Glasgold Group Notice of Privacy Practices and Acknowledgement
This policy applies to the Glasgold Group, its participating physicians and clinicians, and all Glasgold Group employees and business units who provide management, administrative, financial, legal, and operational support to or on behalf of the Glasgold Group.
STATEMENT OF POLICY
The Glasgold Group is required by law to protect the privacy of health information that may reveal the identity of a patient and must provide a copy of the privacy practice notice (the “Notice”) to each patient the first time such patient presents for treatment.
IMPLEMETATION OF POLICY
- Notices will be displayed in the Glasgold Group waiting room.
- Patients will receive a copy of the Notice at the time of their first appointment.
- Patients will be requested to sign an acknowledgement of receipt of the Notice.
- The acknowledgement will be kept in the patient’s medical record.
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.
We are required by law to protect the privacy of health information that may reveal your identity, and to provide you with a copy of this notice which describes the health information privacy practices of the Glasgold Group. A copy of our current notice will always be posted in our offices. You will be given a Notice at the time you first seek treatment. You will also be able to obtain a copy by calling the office or by asking for one at the time of your next visit.
WHAT HEALTH INFORMATION IS PROTECTED
We are committed to protecting the privacy of information we gather about you while providing health-related services. Some examples of protected health information are:
- information indicating that you are a Glasgold Group patient or
- information about your health condition (such as a disease you may have)
- information about health care products or services you have received or may
receive in the future (such as an operation); or
- information about your health care benefits under an insurance plan (such as whether a prescription is covered); when combined with:
Demographic information (such as your name, address, or insurance status unique numbers that may identify you (social security number, phone number, or your driver’s license number); or other types of identifying information.
REQUIREMENT FOR WRITTEN AUTHORIZATION
We will obtain your written authorization before using your health information or sharing it with others outside the Glasgold Group, except as we describe in this notice. You may also initiate the transfer of your records to another person by completing a written authorization form. If you provide us with written authorization, you may revoke that written authorization at any time, except to the extent that we have already replied to it. To revoke a written authorization, please request in writing to the Glasgold Group.
HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION WITHOUT YOUR WRITTEN AUTHORIZATION
There are situations when we do not need your written authorization before using your health information or sharing it with others. They are:
1. Treatment, Payment, and Health Care Operations
The Glasgold Group may use your health care information or share it with others in order to provide health care services to you, obtain payment for those services, and run the Glasgold Group’s normal business operations. In some cases, we may also disclose your health information for payment activities and certain business operations of another health care provider or payor. Below are examples of how your information may be used and disclosed for treatment, payment, and normal business operations without your written authorization.
Treatment: We may share your health information with other clinicians in the Glasgold Group involved in taking care of you, and they may in turn use that information to diagnose or treat you. Glasgold Group doctors or clinicians may share your health information with someone at another medical practice or hospital, to determine how to diagnose or treat you. Your doctor may also share your health information with another doctor to whom you have been referred.
Payment: We may use your health information or share it with others so that we obtain payment for your health care services. For example, we may share information about you with your health insurance company in order to obtain reimbursement after we have treated you. We may share information about you with your insurance company to determine whether it will cover your treatment.
Appointment Reminders, Treatment Alternatives, Benefits, and Services: In the course of providing treatment for you, we may use your health information to contact you with a reminder that you have an appointment for treatment or services. We may also use your health information in order to recommend possible treatment alternatives or health‑related benefits and services that may be of interest to you.
Business Associates: We may disclose your health information to other business associates who need the information in order to assist us with obtaining payment.
2. Friends and Family Involved in Your Health Care
If you do not object, we may share your health information with a family member, or close personal friend who is involved in your care or payment for that care.
3. Emergencies or Public Need
Emergencies: We may use or disclose your health information if you need an emergency treatment or if we are required by law to treat you but are unable to obtain your written consent. If this happens, we will try to obtain your written consent as soon as we reasonably can after we treat you.
As Required by Law: We may use or disclose your health information if we are required by law to do so. We also will notify you of these uses and disclosures if law requires notice.
Public Health Activities: We may disclose your health information to authorized public health officials so they may carry out their activities under the law, such as controlling disease or public health hazards.
Victims of Abuse, Neglect, or Domestic Violence: We may release your health information to a public health authority that is authorized to receive reports of abuse, neglect, or domestic violence.
Health Oversight Activities: We may release your health information to government agencies authorized to conduct audits, investigations and inspections of our office.
Lawsuits and Disputes: In response to a subpoena we may disclose your health information if we are ordered to do so by a court or administrative tribunal that is handling a lawsuit or other dispute.
Law Enforcement: We may disclose your health information to law enforcement officials for certain reasons, such as complying with court orders, assisting in the identification of fugitives or the location of missing persons.
To Avert a Serious and Imminent Threat to Health or Safety: We may use your health information or share it with others when necessary to prevent a serious and imminent threat to your health or safety, or the health or safety of another person or the public.
National Security and Intelligence Activities or Protective Services: We may disclose your health information to authorized federal officials who are conducting national security and intelligence activities.
Military and Veterans: We may disclose health information about you to appropriate military command authorities for activities they deem necessary to carry out in their military mission.
Workers’ Compensation: We may disclose your information for benefits for work-related injuries.
Marketing: We may not disclose your health information or share it with others outside the Glasgold Group for purposes of marketing without your prior authorization.
4. Incidental Disclosures
While we will take reasonable steps to safeguard the privacy of your health information, certain disclosures of your health information may occur for example, during the course of treatment session, other patients in the treatment area may see or over hear discussion of your health information.
YOUR RIGHTS TO ACCESS AND CONTROL YOUR HEALTH INFORMATION
You have the following rights to access & control your health information
The Right to Inspect and Copy Records
You have the right to inspect and obtain a copy of any of your health information that may be used to make decisions about you and your treatment for as long as we maintain this information in our records. To inspect or obtain a copy of your health information, please submit your request in writing.
The Right to Amend Records
If you believe that the health information that we have about you is incorrect or incomplete, you may request in writing that we amend the information for as long as the information is kept in our records. Your request should include the reasons why you think we should make the amendment. If we deny part or your entire request, we will provide a written notice that explains our reasons for doing so.
The Right to Request Confidential Communications
You have the right to request that we contact you about your medical matters in a way that is more confidential for you, such as calling you at home instead of at work.
The Right to File a Complaint
If you believe your privacy rights have been violated, you may file a complaint with us.
This notice has been updated as of August 31, 2009 and replaces the previous notice. We reserve the right to change the terms of Notice of Privacy Practices such as in this case. You have recourse if you feel that your privacy protections have been violated. You have the right to file written complaint with our office, or the Department of Health and Human Services, Office of Civil Rights, about violations of the provisions of this notice or the policies and procedures of our office. We will not retaliate against you for filing a complaint.
Contact information:
The U.S. Department of Health & Human Services
Office of Civil Rights
200 Independence Ave., S.W.
Washington, D.C. 20201
(202)619-0257
Toll Free (877)696-6775 |
