Effective: 4/14/03
NOTICE OF PRIVACY
PRACTICES
As Required by the Privacy
Regulations Created as a Result of the Health Insurance Portability
and
Accountability Act of 1996 (HIPAA)
THIS NOTICE DESCRIBES HOW
HEALTH
INFORMATION ABOUT YOU AS A PATIENT OF THE PENNSYLVANIA NEUROSURGERY
AND NEURO-SCIENCE INSTITUTE, INC. MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET
ACCESS TO YOUR PROTECTED HEALTH INFORMATION.
PLEASE REVIEW THIS NOTICE
CAREFULLY.
A. OUR COMMITMENT TO YOUR
PRIVACY
The Pennsylvania
Neurosurgery and Neuroscience Institute, Inc. (PNNI) is dedicated to
maintaining the privacy of your protected health information (PHI). In
conducting our business,
we will create records regarding you and the
treatment and services we provide to you. We are
required by law to maintain
the confidentiality of health information that identifies you. We also
are
required by law to provide you with this notice of our legal duties and the
privacy practices
that we maintain in our practice concerning your PHI. By
federal and state law, we must follow
the terms of the notice of privacy
practices that we have in effect at the time.
We realize that these laws
are complicated, but we must provide you with the following
important
information:
* How we may use and disclose your PHI
* Your privacy rights
in your PHI
* Our obligations concerning the use and disclosure of your
PHI
The terms of this notice
apply to all records containing your PHI that are created or retained by our
practice. We reserve the right to revise or amend this Notice of Privacy
Practices. Any revision or amendment to this notice will be effective for all of
your records that our practice has created or maintained in the past, and for
any of your records that we may create or maintain in the future. Our practice
will post a copy of our current Notice of Privacy Practices in our offices in a
visible location at all times, and you may request a copy of our most current
Notice of Privacy Practices at any time.
B. IF YOU HAVE QUESTIONS
ABOUT THIS NOTICE, PLEASE CONTACT:
Pennsylvania
Neurosurgery and
Neuroscience Institute, Inc.
4310
Londonderry Road
Harrisburg, PA 17109
Attention: Privacy
Officer
C. WE MAY USE AND DISCLOSE
YOUR PROTECTED HEALTH INFORMATION (PHI) IN THE FOLLOWING WAYS
The following categories
describe the different ways in which we may use and disclose your
PHI.
1. Treatment. PNNI may use
your protected health information for our treatment purposes as well as the
treatment purposes of other health care providers. Treatment includes the
provision,
coordination, or management of healthcare services to you by one
or more health care providers. Some examples of treatment uses and disclosures
include:
* PNNI providers and staff – including, but not limited to, our
doctors, physician assistants, medical assistants, practice manager, front
office staff– may use and disclose your PHI with each other in order to treat
you or to assist in your treatment.
* PNNI may use and disclose your PHI with
an outside physician to whom we have referred you for care.
* PNNI may use
and disclose your PHI with an outside physician with whom we are consulting
regarding your care.
* PNNI may use and disclose your PHI with an outside
laboratory, radiology center, or other health care facility where we have
referred you for testing.
* PNNI may use and disclose your PHI with an
outside home health agency, durable medical equipment agency or other health
care provider to whom we have referred you for health cares services and
products.
* PNNI may use and disclose your PHI with a hospital or other
health care facility where we are admitting or treating you.
* PNNI may use
and disclose your PHI with another health care provider who seeks this
information for the purpose of treating you.
2. Payment. PNNI may use and
disclose your PHI in order to bill and collect payment for the services and
items you may receive from us or so that you may obtain reimbursement for that
care, for example, from your health insurer. Some examples of payment uses and
disclosures
include:
* PNNI and/or its billing service may use and
disclose your PHI with your health insurer to determine whether you are eligible
for coverage or whether proposed treatment is a covered service.
* PNNI
and/or its billing service may use and disclose your PHI to submit a claim form
to your health insurer.
* PNNI and/or its billing service may provide
supplemental information to your health insurer so that your health insurer can
obtain reimbursement from another health plan under a coordination of benefits
clause in your subscriber agreement.
* PNNI and/or its billing service may
use and disclose your PHI demographic information with other health care
providers who seek this information to obtain payment for health care services
provided to you.
* PNNI and/or its billing service may use and disclose your
PHI to mail you bills in
envelopes with our practice name and return
address.
* PNNI and/or its billing service may use and disclose your PHI to
provide a bill to a family member or other person designated as responsible for
payment for services rendered to you.
* PNNI and/or its billing service may
use and disclose your PHI to your health insurer to support the medical
necessity of a health service.
* PNNI may allow your health insurer access to
your PHI for a medical necessity or quality review audit.
* PNNI may use and
disclose your PHI to a billing agency, collection agency, or our attorney for
purposes of securing payment of a delinquent account
* PNNI may use and
disclose your PHI in a legal action for purposes of securing payment of a
delinquent account.
* PNNI may use and disclose your PHI for claim payment
information with a Human Resources representative from your employer if you have
asked he or she to get involved on your behalf.
3. Health Care Operations.
PNNI may use and disclose your PHI to operate our business as well as certain
health care operation purposes of other health care providers and health plans.
Some examples of health care operation purposes include:
* Quality
assessment and improvement activities.
* Population based activities relating
to improving health or reducing health care costs
* Accreditation,
certification, licensing and credentialing activities.
* Health care fraud
and abuse detection and compliance programs.
* Conducting other medical
review, legal services, and auditing functions.
* Business planning and
development activities, such as conducting cost management and planning related
analyses.
* Sharing information regarding patients with entities that are
interested in purchasing our practice and turning over patient records to
entities that have purchased our practice.
D. USES AND DISCLOSURES
FOR OTHER PURPOSES
1. Appointment Reminders. PNNI may use and disclose
your PHI to contact you and remind
you of an appointment.
2. Treatment Options. PNNI
may use and disclose your PHI to inform you of potential treatment options or
alternatives.
3. Health-Related Benefits
and Services. PNNI may use and disclose your PHI to inform you of health-related
benefits or services that may be of interest to you.
4. Release of Information to
Family/Friends/Personal Representatives. PNNI may release your PHI to the extent
necessary to obtain help from a family member, friend or other person that you
indicate is involved in your care, or the payment for your health care, or who
assists in
taking care of you. PNNI may disclose health information to your
personal representative. Your
personal representative would be your legal
guardian, someone who has power of attorney over
your health care decisions,
or your parent if you are an unemancipated minor under the age of
18. A personal
representative would also include an executor, or an administrator acting on
behalf of a deceased individual or the estate.
5. Disclosures Required By
Law. PNNI will use and disclose your PHI when we are required
to do so by
federal, state or local law.
E. USE AND DISCLOSURE OF
YOUR PHI IN CERTAIN SPECIAL
CIRCUMSTANCES
The following categories
describe unique scenarios in which we may use or disclose your identifiable
health information:
1. Public Health Risks. PNNI
may disclose your PHI to public health authorities that are
authorized by
law to collect information for the purpose of:
* maintaining vital records,
such as births and deaths.
* reporting child abuse or neglect,
*
preventing or controlling disease, injury or disability.
* notifying a person
regarding potential exposure to a communicable disease.
* notifying a person
regarding a potential risk for spreading or contracting a disease or
condition.
* reporting reactions to drugs or problems with products or
devices.
* notifying individuals if a product or device they may be using has
been recalled.
* notifying appropriate government agency(ies) and
authority(ies) regarding the potential abuse or neglect of an adult patient
(including domestic violence); however, we will only disclose this information
if the patient agrees or we are required or authorized by law to disclose this
information.
* notifying your employer under limited circumstances related
primarily to workplace
injury or illness or medical surveillance.
*
notifying appropriate government agency(ies) and authority(ies) regarding
information on your medical treatment and response(s) to an investigational
treatment or drug that you have received or may receive under a separate form of
consent by you.
* OSHA requirements for workplace surveillance and injury
reports.
2. Health Oversight
Activities. PNNI may disclose your PHI to a health oversight agency for
activities authorized by law. Oversight activities can include, for example,
investigations,
inspections, audits, surveys, licensure and disciplinary
actions; civil, administrative, and criminal procedures or actions; or other
activities necessary for the government to monitor government programs,
compliance with civil rights laws and the health care system in
general.
3. Lawsuits and Similar
Proceedings. PNNI may use and disclose your PHI in response to a court or
administrative order, if you are involved in a lawsuit or similar proceeding. We
also may disclose your PHI in response to a discovery request, subpoena, or
other lawful process by
another party involved in the dispute, but only if
we have made an effort to inform you of the request or to obtain an order
protecting the information the party has requested.
4. Law Enforcement. PNNI may
release PHI if asked to do so by a law enforcement official:
* Regarding a
crime victim in certain situations, if we are unable to obtain the person’s
agreement.
* Concerning a death we believe has resulted from criminal
conduct.
* Regarding criminal conduct at our offices.
* In response to a
warrant, summons, court order, subpoena or similar legal process.
* To
identify/locate a suspect, material witness, fugitive or missing person.
* In
an emergency, to report a crime (including the location or victim(s) of the
crime, or the description, identity or location of the perpetrator).
*
Comply with legal requirements ie: mandatory reporting of gun shot wounds.
5.
Deceased Patients. PNNI may release PHI to a medical examiner or coroner to
identify a
deceased individual or to identify the cause of death. If
necessary, we also may release
information in order for funeral directors to
perform their jobs.
6. Organ and Tissue
Donation. PNNI may release your PHI to organizations that handle organ, eye or
tissue procurement or transplantation, including organ donation banks, as
necessary to facilitate organ or tissue donation and transplantation if you are
an organ donor.
7. Research. PNNI may use
and disclose your PHI for research purposes in certain limited
circumstances. We will obtain your written authorization to use your PHI for
research purposes except when an IRB or Privacy Board has determined that the
waiver of your authorization satisfies the following: (i) the use or disclosure
involves no more than a minimal risk to the individual’s privacy based on the
following: (A) an adequate plan to protect the identifiers from
improper use
and disclosure; (B) an adequate plan to destroy the identifiers at the earliest
opportunity consistent with the research (unless there is a health or research
justification for retaining the identifiers or such retention is otherwise
required by law); and (C) adequate written assurances that the PHI will not be
re-used or disclosed to any other person or entity (except as required by law)
for authorized oversight of the research study, or for other research for which
the use or disclosure would otherwise be permitted; (ii) the research could not
practicably be conducted without the waiver; and (iii) the research could not
practicably be conducted without access to and use of the PHI.
8. Serious Threats to Health
or Safety. PNNI may use and disclose your PHI when necessary to reduce or
prevent a serious threat to your health and safety or the health and safety of
another
individual or the public. Under these circumstances, we will only
make disclosures to a person or organization able to help prevent the threat.
9. Military. PNNI may
disclose your PHI if you are a member of U.S. or foreign military forces
(including veterans) and if required by the appropriate authorities.
10. National Security. PNNI
may disclose your PHI to federal officials for intelligence and national
security activities authorized by law. We also may disclose your PHI to federal
officials in order to protect the President, other officials or foreign heads of
state, or to conduct investigations such as medical suitability determinations
for the Department of State.
11. Inmates. PNNI may
disclose your PHI to correctional institutions or law enforcement
officials
if you are an inmate or under the custody of a law enforcement official.
Disclosure for these purposes would be necessary: (a) for the institution to
provide health care services to you,
(b) for the safety and security of the
institution, and/or (c) to protect your health and safety or the
health and
safety of other individuals.
12. Workers’ Compensation.
PNNI may release your PHI for workers’ compensation and similar programs
established by law, that provide benefits for work-related injuries or illness
without regard to fault. This would include submitting a claim for payment to
your employer’s workers’ compensation carrier if we treat you for a work-related
injury.
13. Business Associates.
Certain functions of the practice are performed by a business associate
such
as a billing company, answering service, or a law firm. PNNI may use and
disclose your
PHI to our business associates and allow them to create and
receive PHI on our behalf. For example, we may share with our billing company
information regarding your care and payment for your care so that the company
can file health insurance claims and bill you or another responsible
party.
14. Incidental Disclosures.
We may disclose your PHI as by-product of an otherwise permitted
use for
disclosure. For example, other patients may overhear your name being paged in
the
waiting room.
F. YOUR RIGHTS REGARDING
YOUR PHI
You have the following
rights regarding the PHI that we maintain about you:
1. Confidential
Communications. You have the right to request that PNNI communicate with you
about your health and related issues in a particular manner or at a certain
location. For instance, you may ask that we contact you at home, rather than
work. In order to request a type of confidential communication, you must
complete a written Request for Confidential Communications form and send or
deliver to Pennsylvania Neurosurgery and Neuroscience Institute, Inc., 4310
Londonderry Road, Harrisburg, PA 17109 Attention: Privacy Officer. This will
specify the requested method of contact, or the location where you wish to be
contacted. Our practice will accommodate reasonable requests. You do not
need to give a
reason for your request.
2. Requesting Restrictions.
You have the right to request a restriction in our use or disclosure of your PHI
for treatment, payment or health care operations. Additionally, you have the
right to
request that we restrict our disclosure of your PHI to only certain
individuals involved in your care or the payment for your care, such as family
members and friends. We are not required to
agree to your request; however,
if we do agree, we are bound by our agreement except when otherwise required by
law, in emergencies, or when the information is necessary to treat you. In
order to request a restriction in our use or disclosure of your PHI, you
must complete a written Request for Limitations and Restrictions of Protected
Health Information form and send or
deliver to Pennsylvania Neurosurgery and
Neuroscience Institute, Inc., 4310 Londonderry Road, Harrisburg, PA 17109
Attention: Privacy Officer. 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.
3. Inspection and Copies.
You have the right to inspect and obtain a copy of the PHI that may
be used
to make decisions about you, including patient medical records and billing
records. In
order to inspect and/or obtain a copy of your PHI, you must
complete a written Request to
Inspect and Copy Protected Health Information
form and send or deliver to Pennsylvania
Neurosurgery and Neuroscience
Institute, Inc., 4310 Londonderry Road, Harrisburg, PA 17109
Attention:
Privacy Officer. PNNI may charge a fee for the costs of copying, mailing, labor
and
supplies associated with your request. PNNI may deny your request to
inspect and/or copy in
certain limited circumstances and you will receive a
Patient Denial Letter to Inspect and Copy
Protected Health Information
letter. However, you may request a review of our denial.
Another licensed
health care professional chosen by us will conduct reviews.
4. Amendment. You may ask us
to amend your health information if you believe it is incorrect
or
incomplete, and you may request an amendment for as long as the information is
kept by or
for our practice. To request an amendment, you must complete a
written Request for
Correction/Amendment of Protected Health Information
form and send or deliver to
Pennsylvania Neurosurgery and Neuroscience
Institute, Inc., 4310 Londonderry Road,
Harrisburg, PA 17109 Attention:
Privacy Officer. You must provide us with a reason that
supports your
request for amendment. PNNI will deny your request if you fail to submit your
request (and the reason supporting your request) in writing. Also, 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 PHI kept by or for the
practice; (c) not part of the PHI which you would be permitted to
inspect
and copy; or (d) not created by our practice, unless the individual or entity
that created
the information is not available to amend the information. PNNI
will provide a written response
of acceptance or denial to your
request.
5. Accounting of Disclosures. All of our patients have the right
to request an “accounting of
disclosures.” An “accounting of disclosures” is
a list of certain non-routine disclosures our
practice has made of your PHI
for non-treatment or operations purposes. Use of your PHI as part
of the
routine patient care in our practice is not required to be documented. For
example, the
doctor sharing information with PNNI staff; or the billing
department using your information to
file your insurance claim. In order to
obtain an accounting of disclosures, you must complete a
written Request for
an Accounting of Certain Disclosures of Protected Health Information
for
Non-TPO Purposes form and send or deliver to Pennsylvania Neurosurgery and
Neuroscience Institute, Inc., 4310 Londonderry Road, Harrisburg, PA 17109
Attention:
Privacy Officer. All requests for an “accounting of disclosures”
must state a time period, which
may not be longer than six (6) years from
the date of disclosure and may not include dates before
April 14, 2003. The
first list you request within a 12-month period is free of charge, but our
practice may charge you for additional lists within 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.
6. Right to a Paper Copy of
This Notice. You are entitled to receive a paper copy of our
Notice of
Privacy Practices. You may ask us to give you a copy of this notice at any time.
To
obtain a paper copy of this notice, contact Pennsylvania Neurosurgery and
Neuroscience
Institute, Inc., 4310 Londonderry Road, Harrisburg, PA 17109
Attention: Privacy Officer
7. Right to File a
Complaint. If you believe your privacy rights have been violated, you may
file a complaint with our practice or with the Secretary of the Department
of Health and Human
Services. To file a complaint with PNNI, you must
complete a written Patient Complaint
Form and send or deliver to
Pennsylvania Neurosurgery and Neuroscience Institute, Inc., 4310
Londonderry
Road, Harrisburg, PA 17109 Attention: Privacy Officer. You will not be
penalized for filing a complaint.
8. Right to Provide an
Authorization for Other Uses and Disclosures. PNNI will obtain
your written
authorization for uses and disclosures that are not identified by this notice or
permitted by applicable law. Any authorization you provide to us regarding
the use and
disclosure of your PHI may be revoked at any time in writing.
After you revoke your
authorization, we will no longer use or disclose your
PHI for the reasons described in the
authorization. Please note, we are
required to retain records of your care.
If you have any
questions regarding this notice of our health information privacy policies,
please contact:
Pennsylvania Neurosurgery and Neuroscience Institute,
Inc.
4310 Londonderry Road
Harrisburg, PA 17109
Attention: Privacy
Officer
Telephone (717) 920-PNNI (7664)
Toll Free:
1-888-920-4360