Privacy Policy - Maple Med Peds

pRIVACY Policy

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please Review Carefully.

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 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 health information that we maintain at that time. Upon your request, we will provide you with any revised Notice of Privacy Practices by 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 appointment.

USES & Disclosures

We will use and disclose elements of your protected health information (PHI) in the following ways:

Without your signed authorization:

Treatment: We will use your health 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 already obtained your permission to have access to your health information. For example, we would give your health information, as necessary, to a home health agency that provides care for you. We will provide health information to other physicians who may be treating you when we have the necessary permission from you In addition, we may provide your health information from time-to-time to another physician or health care provider (e.g., a specialist or laboratory), who becomes involved in your care by providing assistance with your health care diagnosis or treatment by your physician.
Payment: Your health information will be used, as needed, to obtain payment for your health care services. Your health insurance may request information regarding eligibility, medical necessity, and appropriate care. For example, obtaining approval for a hospital stay may require that your health information be disclosed to the health plan to obtain approval for the hospital admission.
Healthcare Operations: We may use or disclose, as needed, your health information in order to support the business of your physician’s practice. This includes, but is not limited to, quality assessment, employee review, training of medical professionals (nurses, physicians), and licensing. For example, we may disclose your health information to medical school students that see patients at our office. In addition, we may use a sign-in sheet at the check-in desk where you will be asked to sign your name, time of appointment, and change in address, phone number or insurance. We may also call you by name in the waiting room when your physician is ready to see you. We may use your health information, as necessary, to contact you to remind you of your appointment or send you an update of any changes in the office. We will share your health information with third party “business associates” (e.g., billing, transcription services, phone answering services) for the practice. Whenever an arrangement between our office and a business associate involves the use of your health information, we will have a written contract that contains terms that will protect the privacy of your health information.
Required By Law: When law requires release, including in judicial settings and to health oversight regulatory agencies and law enforcement.
In Emergency situations: or to avert serious health/safety situations.
To medical examiners, coroners, or funeral directors to aid in identifying you or to help them in performing their duties.
To organ, tissue, and other donations organization, upon or proximate to your death, if we have no indication on hand about your donation preferences (or a positive indication).
Public Health: We may disclose your health information for public health 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 health information, if directed by the public health authority, a foreign government agency that is collaborating with the public health authority.
Communicable Diseases: We may disclose your 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/condition.
Health Oversight: We may disclose 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 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 health information if we believe that you have been a victim of abuse, neglect, or domestic violence to the governmental agency authorized to receive such information. In this case, the disclosure will be made consistent with the requirements of federal and state law.
Food and Drug Administration: We may disclose your 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.
Military Activity and National Security: When the appropriate conditions apply, we may use or disclose 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 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.
Workmans’ Compensation/No Fault: we may disclose your health information as authorized to comply with workers’ compensation laws and similar legally established programs.
Inmates: We may use or disclose your health information if you are an inmate of a correctional facility and your physician created or received your health information in the course of providing care to you.
Research: We may use or disclose your PHI as authorized by the confidentiality agreement of each study required for participation in each study protocol.

Special Cases:

To contact you about appointment reminders, treatment alternatives, and other health related benefits and services.
To the sponsor of your health care.

Other:

All other uses and disclosure by us will require us to obtain from you a written authorization in addition to any other permission you will provide us.

YOUR RIGHTS

You have the following rights concerning your personal health information (PHI):

Restrictions: To request restricted access to all or part of your PHI. To do this our office will need a form or letter from the patient or guardian explaining what part of the PHI you wish to be restricted with the date and patient/guardian’s signature.
Confidential Communications: To received correspondence of confidential information by alternate means or location. To do this the physician will need a letter from patient/guardian with the confidential information indicated and dates with patient/guardian signature.
Access: You have the right to inspect and copy your health information. This means you may inspect and obtain a copy of your health information that is contained in a designated record set (your chart) for as long as we maintain the health information. This is achieved by instructing the physician by a dated letter indicating you would like a copy of your records, if you would like them mailed or picked up with patient/guardian signature and patient’s full name and date of birth(s). This may take up to 10 days to accomplish from the time the office receives the letter.
Amendments: To request changes be made to your PHI. This needs to be done through your physician in writing. We are not required to grant your request, but the physician will take it under consideration.
Accounting: To receive an accounting of the disclosures by us of your PHI since 4/14/03 we will require this in writing and we should have that form to you within seven working days.
This Notice: To get updates or reissue of this notice, at your request.
Complaints: To complain to us or the U.S. Dept. of Health and Human Services if you feel your privacy rights have been violated. To register a complaint with us ask to see the office manager, Laura, who will gladly acknowledge the complaint and take the required action to fix the situation. The law forbids us from taking retaliatory action against you if you complain.

Our Duties: We are required by law to maintain the privacy of your PHI. We must abide by the terms of this notice or any update of this notice.

Privacy Contact: For more information about our privacy practices, please contact:

Anna Jacobi, Office Manager

(716) 634-5410 prompt #7

1835 Maple Road

Williamsville, New York 14221

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