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The Sleep Health Center
Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.  PLEASE READ CAREFULLY.

In 1997, The Federal Government passed the Health Insurance Portability Accountability Act.  As part of this legislation, there are provisions for Privacy that go into effect on April 2003.  This notice of Privacy Practices is required to be given to you as part of this legislation and describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law.  It also describes your rights to access and control your protected information.  “Protected Health Information” is information about you, including demographic information (name, age, date of birth, address) that may identify you and that relates to your past, present or future physical or mental health and related health care services.

We are required to abide by the terms of this Notice of Privacy Practices.  We may change our notice at any time.  The new notice will be effective for all protected health information that we maintain at that time.  Upon your request, we will provide you with any revised Notice of Privacy by calling our office and requesting that a revised copy be sent to you in the mail or asking for one at the time of your next appointment.

Uses and Disclosures of Protected Health Information

Uses and Disclosures of Protected Health Information Based Upon Your Written Consent.
You will be asked by our office to sign a Consent Form.  Once you have consented to use and disclosure of your protected health information for treatment, payment and health care operations by signing the consent form, our office will use or disclose your protected health information as described in this Section 1.  Your protected health information may be used and disclosed by your physician, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you.  Your protected health information may also be used and disclosed to pay your health care bills and to support the operation of the physician’s practice.

Following are examples of the types of uses and disclosures of your protected health information that the physician’s office is permitted to make once you have signed our consent form.  These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by our office once you have provided consent. 

Treatment:  We will use and disclose your protected health information to provide, coordinate or manage your health care and any related services.  This includes the coordination or management of your health care with a third party that has already obtained your permission to have access to your protected health information.  For example, we would disclose your protected health information, as necessary, to a durable medical equipment company that provides care to you.  We will also disclose protected health information to other physicians who may be treating you when we have the necessary permission from you to disclose protected health information.  For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.

In addition, we may disclose your protected health information from time-to time to another physician or health care provider (e.g., a specialist or laboratory) who, at the request of your physician, becomes involved in your care by providing assistance with your health care diagnosis or treatment physician.

Payment:  Your protected health information will be used, as needed, to obtain payment for your health care services.  This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we recommend for you such as:  making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity and undertaking utilization review activities.  For example, obtaining approval for diagnostic testing may require that your relevant protected health information be disclosed to the health plan to obtain approval to perform the testing.

Healthcare Operations: We may use or disclose, as needed, your protected health information in order to support the business activities of our practice.  These activities include, but are not limited to, quality assessment activities, employee review activities, licensing, and marketing activities and conducting or arranging for other business activities. 

We may use a sign-in sheet in the reception area where you will be asked to sign your name.  We may call you by name in the Waiting room when your physician is ready to see you.  We may use or disclose your protected health information as necessary, to contact you to remind you of your appointment.

We will share your protected health information with third party “business associates” that perform activities for our practice (for example, our transcription services are provided by a contractor).  Whenever an arrangement between our Center and a business associate involves the use or disclosure of your protected health information, we will have a written contract with that business associate that contains terms that will protect the privacy of your protected health information.

We may use or disclose your protected health information, as necessary, to provide you with information about treatment alternatives or other health-related benefits that may be of interest to you.  We may also use and disclose your protected health information for other marketing activities.  For example, your name and address may be used to send you a newsletter about our practice and the services we offer.  We may also send you information about products or services that we believe may be beneficial to you.  You may contact our Privacy Contact to request that these materials not be sent to you.

Uses and Disclosures of Protected Health Information Based Upon Your Written Authorization.
Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law as described below.  You may revoke this authorization at any time, in writing, except to the extent that your physician or the physician’s staff has taken an action in reliance on the use or disclosure indicated in the authorization.

Other Permitted and Required Uses and Disclosures that May Be Made With Your Consent, Authorization or Opportunity to Object
We may use and disclose your protected health information in the following instances.  You have the opportunity to agree or object to the use or disclosure of all or part of your protected health information.  If you are not present or able to agree or object to the use or disclosure of the protected health information then your physician, may, using professional judgment, determine whether the disclosure is in your interest.  In this case, only the protected health information that is relevant to your health care will be disclosed.

Others Involved in Your Healthcare:  Unless you object, we may disclose to a member of your family, relative, a close friend or any other person you identify, your protected health information that directly relates to that person’s involvement in your health care.  If you are unable to agree or object to this disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment.  We may use or disclose protected health information to notify or assist in notifying a family member, personal representative, or any other person that is responsible for your care of your location and general condition.  Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.

Emergencies:  We may use or disclose your protected health information in an emergency treatment situation.
 
Communication Barriers:  We may use and disclose your protected health information if your physician or another physician in the practice attempts to obtain consent from you but is unable to do so due to substantial communication barriers and the physician determines, using professional judgment that you intend to consent to use or disclosure under the circumstances.

Others Permitted and Required Uses and Disclosures That May Be Made Without Your Authorization or Opportunity to Object. 
We may use or disclose your protected health information in the following situations without your consent or authorization.  These situations include:

Required by Law:  We may use or disclose your protected health information to the extent that the use or disclosure is required by law.  The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law.  You will be notified, as required by law, of any such use or disclosure.

Public Health:  We may disclose your protected health information for public health activities and purposed to a public health authority that is permitted by law to collect or receive the information.  The disclosure will be made for the purpose of controlling diseases, injury or disability.

Communicable Diseases:  We may disclose your protected health information, if authorized by law to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.

Health Oversight:  We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections.  Oversight agencies seeking this information include government agencies that oversee the health care system, government programs, other government regulatory programs and civil rights laws.

Abuse or Neglect:  We may disclose your protected health information to a public authority that is authorized by law to receive reports of child abuse or neglect.  In addition, we are required by law to disclose your protected health information if we believe that you have been a victim of abuse, neglect or domestic violence to the government entities authorized to receive such information.  In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws. 

Food and Drug Administration:  We may disclose your protected health information to a person or company required by the Food and Drug Administration to report adverse events, product defects, problems, biologic product deviations; track products; to enable product recalls; to make repairs or replacements; or to conduct post marketing surveillance, as required. 

Legal Proceedings:  We may disclose protected health information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request or other lawful process.

Law Enforcement:  We may also disclose protected health information, so long as applicable legal requirements are met, for law enforcement purposes.  These law enforcement purposes include legal processes and otherwise required by law, limited information requests for identification and location purposes, pertaining to victims of a crime, suspicion that death has occurred as a result of criminal conduct, in the event that a crime occurs on the premises of this practice and medical emergency and it is likely that a crime has occurred.

Coroners, Funeral Directors and Organ Donation:
Although due to the nature of our practice we do not anticipate this need, we may disclose protected health information to a coroner or medical examiner for identification purposes, determining cause of death or for the medical examiner to perform other duties authorized by law.  We may also disclose protected health information to a funeral director, as authorized by law, in order to permit the funeral director to carry out their duties.  We may disclose such information in reasonable anticipation of death.  Protected health information may be used and disclosed for cadaver organ, eye or tissue donation purposes.

Research Purposes:  We may disclose your protected health information to researchers when the research proposal and established protocols ensures the privacy of your protected health information.

Military Activity and National Security:  When the appropriate conditions apply, we may use or disclose protected health information of individuals who are Armed Forces personnel or retired for activities deemed necessary by appropriate military command authorities, for the purpose of a determination by Department of Veterans Affairs of your eligibility benefits, or to foreign military authority if you are a member of that foreign military services.  We may also disclose your protected health information to authorized federal officials for conducting national security and intelligence activities.

Worker’s Compensation:  We may disclose your protected health information as authorized to comply with worker’s compensation laws and other similar legally established programs. 

Required Uses and Disclosures:  Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500 et. Seq.

Your Rights

Following is a statement of your rights with respect to your protected health information and a description of how you may exercise these rights.

You have the right to inspect and copy your protected health information.  This means you may inspect and obtain a copy of protected health information about you that is contained in a designated record set for as long as we maintain the protected health information.  A “designated record set” contains medical and billing records that we use to make decisions about your care.

Under Federal Law, however, you may not inspect or copy the following records:  psychotherapy notes; information compiled in reasonably anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information.  Depending on the circumstances, a decision to deny access may be reviewable.  Please contact our Privacy Contact if you have questions about access to your medical record.  You may be charged for the fees associated with copying your record.

You have the right to request a restriction of your protected health information.  This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations.  You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices.  Your request must be in writing and state the restriction requested and to whom you want the restriction to apply.

We are not required to agree to a restriction that you may request.  If our doctors believe it is in your best interest to permit use and disclosure of your protected health information, the information will not be restricted.  One example of this is that you may not want your protected health information to be released to your insurance company.  However, insurance companies providing coverage for our patients require us to provide them with this information to make benefits determinations and pay for your care.  Without providing your protected health information, we may not access information about your benefits and determine eligibility or file your claims on your behalf; therefore, if insurance will be used to pay for your services, we will release your protected health information to you insurance provider.
If our physician agrees to your requested restriction, we will not use or disclose your protected health information in violation of that restriction unless it is needed to provide emergency treatment.  With this in mind, please discuss your wish to request a restriction with our doctors.  You may request a restriction by asking our staff for a written form for this purpose.

You have the right to request to receive confidential communications from us by alternative means or at an alternative location.  We will accommodate reasonable requests.  We may also condition this accommodation by asking you for information as to how payment will be handed or specification of the alternative address or other method of contact.  We will not request an explanation from you as to the basis for the request.  Please make this request in writing to our Privacy Contact. 

You may have the right to have your physician amend your protected health information.  This means you may request an amendment of protected health information about you in a designated record set for as long as we maintain this information.  In certain cases, we may deny your request for an amendment.  If we deny your request for amendment, you have the right to file a statement of disagreement with us, and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.  Please contact our Privacy Contact to determine if you have questions about amending your medical record.

You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information.  This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice of Privacy Practices.  It excludes disclosures we have made to you, for a facility directory, to family members or friends involved in your care for notification purposes.  You have the right to receive specific information regarding these disclosures that occurred after April 14, 2003.  You may request a shorter timeframe.  The right to receive this information is subject to certain exceptions, restrictions and limitation.

You have the right to obtain a paper copy of this notice from us, upon request, even if you agreed to accept this notice electronically.

Complaints.

We will do our best to partner with you in protecting your privacy.  You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us.  You may file a complaint with us by notifying our Privacy Contact of your complaint.  We will not retaliate against you for filing a complaint.

This notice becomes effective on April 14, 2003

The Staff of The Sleep Health Center