Revised June 2009
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 it carefully.
This Notice describes how we protect the personal medical/health information we have about you. When this information becomes a part of your personal medical/health record, it serves as a basis for developing a plan of services for you, a means of communicating with the health professionals who contribute to your care and a source of verification that services were provided. This Notice also describes your rights with regard to your personal medical/health information. We are required by federal law to maintain the privacy of this personal medical/health information and to provide you with this notice of our legal duties and privacy practices.
A. The primary reasons for which we may use and
disclose your personal medical/health information are as follows:
B. Other Uses and
Disclosures of Medical/Health Information that Do Not Require Your
Authorization:
Business Associates: We will
share your protected medical/health information with business associates that
perform activities for us such as accounting and audits. Whenever an arrangement between our offices
and a business associate involves the use or disclosure of your medical/health
information, we will have a written contract that requires the business
associate protect the privacy of your medical/health information.
Appointment Reminders/ Other Health Services: We may use or disclose your
medical/health information to contact you at the address and/or telephone number
you give us to provide appointment reminders, information about treatment
alternatives or other health-related benefits and services that may be of
interest to you. We
may also use and disclose your medical/health information for other marketing
activities. For example, your name and address may be used to send you a
newsletter about 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.
Communication with Family or Personal Representative: 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/health information that directly relates to that person’s
involvement in your medical/health care. If you are unable to agree or object
to such a disclosure, we may disclose such information as necessary if we
determine that it is in your best interest based on our professional judgment.
Emergencies: We may use or disclose
your medical/health information in an emergency treatment situation. If this
happens, we shall try to obtain your consent as soon as reasonably practicable
after the delivery of treatment.
Communication Barriers: We may use and disclose
your medical/health information if we attempt to obtain consent from you but
are unable to do so due to substantial communication barriers and we determine,
using professional judgment, that you intend to consent to use or disclosure
under the circumstances.
Public Health: As required by law, we
may disclose your medical/health information to a public health or legal
authority charged with preventing or controlling disease, injury or
disability. For example, we may be
required to disclose the fact that you have a communicable disease.
Health Oversight: We may disclose
medical/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 benefit programs, other government regulatory
programs and civil rights laws.
Abuse or Neglect: We may disclose your
medical/health information to the governmental entity or agency authorized to
receive such information consistent with the requirements of applicable federal
and state laws if we believe that you have been a victim of abuse, neglect or
domestic violence.
Food and Drug
Administration: We may disclose your medical/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.
Legal Proceedings: We may disclose
medical/health information 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
medical/health information, so long as applicable legal requirements are met,
for law enforcement purposes.
Coroners, Funeral
Directors, and Organ Donation: We may disclose medical/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 medical/health information to a funeral director
to permit the funeral director to carry out his lawful duties. We may disclose
such information in reasonable anticipation of death. Medical/Health
information may be used and disclosed for cadaveric organ, eye or tissue
donation purposes.
Criminal Activity: Consistent with
applicable laws, we may disclose your personal medical/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 disclose medical/health information if it is necessary for law enforcement
authorities to identify or apprehend an individual.
Workers’ Compensation: Your medical/health
information may be disclosed by us as authorized to comply with workers’ compensation
laws and other similar legally-established programs.
Serious Threat to Health or Safety: We may use or disclose personal medical/health
information if we believe in good faith that it is necessary to lessen or
prevent a serious and imminent threat to the health and safety of a person or
the public in a manner consistent with law and ethical standards.
Specialized Government Functions: Your personal medical/health information may be
disclosed to other entities that are covered by this law that are government
programs providing public benefits. For
example, we may share information with the Department of Social Services,
Family Support Division to determine your spenddown requirements.
The examples of permitted uses and disclosures listed above are not provided as an all inclusive list of the uses and disclosures that may be made. They are provided to describe in general uses and disclosures that may be made of your personal medical/health information.
C. Other Uses and
Disclosures:
Other uses and disclosures of personal medical/health information will only be made with your written authorization or that of your legal representative. You may revoke an authorization, in writing, at any time except to the extent that we have already taken action in good faith relying on the authorization.
D. Your Rights Regarding Personal Medical/Health
Information We Maintain About You
Following is a statement
of your rights with respect to your medical/health information and a brief
description of how you may exercise these rights.
You have the right to
inspect and copy your medical/health information. You may inspect and
obtain a copy of medical/health information about you that is contained in a
designated record set for as long as we maintain the medical/health
information. A “designated record set” contains medical and billing records
about you that we maintain and any other records that we use for making
decisions about you. You may be charged
a fee for the costs of copying, mailing or other such costs associated with
your request. 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
health information that is subject to law that prohibits access to
medical/health information. If your
request for access is denied, you may request that the decision be
reviewed. Requests for access should be
directed in writing to the Privacy
Officer listed in this notice.
You have the right to
request a restriction of your medical/health information. This means you may ask
us not to use or disclose any part of your medical/health information for the
purposes of treatment, payment or healthcare operations. You may also request
that any part of your medical/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
to apply.
We are not required to
agree to a restriction that you may request. If we believe it is in your best
interest to permit use and disclosure of your medical/health information, your
medical/health information will not be restricted. If we do agree to the
requested restriction, we may not use or disclose your medical/health
information in violation of that restriction unless it is needed to provide
emergency treatment. To request a restriction, you must make your
request in writing. You must tell
what information you want to restrict; whether you want to limit our use,
disclosure or both; and to whom you want the restrictions to apply. We will not agree to restrictions on uses or disclosures
that are legally required.
You have the right to
request to receive confidential communications from us by alternative means or
at an alternative location. You have the right
to request that communications involving personal medical/health information be
provided to you at an alternative location or by an alternative means of
communication. We will accommodate
reasonable requests if you clearly state on the request that disclosure could
endanger you. To request confidential
communications, you must make your
request in writing to our Privacy Officer and specify how or where you wish
to be contacted.
You may have the right
to request an amendment to your medical/health information. If you believe your
personal medical/health information is incorrect or that an important part of
it is missing, you may request an amendment of medical/health information about
you for as long as we maintain this information. You must request the amendment in writing and specify the reason for
your request. We may deny your
request if the information was not created by us, is not part of the
information that you are permitted to inspect and copy, it is accurate and
complete. In we deny your request, 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 such rebuttal.
Requests should be directed to our Privacy Officer.
You have the right to
receive an accounting of certain disclosures we have made, if any, of your
protected medical/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
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.
You may also obtain a copy of this notice at our website, http://www.bcfr.org.
If you wish to exercise any of these rights, please contact
the Privacy Officer, Jane Kruse, 573-874-1995 ext. 106, BCFR, 1209 E. Walnut,
Columbia, MO 65201.
You have the right to
file a complaint:
If you have questions or
would like additional information, or if you believe your privacy rights have
been violated, you may contact our Privacy Officer,
If
you are receiving services available through the Department of Mental Health,
you may contact and file a complaint with the Department’s Privacy Officer or
Designee at 573-882-9835 or by writing: Privacy Officer, Central Missouri
Regional Office,
All
persons also have the right to file a complaint with the Region VII Office for
Civil Rights, U.S. Department of Health and Human Services. You may call them
at 816-426-7278 or write to them at
It
is recommended that you use the Office for Civil Rights Health Information
Privacy Complaint Form, which can be found at http://www.hhs.gov/ocr/privacy/hipaa/complaints/hipcomplaintpackage.pdf. You may email the completed complaint to OCRComplaint@hhs.gov. Complaint requirements:
·
Submit your complaint in any written format by mail, fax, or
email;
·
Name the covered entity involved and describe the acts or
omissions you believe violated the requirements of the Privacy Rule; and
·
Be filed within 180 days of when you knew that the act or omission
complained of occurred. OCR may extend
the 180-day period if you can show “good cause.”
We will not retaliate or penalize you for filing a complaint.
This notice was published
and became effective June 2009.
We are required to abide
by the terms of this Notice of Privacy Practices. We may change the terms of
our notice at any time. The new notice will be effective for all protected
medical/health information that we maintain at that time. Upon your request, we
will provide you with any revised Notice of Privacy Practices by accessing our
website at www.bcfr.org, calling the 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. A copy of the current
notice will be posted in our main office.