consultation or a referral.
Payment
We may use and disclose medical information about you so that the treatment and services you receive may be billed to, and payment may be collected from you, an insurance company or another third party.
Health Care Operations
We may use and disclose medical information about you for health care operations. Health care operations are the uses and disclosures of information that are necessary to run CNOS and to make sure that all of our patients receive quality care. We may use medical information to review our treatment and services and to evaluate the performance of our staff and physicians in caring for you.
Appointment Reminders and Other Health Information
We may use your medical information to send you reminders about future appointments. We may also contact you with information about new or alternative treatments or other health care services.
To People Assisting in Your Care
CNOS will only disclose medical information to those taking care of you, helping you to pay your bills or other close family members or friends if these people need to know this information to help you, and then only to the extent permitted by law. We may, for example, provide limited medical information to allow a family member to pick up a prescription for you. We may provide certain information regarding your condition to family members following the disclosure requirements under state law. If you are able to make your own health care decisions, CNOS will ask your permission before using your medical information for these purposes. If you are unable to make health care decisions, CNOS will disclose relevant medical information to family members or other responsible people if we feel it is in your best interest to do so, including an emergency situation.
As Required by Law
We will disclose medical information about you when we are required to do so by federal, state or local law.
To Avert a Serious Threat to Health or Safety
We 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 must be only to someone able to prevent the threat, or the target of the threat.
• With regard to HIV/AIDS related information, we may release to the Department of Public Health any relevant information provided by an HIV-positive person regarding any person with whom the HIV-positive person has had sexual relations or has shared drug injecting equipment. We may also reveal the identity of a person who has tested positive for HIV to the extent necessary to protect a third party from the direct threat of transmission. In the event the person who tests positive for HIV is a convicted or alleged sexual assault offender, we are required under Iowa law to disclose the test results to the convicted or alleged offender and to the victim counselor or other person designated by the victim, who shall disclose the results to the victim.
• We may notify a care provider who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition (notification will not include the name of the individual tested for the contagious or infectious disease unless the individual consents).
• We may report to the State Department of Transportation information about patients with physical or mental impairments that would interfere with their ability to safely operate a motor vehicle.
To Business Associates
Some services are provided by or to CNOS through contracts with business associates. Examples include CNOS’s attorneys, consultants, collection agencies and accreditation organizations. We may disclose information about you to our business associate so that they can perform the job we have contracted with them to do. To protect the information that is disclosed, each business associate is required to sign an agreement to appropriately safeguard the information and not to redisclose the information unless specifically permitted by law.
Your medical information may be released in the following special situations:
Organ and Tissue Donation
We may release your medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transportation.
Military and Veterans
If you are a member of the armed forces, we will release medical information about you as requested by military command authorities if we are required to do so by law or when we have your written consent. We may also release medical information about foreign military personnel to the appropriate foreign military authority as required by law or with written consent.
Workers’ Compensation
We may release medical information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness. We are permitted to disclose this information to the parties involved in the claim without any specific consent, as long as the information is related to a workers’ compensation claim.
Public Health
We may disclose medical information to public health authorities about you for public health activities as required by state law. These disclosures generally include reports pertinent to the following information:
• Prevention and control of disease, injury or disability
• Births and deaths
• Child abuse or child death
• Domestic abuse deaths
• Reactions to medications or problems with products
• Product recalls
• Sexually transmitted disease or infection
Health Oversight Activities
CNOS may disclose medical information to a health oversight agency for health oversight activities that are authorized by law. These oversight activates include, for example, government audits, investigations, inspections, and licensure 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, dispute or other judicial proceeding, we will disclose medical information about you only in response to a valid court order, administrative order, subpoena of a substitute medical decision-making board, or a grand jury subpoena, or with your written consent. We may disclose information in the context of civil litigation where you have put your condition at issue in the litigation.
Law Enforcement
We may release medical information if asked to do so by a law enforcement official in response to a valid court order, grand jury subpoena, or warrant or with y our written consent. In addition, we are required to report certain types of wounds, such as gunshot or stab wounds.
We will not disclose information regarding substance abuse to any law enforcement officer or law enforcement agency unless you have authorized the disclosure. We may disclose information relevant to a determination of whether a person is or continues to be a sexually violent predator to law enforcement agencies or the attorney general.
We may also release information to law enforcement for the following reasons:
• To identify or locate a suspect, fugitive, material witness or missing person
• About a death we believe may be the result of criminal conduct
• About criminal conduct at our facility
• In emergency circumstances to report a crime, the location of the crime or victims, or the identity, description or location of the persons who committed the crime
Coroners, Medical Examiners, and Funeral Directors
We will release medical information to a coroner or medical examiner in the case of certain types of death. This may be necessary, for example, to identify you or determine the cause of death. We may also release the fact of death and certain demographic information about you to funeral directors as necessary to carry out their duties.
National Security and Intelligence Activities
We will disclose medical information about you to authorized federal officials for intelligence, counter-intelligence and other national security activities only as required by law or with your written consent.
Protective Services for the President and Others
We will disclose medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons, or foreign heads of state, or conduct special investigations only as required by law or with your written consent.
Inmates
If you are an inmate of a correctional institution or under the custody of a law enforcement official, we will release medical information about you to the correctional institution or law enforcement official only as required by law or with your written consent.
Identity Theft Prevention Program
Medical identity theft is very serious because, in addition to financial problems, identity theft can lead to inappropriate medical care when incorrect information is included in a patient’s medical record. CNOS has implemented steps to detect, prevent, investigate and mitigate the intentional and inadvertent misuse of a patient’s identity to commit identity theft.
You have the following rights regarding medical information we maintain about you:
Requests must be made in writing. To request the appropriate form, please contact:
Chris Robeson at (605) 217-4808 or Jean Brodersen at (605) 217-2639.
Right to Inspect and Copy
You have the right to inspect and receive a copy of your medical information that is used to make decisions about your care. Usually, this includes health & billing records maintained by CNOS.
If you wish to inspect and copy medical information, you must submit your request in writing to CNOS. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request, to the extent permitted by state and federal law. Upon your specific request, you have the right to receive heath information in electronic format. We will transmit directly to an entity or individual as specified in your request. We may charge a fee for labor costs associated with electronic record requests.
We may deny your request to inspect and copy your information in certain very limited circumstances. For example, we may deny access if your physician believes it would be harmful to your health or could cause a threat to others. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by CNOS will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
Right to Request Amendment
If you believe that medical information we have about you is incorrect or incomplete, you have the right to ask us to change the information. You have the right to request an amendment for as long as the information is kept by or for CNOS.
To request a change to your information, your request must be made in writing and submitted to CNOS. In addition, you must provide a reason that supports your request.
CNOS 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, we may deny your request of you ask us to amend information that:
• Was not created by CNOS, 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 for or by CNOS;
• Is not part of the information which you would be permitted to inspect or copy; or Is accurate and complete.
Right to An Accounting of Disclosures
You have the right to request an ‘accounting of disclosures’. This is a list of the disclosures we made of medical information about you. This list will not include disclosures for treatment, payment and health care operations, disclosures that you have authorized or that have been made to you, disclosures for national security or intelligence purposes, disclosures to correctional institutions or law enforcement with custody of you, disclosures that took place more than six years prior to the date of your request.
To request this list of disclosures, you must submit your request in writing to CNOS. Your request must state a time period for which you would like the accounting. The accounting period may not go back further than six years from the date of the request.You may receive one free accounting in any 12-month period. We will charge you for additional requests.
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 example, you could ask that we not use or disclose information about treatment that you received to other physicians. We are not required to agree to any other requested restrictions. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
If you pay out-of-pocket in full for an item or service, then you may request that we not disclose informaiton pertaining solely to such item or service to your health plan. We are required to agree to such a request.
To request restrictions, you must make your request in writing to CNOS. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, or both; and (3) to whom you want the limits to apply. For example, if you want to prohibit disclosures to your spouse.
Right to 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 only by mail.
To request confidential communications, you must make your request in writing to CNOS. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted and we may require you to provide information about how payment will be handled.
Changes to This Notice
The effective date of this notice is April 22, 2011. 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. If the terms of this notice are changed, CNOS will provide you with the revised notice upon request. We will post the revised notice on our web site and at designated locations at CNOS.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with CNOS. To file a complaint, contact the Executive Director or Privacy Officer at CNOS. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
Other Uses of Medical Information
Except as described above, CNOS will not use or disclose your protected health information without a specific written authorization from you. If you provide us with this written authorization to use or disclose medical information about you, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose medical information about you for the reasons covered by your written authorization, except to the extent we have already relied on your authorization. We are unable to take back any disclosures we have already made with your permission and we are required to retain our records of the care that we provided to you.
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