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HEMATOLOGY- ONCOLOGY ASSOCIATES, P.C. |
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Diplomates, American Board of Internal Medicine and Medical Oncology |
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A Founding Member of the New Mexico Cancer Care Alliance |
1001 Coal Ave. SE
Albuquerque, NM 87106
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.
If you have any questions about this Notice please contact: the Operations Manager or
Office Administrator (our Privacy Contacts).
This Notice of Privacy Practices describes how we may use and disclose your Protected Health
Information (PHI) 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 PHI. ¡°PHI¡± is information about you, including
demographic information, that may identify you and that relates to your past, present or future physical or mental health or
condition and related health care services.
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 PHI that we maintain at that time. Upon your
request, we will provide you with any revised Notice of Privacy Practices. A revised copy can be sent to you in the mail or a
copy can be given to you at the time of your next appointment.
1. Uses and Disclosures of PHI Acknowledgment of the Privacy Notice
Your PHI may be used and disclosed by your health care provider, 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 PHI may also be used and disclosed to pay your health care bills and to support the operation of the health care
provider¡¯s practice.
Following are examples of the types of uses and disclosures of your PHI that the health care
provider¡¯s office is permitted to make. These examples are not meant to be exhaustive, but to describe the types of uses and
disclosures that may be made by our office.
Treatment: We will use and
disclose your PHI to provide, coordinate, or manage your health care and any related services. For example, we might use your
health information in order to write a prescription for you, or we might disclose your health information to a pharmacy when
we order a prescription for you. We will also disclose PHI to other health care providers who may be treating you. For
example, your PHI may be provided to a health care provider to whom you have been referred to ensure that the health care
provider has the necessary information to diagnose or treat you.
In addition, we may disclose your PHI from time-to-time to another health care provider or
health care provider (e.g., a specialist or laboratory) who, at the request of your health care provider, becomes involved in
your care by providing assistance with your health care diagnosis or treatment to your health care provider.
2. Your Rights
Following is a statement of your rights with respect to your PHI and a brief description of how
you may exercise these rights.
You have the right to inspect and copy your PHI
This means you may inspect and obtain a copy of PHI about you that is contained in a designated
record set for as long as we maintain the PHI. A ¡°designated record set¡± contains medical and billing records and any other
records that your health care provider and the practice use for making decisions about you. You must submit your request
in writing in order to inspect and/or obtain a copy of your health information. If you request a copy, our practice may charge
a fee for the costs of copying, mailing, labor and supplies associated with your request. Such requests will be honored
within 30 days or as required by law, and you will be notified in writing of HOA¡¯s receipt of the request and the date upon
which the information will be available to 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 PHI that is subject to law that prohibits access to PHI. Depending on the circumstances, a decision to deny
access may be reviewable. In some circumstances, you may have a right to have this decision reviewed. Please contact our
Privacy Contact if you have questions about access to your medical record.
Please note: The Privacy Rule permits an exception to access of PHI created or obtained by a
covered health care provider/researcher for a clinical trail. Per this exception, your right to access your PHI will be
suspended while the clinical trial is in progress, provided that if you are a research participant in a clinical trail, you
agreed to this denial of access when consenting to participate in the clinical trail. In addition, at the conclusion of the
clinical trail, your right to access PHI will be reinstated.
You have the right to request a restriction of your PHI. This
means you may ask us not to use or disclose any part of your PHI for the purposes of treatment, payment or healthcare
operations. You may also request that any part of your PHI 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 health care provider is not required to agree to a restriction that you may request. If
health care provider believes it is in your best interest to permit use and disclosure of your PHI, your PHI will not be
restricted. If your health care provider does agree to the requested restriction, we may not use or disclose your PHI in
violation of that restriction unless it is needed to provide emergency treatment. In order to request a restriction in our
use or disclosure of your PHI, you must make your request in writing to the Privacy Contact. Your request must describe in a
clear and concise fashion:
(a)
The information you wish restricted;
(b)
Whether you are requesting to limit our practice¡¯s
use, disclosure or both; and
(c)
To whom you want the limits to apply.
If, in our sole opinion, your request does not involve
information that is required by us to carry out treatment, payment or health care operations, we will accept your request for
restrictions and will notify you if your request will be honored within 30 days or as required by law.
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 Contact. Such request will be honored within 30 days, or as
required by law.
You may have the right to have your health care provider amend your PHI.
This means you may request an amendment of PHI 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. We may deny your request if you ask us to
amend information that is in our opinion: (a) accurate and complete; (b) not part of the health information kept by or for the
practice; (c) not part of the health information which you would be permitted to inspect and copy; or(d) not created by our
practice. 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. To request an amendment, your
request must be in writing and submitted to the Privacy Contact. You must provide us with a reason that supports your
request for amendment. Our practice will deny your request if you fail to submit your request (and the reason supporting your
request) in writing. Upon agreement by your health care provider, request to amend health information will be honored
within 30 days or as required by law, and you will be notified in writing of HOA¡¯s action taken. 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
PHI. 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 a
provider involved in your care, to family members or friends involved in your care, or for notification purposes. In order
to obtain an accounting of disclosures, you must submit your request in writing to the Privacy Contact at the address listed
at the top of this document. Such request will be honored within 30 days or as required by law, and you will be notified
in writing of the date on which the accounting will be available to you. All requests for an account of disclosures must state
a time period, which may not be longer than six (6) years form the date of the disclosure and may not include dates before
April 14, 2003. You may request a shorter timeframe. The right to receive this information is subject to certain exceptions,
restrictions and limitations. The first request within a 12-month period is free of charge, but our practice may charge you
for additional lists with the same 12-month period. Our practice will notify you of the costs involved with additional
requests, and you may withdraw your request before you incur any costs.
HOA¡¯s has also required in our business associate contracts
that they offer a means to provide such a listing for you.
3. Complaints
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.
All complaints must submitted in writing. We will not retaliate against you for filing a complaint.
You may contact our Privacy Contact at (505) 938-5858 for further
information about the complaint process.
This notice was published and becomes effective on April 14, 2003.
Payment: Your PHI 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 a hospital stay may require that your relevant PHI be disclosed to the health
plan to obtain approval for the hospital admission. We may also disclose your PHI to obtain payment from third parties that
may be responsible for such costs, such as a family member. We may disclose your PHI to other health care providers and
entities to assist in their billing and collection efforts.
Healthcare Operations: We may
use or disclose, as-needed, your PHI in order to support the business activities of your health care provider¡¯s practice.
These activities include, but are not limited to, quality assessment activities, employee review activities, training of
medical students, licensing, marketing and conducting or arranging for other business activities.
For example, we may disclose your PHI to medical school students that see patients at our
office. In addition, we may use a sign-in sheet at the registration desk where you will be asked to sign your name and
indicate your health care provider. We may also call you by name in the waiting room when your health care provider is ready
to see you. We may use or disclose your PHI, as necessary, to contact you to remind you of your appointment.
We will share your PHI with third party ¡°business associates¡± that perform various activities
(e.g., billing, transcription services) for the practice. Whenever an arrangement between our office and a business associate
involves the use or disclosure of your PHI, we will have a written contract that contains terms that will protect the privacy
of your PHI.
Uses and Disclosures of PHI Based upon Your Written Authorization
Our practice will obtain your written authorization to uses and disclosures that are not
identified by this notice or permitted by applicable law. Any authorization you provide us regarding the use and disclosure
of your health information may be revoked at any time. A request to revoke an authorization must be submitted in writing.
After you revoke your authorization, we will no longer use or disclose your health information for the reasons described in
the authorization. However, if you are a research participant, we may continue to use your PHI that was obtained prior to the
time you revoked your authorization, as necessary to maintain the integrity of the clinical trail/research study. For
example, we are permitted to continue use and disclosure of PHI to account for your withdrawal from the clinical
trail/research study, as necessary to incorporate the information as part of a marketing application submitted to the Food and
Drug Administration, to conduct investigation of scientific misconduct, or report adverse events. Please note, we are
required by law to retain records of your care.
Other Permitted and Required Uses and Disclosures That May Be Made With Your Consent,
Authorization or Opportunity to Object
You have the opportunity to agree or object to the use or disclosure of all or part of your PHI.
If you are not present or able to agree or object to the use or disclosure of the PHI, then your health care provider may,
using professional judgment, determine whether the disclosure is in your best interest. In this case, only the PHI that is
relevant to your health care will be disclosed. We may use and disclose your PHI in the following instances:
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(s) assisting in your
care, your PHI that directly relates to that person¡¯s involvement in your 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. We may use or disclose PHI to notify or assist in notifying a family member, personal representative or
any other person that is responsible for your care of your location, general condition or death. Finally, we may use or
disclose your PHI 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 PHI in an emergency treatment situation. If this happens, your health care provider shall try to obtain your
consent as soon as reasonably practicable after the delivery of treatment. If your health care provider or another health care
provider in the practice is required by law to treat you and the health care provider has attempted to obtain your consent but
is unable to obtain your consent, he or she may still use or disclose your PHI to treat you.
Communication Barriers: We may
use and disclose your PHI if your health care provider or another health care provider in the practice attempts to obtain
consent from you but is unable to do so due to substantial communication barriers and the health care provider determines,
using professional judgment, that you intend to consent to use or disclosure under the circumstances.
Research: We will use and disclose PHI for research
with individual authorization, or without individual authorization under limited circumstances. Please ask to speak with our
Privacy Contact if you would like to know the limited circumstances permitted by applicable law.
Other Permitted and Required Uses and Disclosures That May Be Made Without Your Consent,
Authorization or Opportunity to Object
We may use or disclose your PHI in the following situations without your consent or
authorization:
Required By Law: We may use or
disclose your PHI to the extent, that law requires the use or disclosure. 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 uses or disclosures.
Public Health: We may disclose
your PHI 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 disease, injury or disability. We may also disclose
your PHI, if directed by the public health authority, to a foreign government agency that is collaborating with the public
health authority.
Communicable Diseases: We may
disclose your PHI, 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 PHI 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 PHI to a public health authority that is authorized by law to receive reports of child abuse or neglect. In
addition, we may disclose your PHI if we believe that you have been a victim of abuse, neglect or domestic violence to the
governmental entity or agency 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 PHI 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 PHI 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 PHI, so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes
include (1) legal processes and otherwise required by law, (2) limited information requests for identification and location
purposes, (3) pertaining to victims 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 has occurred.
Coroners, Funeral Directors, and Organ Donation:
We may disclose PHI 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 PHI 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. PHI may be used and disclosed for cadaveric organ, eye or tissue donation
purposes.
Criminal Activity: Consistent
with applicable federal and state laws, we may disclose your PHI, 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 PHI if
it is necessary for law enforcement authorities to identify or apprehend an individual.
Military Activity and National Security:
When the appropriate conditions apply, we may use or disclose PHI 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 PHI 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 PHI
may be disclosed by us as authorized to comply with workers¡¯ compensation laws and other similar legally established programs.
Inmates: We may use or disclose
your PHI if you are an inmate of a correctional facility and your health care provider created or received your PHI 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.
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