Notice of Privacy Practices
J. ALAN FRIERSON, M.D.
CHERYL PIPPIN, C-PNP LORRAINE SCOTT, PA-C
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.
If you have any questions about this notice, please contact Toni Gauger, CHC, Manager, at (541) 773-3688; 1322 E McAndrews Road, Suite 202, Medford OR 97504
WHO WILL FOLLOW THIS NOTICE
This notice describes the information privacy practices followed by our employees, staff and other office personnel. The practices described in this notice will also be followed by physicians you consult with by telephone (when your regular physician from our office is not available) who provide “call coverage” for your physician.
YOUR HEALTH INFORMATION
This notice applies to the information and records we have about your/your child’s health, health status and the health care and services you receive at this office. Your health information may include information created and received by this office, may be in the form of written or electronic records or spoken words, and may include information about you/your child’s health history, health status, symptoms, examinations, test results, diagnoses, treatments, procedures, prescriptions, related billing activity and similar types of health-related information.
We are required by law to give you this notice. It will tell you about the ways in which we may use and disclose health information about you/your child and describes your rights and our obligations regarding the use and disclosure of that information.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
For Treatment. We may use health information about you/your child to provide you with medical treatment or services. We may disclose health information about you/your child to doctors, nurses, technicians, office staff or other personnel who are involved in taking care of you/your child and you/your child’s health. Disclosure of Protected Health Information (PHI) to other health care providers for treatment purposes may be made through computer networks, or other means of communication.
For example, your doctor may be treating your child for a heart condition and may need to know if he/she has other health problems that could complicate their treatment. The doctor may use you/your child’s medical history to decide what treatment is best for your child. The doctor may also tell another doctor about your child’s condition so that doctor can help determine the most appropriate care for your child.
Different personnel in our office may share information about you/your child and disclose information to people who do not work in our office in order to coordinate your or your child’s care, such as phoning in prescriptions to your pharmacy, scheduling lab work and ordering x-rays, making referrals, etc. Family members and other health care providers may be part of your or your child’s medical care outside of this office and may require information about you/your child that we have. We will request your permission before sharing your child’s health information with your family or friends unless you are unable to give permission to such disclosures, if you are unavailable or due to your health condition. We will request your permission at the point in time you are available or able to grant permission.
For Payment. We may use and disclose health information about you/your child so that the treatment and services received at this office may be billed to and payment may be collected from you, an insurance company or a third party.
For example, we may need to give your health plan information about a service received here so your health plan will pay us or reimburse you for the service. We may also tell your health plan about a treatment you/your child is going to receive to obtain prior approval or to determine whether your plan will cover treatment.
For Health Care Operations. We may use and disclose health information about you/your child in order to run the office and make sure that you and our other patients receive quality care.
For example, we may use you/your child’s health information to evaluate the performance of our staff in caring for your child. We may also use health information about all or many of our patients to help us decide what additional services we should offer, how we can become more efficient, or whether certain new treatments are effective.
We may also disclose your health information to health plans that provide you insurance coverage and other health care providers that care for you. Our disclosures of your/your child’s health information to plans and other providers may be for the purpose of helping these plans and providers provide or improve care, reduce cost, coordinate and manage health care services, train staff and comply with the law.
Appointment Reminders. We may contact you as a reminder that you/your child has an appointment for treatment or medical care at this office. We may do this by phone or by a mailed reminder note. We will leave our office name on answering machines but not the reason for calling and ask that you please call back.
Photos and Artwork Received. Photos and artwork received from our patients may be posted on our bulletin boards unless you specifically object in writing. If there is no objection, we will assume that this is acceptable.
Treatment Alternatives. We may tell you about or recommend possible treatment options or alternatives that may be of interest to you.
Health-Related Products and Services. We may tell you about health-related products or services that may be of interest to you.
Please notify us if you do not wish to be contacted for appointment reminders, or if you do not wish to receive communications about treatment alternatives or health-related products and services. If you advise us in writing (at the address listed at the top of this notice) that you do not wish to receive such communications, we will not use or disclose your information for these purposes.
We may use or disclose health information about you/your child for the following purposes, subject to all applicable legal requirements and limitations:
To Avert a Serious Threat to Health or Safety. We may use and disclose health information about you/your child when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
Required By Law. We will disclose health information about you/your child when required to do so by federal, state or local law.
Research. We may use and disclose health information about you/your child for research projects that are subject to a special approval process. We will ask you for your permission if the researcher will have access to you/your child’s name, address or other information that reveals who you/your child are, or will be involved in your care at this office; unless it is determined by our Institutional Review Board that your/your child’s privacy will be protected as part of the research and it may interfere with the research if you are contacted. We will offer you the option of opting out of any research related to genetic studies.
Organ and Tissue Donation. If you/your child is an organ donor, we may release health information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate such donation and transplantation.
Military, Veterans, National Security and Intelligence. If you are or were a member of the armed forces, or part of the national security or intelligence communities, we may be requested by military command or other government authorities to release health information about you. We may also release information about foreign military personnel to the appropriate foreign military authority.
Workers’ Compensation. We may release health information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
Public Health Risks. We may disclose health information about you/your child for public health reasons in order to prevent or control disease, injury or disability; or report births, deaths, non-accidental physical injuries, reactions to medications or problems with products.
Health Oversight Activities. We may disclose health information to a health oversight agency for audits, investigations, inspections, or licensing purposes. These disclosures may be necessary for certain state and federal agencies to monitor the health care system, government programs and compliance with civil rights laws.
Lawsuits and Disputes. If you/your child is involved in a lawsuit or a dispute, we may disclose health information about you in response to a court or administrative order. Subject to all applicable legal requirements, we may also disclose health information about you in response to a subpoena.
Law Enforcement. We may release health information if asked to do so by a law enforcement official in response to a court order, subpoena, warrant, summons or similar process, subject to all applicable legal requirements.
Coroners, Medical Examiners and Funeral Directors. We may release health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death.
Information Not Personally Identifiable. We may use or disclose health information about you in a way that does not personally identify you/your child or reveal who you are.
Family and Friends. We may disclose health information about you/your child to your family members or friends if we obtain your verbal agreement to do so or if we give you an opportunity to object to such disclosure and you do not raise an objection. We may also disclose health information to your family or friends if we can infer from the circumstances, based on our professional judgement that you would not object. For example, we may assume you agree to our disclosure of your personal health information to an individual when you bring that individual with you into the exam room during treatment or while treatment is discussed.
In situations where you are not capable of giving consent (because you are not present or due to your incapacity or medical emergency), we may, using our professional judgment, determine that a disclosure to you/your child’s family member(s) or friend is in you/your child’s best interest. In that situation, we will disclose only health information relevant to the person’s involvement in you/your child’s care. For example, we may inform the person who accompanied you to the emergency room that you suffered a heart attack and provide updates on you/your child’s progress and prognosis. We may also use our professional judgement and experience to make reasonable inferences that it is in your/your child’s best interest to allow another person to act on your/your child’s behalf to pick, for example, filled prescriptions, medical supplies, or x-rays.
OTHER USES AND DISCLOSURES OF HEALTH INFORMATION
We will not use or disclose your/your child’s health information for any purpose other than those identified in the previous sections without your specific, written Authorization. We must obtain your Authorization separate from any consent we may have obtained from you. If you give us Authorization to use or disclose health information about you/your child, you may revoke that Authorization, in writing, at any time. If you revoke your Authorization, we will no longer use or disclose information about you for the reasons covered by your written Authorization, but we cannot take back any uses or disclosures already made with your permission.
In some instances, we may need specific, written authorization from you in order to disclose certain types of specially protected information such as HIV/AIDS, substance abuse, mental health, and genetic testing information for purposes such as treatment, payment and healthcare operations.
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU
You have the following rights regarding health information we maintain about you/your child:
Right to Inspect and Copy. You have the right to inspect and copy your/your child’s health information, such as medical and billing records, that we use to make decisions about your care. Oregon State law is more restrictive with regard to parental access to a minor’s health information regarding venereal disease, birth control information and services and sexually transmitted disease. This information is viewed as confidential and we may deny access to the parent or guardian unless the minor gives consent. An exception to this would be if the minor poses a risk to himself or herself or others or we are required by law to disclose such information.
You must submit a written request to Toni Gauger, CHC, Manager, in order to inspect and/or copy your/your child’s health information. If you request to inspect or view your health information, we will not charge you for inspection or viewing.
If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other associated supplies. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred. A modified request may include requesting a summary of your/your child’s medical record.
You have the right to request an electronic copy of your record if we maintain all or part of your record electronically. You are only entitled to ask for a copy of that part of your record we store electronically. You may be charged for our staff costs to create the electronic copy. We will notify you of the cost at the time of your request and you may choose to withdraw or modify your request at that time.
We may deny your request to inspect and/or copy your/your child’s record or parts of the record in certain limited circumstances. If you are denied copies of or access to health information that we keep about you, you may ask that our denial be reviewed. If the law gives you a right to have our denial reviewed, we will select a licensed health care professional to review your request and our denial. The person conducting the review will not be the person who denied your request, and we will comply with the outcome of the review. You are not entitled to copies of psychotherapy notes.
Right to Amend. If you believe health information we have about you/your child is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment as long as the information is kept by this office.
To request an amendment, complete and submit a MEDICAL RECORD AMENDMENT/CORRECTION FORM to Toni Gauger, CHC, Manager. These forms are available upon request from this office.
We 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 or partially deny your request if you ask us to amend information that:
§ We did not create, unless the person or entity that created the information is no longer available to make the amendment
§ Is not part of the health information we keep
§ You would not be permitted to inspect and copy
§ Is accurate and complete
If we deny or partially deny your request for amendment, you have the right to submit a rebuttal and request the rebuttal be made a part of your/your child’s medical record. Your rebuttal needs to be one (1) page in length or less and we have the right to file a rebuttal responding to yours in your medical record. You also have the right to request that all documents associated with the amendment request (including rebuttal) be transmitted to any other party any time that portion of the medical record is disclosed.
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/your child for purposes other than treatment, payment and health care operations, and a limited number of special circumstances involving national security, correctional institutions and law enforcement. The list will also exclude any disclosures we have made based on your written authorization.
To obtain this list, you must submit your request in writing to Toni Gauger, CHC, Manager. It must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper, electronically etc.). The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the costs involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
Right to Request Restrictions. You have the right to request a restriction or limitation on the health information we use or disclose about you/your child for treatment, payment or health care operations. You also have the right to request a limit on the health information we disclose about you/your child to someone who is involved in your/your child’s care or the payment for it, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery you/your child had.
We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you/your child emergency treatment or we are required by law to use or disclose the information. You can revoke any honored restriction request at any time. Such requests must be in writing.
We are required to honor your request if you paid for diagnosis, treatment, medical equipment, etc., “out of pocket”. In addition, we are required to honor your request if the request is to not disclose your/your child’s health information to your health insurance plan for payment or healthcare operations. If you request we not provide your/your child’s health information to your health plan for payment purposes, we will require you to pay “in full” for any services or supplies provided at the time of service.
To request restrictions, you may complete and submit the REQUEST FOR RESTRICTIONS ON USE/DISCLOSURE OF MEDICAL INFORMATION to Toni Gauger, CHC, Manager.
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 by mail.
To request confidential communications, you may complete and submit the REQUEST FOR CONFIDENTIALCOMMUNICATION form to Toni Gauger, CHC, Manager. 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.
Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. To obtain such a copy, contact Toni Gauger, CHC, Manager. You may also find a copy of this notice on our website.
CHANGES TO THIS NOTICE
We reserve the right to change this notice, and to make the revised or changed notice effective for medical information we already have about you/your child as well as any information we receive in the future. We will post a summary of the current notice in the office with its revision date at the bottom of this document. You are entitled to a copy of the notice currently in effect.
We will inform you of any significant change to this Notice. This may be through our practice website, a sign prominently posted in our office, or other means of communication.
If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services at:
U.S. Department of Health & Human Services
2201 Sixth Avenue, – Mail Stop RX-11
Seattle, WA 98121
(206) 615-2290 (Voice)
(206) 615-2296 (TTD)
(206) 615-2297 (Fax)
To file a complaint with our office, contact Toni Gauger, CHC, Manager, at (541) 773-3688, 1322 E McAndrews Road, Suite 202, Medford OR 97504. You will not be penalized for filing a complaint.
Find out more about patient privacy, as well as other practices our clinic implements to protect you and your child, by reaching out.