HARBOR VIEW MEDICAL
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 REVIEW
If you have questions about this
Notice please contact Sharon Cox, Privacy Officer at 816-781-
This Notice of Privacy Practices
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
health information. ‘Protected health information’ is information
about you, including demographic information, that may identify
you and relates to your past, present, or future physical or
mental health or condition or any health care services provided
We are required to maintain the
privacy of your medical information. We are also required to
follow the terms of this Notice of Privacy Practices. We may
change the terms of this notice at any time, any changes will
be effective for any information we have about you at that time
or may obtain in the future. The most current copy of the Notice
will be provided to you at your next appointment following its
implementation. The Notice of Privacy practices will also be
available by calling 816-781-6127 and requesting one be sent
to you by mail. The most recent version
of the notice will also be available for review if your are in
Uses and Disclosures of Your Medical
Harbor View Medical uses your
medical information to provide you with medical treatment and
services, to receive payment for those services, and in daily
health care operations.
We will use and disclose your medical 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 received your permission
to have access to your medical information. For example, to
a home health agency that is providing care to you. We will
also disclose medical information to other physicians that
may be treating you. For example, your medical 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
to another physician or health care provider (e.g., a laboratory,
specialist or other health care provider) who, at the request
of your physician, becomes involved in your care by providing
assistance with your medical diagnosis or treatment to your
Your medical 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 or reviewing
services provided to you for medical necessity. An example of
this would be obtaining approval for a hospital stay from your
health plan that might require your health information be disclosed
to the health plan in order to obtain approval.
We may use or disclose, as needed, your medical information
in order to support the everyday business activities of Harbor
View Medical. These activities include, but are not limited
to, quality assessment activities, employee review activities,
training of medical students, licensing, and conducting or
arranging other business activities that function on our behalf.
For example, we may use a sign in sheet at the registration
desk where you will be asked to sign your name and indicate
your physician. We may call you by name in the waiting room
when your physician is ready to see you. We may use your information
to contact you to remind you of your appointment.
We will share medical information with third party ‘business
associates’ that perform various activities on our behalf (for
instance, computer programmers). Whenever an arrangement between
our office and a business associate involves the use or disclosure
of your protected health information, we will have a written
contract that contains terms that will protect the privacy
of that information.
We may use or disclose your medical information to provide
you with information about treatment alternatives or other
health-related benefits and services that may be available. You
may contact our Privacy Officer to request that these materials
not be sent to you.
Other Permitted Uses and Disclosures
That May Be Made With Your Authorization or Opportunity To
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. Your authorization will cover a
disclosure for a specific purpose and specified period of time.
You may revoke this authorization, in writing, at any time,
except to the extent your physician has taken some action in
reliance on that information.
Other Instances of Disclosures
We may use and disclose your
medical information in the following instances. You will have
the opportunity to agree or object to the use or disclosure,
if you are not present or able to agree or object, then your
physician may, using professional judgment, determine whether
the disclosure is in your best interest. Only the medical 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, a relative, a close friend
or any other person you identify your medical information that
directly relates to that person’s involvement in your healthcare.
If you are unable to agree or object to such 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. 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.
Uses and Disclosures, Either
Permitted or Required, 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 authorization. These situations include:
Required by Law: We
may use or disclose your protected health information to the
extent that law requires the use or disclosure. You will be notified,
as required by law, of any such disclosures.
Public Health Activities: We may disclose
your protected health information for public health activities
and purposes 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
and disability. These activities include but are not limited
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.
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 or problems, biologic product deviations, track
products; to enable product recalls; to make repairs or replacements,
or to conduct post marketing surveillance, as required.
To Government Entities Regarding Abuse and Neglect: We
may disclose your protected health information to a public
health authority that is authorized by law to receive reports
of child abuse or neglect. In addition, we may disclose your
protected health information if we believe you have been a
victim of abuse, neglect, or domestic violence. In this case,
the disclosure will be made consistent with the requirements
of applicable federal and state laws.
Health Oversight Activities: 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 benefits programs, other government regulatory programs
and civil rights laws.
Judicial and Administrative 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, in certain conditions
in response to a subpoena, discovery request or other lawful
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 (1) legal processes and as required by law,
(2) for purposes of identifying or locating a missing person,
fugitive, suspect or material witness, (3) information pertaining
to a victim of a crime, (4) suspicion that death has occurred
as a result of criminal conduct, (5) in the event that a crime
occurs on the premises of the practice, and (6) medical emergency
(not on the Practice's premises) and it is likely that a crime
Criminal Activity: Consistent with applicable
federal and state laws, we may disclose your protected health
information, if we believe that the use or disclosure is necessary
to prevent or lessen a serious and imminent threat to the health
or safety of a person or the public. We may also disclose protected
health information if it is necessary for law enforcement authorities
to identify or apprehend an individual.
Coroners, Medical Examiners, and Organ, Eye or Tissue
Donation: We may disclose protected health information
to a coroner or medical examiner for identification purposes,
determining cause of death or for the coroner or 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 cadaveric organ, eye or tissue
Research: We may disclose your protected
health information to researchers when their research has been
approved by an institutional review board or privacy board
that has reviewed the research proposal and established protocols
to ensure the privacy of your protected health information.
Specialized Government Functions: When the
appropriate conditions apply, we may use or disclose protected
health information of individuals who are Armed Forces personnel
(1) for activities deemed necessary by appropriate military
command authorities; (2) for the purpose of a determination
by the Department of Veterans Affairs of your eligibility for
benefits, or (3) 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,
including for the provision of protective services to the President
or others legally authorized.
Workers’ Compensation: Your protected health
information may be disclosed by us as to comply with workers'
compensation laws and other similar legally established programs.
Inmates: We may use or disclose your protected
health information if you are an inmate of a correctional facility
and your physician created or received your protected health
information in the course of providing care to you.
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.
Following is a statement of
your rights with respect to your protected health information
and a brief 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 and any
other records that your physician and the practice uses for
making decisions about you.
Under federal law, however, you may not inspect or copy the following records;
psychotherapy notes; information compiled in reasonable 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. In some circumstances, you may have a
right to have this reviewed. Please contact our Privacy Officer if you
have questions about access to your medical 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 state the specific
restriction requested and to whom you want the restriction
Your physician is not required to agree to a restriction that
you may request. If your physician believes it is in your best
interest to permit use and disclosure of your protected health
information, your protected health information will not be
restricted. If your physician does agree to the requested restriction,
we may 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 any restriction
you wish to request with your physician. You
may request a restriction by contacting our Privacy Office,
Sharon Cox at 781-6127.
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 handled or specification
of an 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 Officer.
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, for instance if the record
is complete and accurate or the information was not created
by this organization, 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 Officer to determine if you have questions about amending your
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 may have made to you, to family members or
friends involved in your care or for notification purposes.
You have the right to receive specific information regarding
these disclosures that occurred after April 14, 2003. You
may also request a shorter time frame. The right to receive
this information is subject to certain exceptions, restrictions
You have the right to obtain a paper copy of this
notice from us, upon request, even if you have agreed
to accept this notice electronically.
If you believe that your privacy
rights have been violated, you may complain to us at 816-781-6127
or to the Department of Health and Human Services through the
Federal Office of Civil Rights. You are protected from retaliation
for any and all complaints you make.
This notice was published
and became effective on 01-01-2003.