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 of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment or health care operations (TPO) 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 services.
· Uses and Disclosures of Protected Health Information
· Treatment: We will use and disclose your protected 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. For example, we would disclose your protected health information, as necessary, to a home health agency that provides care to you. For example, your protected health information may be provided to a physician to whom you have been referred to ensure the physician has the necessary information to diagnose or treat you.
· Payment: Your protected health information will be used, as needed, to obtain payment for your health care services. For example, obtaining approval for a hospital stay may require that your relevant protected 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 protected health information in order to support the business activities of your physician’s practice. These activities include, but are not limited to, quality assessment activities, employee review activities licensing, and conducting or arranging for other business activities We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment.
· Other Permitted and Required Uses and Disclosures Will be made only with your consent, authorization or opportunity to object unless required by law.
· You may revoke this authorization, at anytime, in writing, except to the extent that your physician or the physician’s practice has taken an action in reliance on the use or disclosure indicated in the authorization.
· You have the right to issue and copy your protected health information. Under Federal law, however, you may not inspect or copy the following records; psychotherapy notes, information compiled in reasonable anticipation or, or in 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.
· 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 purpose of treatment, pay mentor healthcare operations. You may also request that any part of your protected health information not to 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
· You have the right to request to receive confidential communication from us by alternative mean means or at an alternative location. 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 alternatively i.e. electronically.
· You may have the right to have your physician amend your protected health information. If we deny your request for amendment, you have the right to file to file a statement of disagreement with us and we may prepare rebuttal to your statement and will provide you with a copy of any such rebuttal
NOTICE OF PRIVACY PRACTICES
Office of Moataz K. Giurgius M.D.
15651 Imperial Hwy #203 La Mirada CA 90638
562-947-8832 Fax 562-947-8839
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. In accordance with the Health Insurance Portability and Accountability Act, we are require by law to provide you with this notice that explains our privacy practices with regard to your medical information and how we may use and disclose your protected health information for treatment, payment, and for health care options, as well as for other purposes that are permitted or required by law. You have certain rights regarding the privacy of you protected health information and we also describe them in this notice.
Request Amendment. You have the right to request that we amend your medical information if you feel that it is incomplete or inaccurate. You must make this request in writing to our practice manager, stating exactly what information is incomplete or inaccurate and your reasoning that supports your request.
We are permitted to deny your request if it is not in writing or does not include a reason to support the request. We may also deny your request if:
- The information was not created by us, or the person who created it is no longer available to make
- The information is not part of the record, which you are permitted to inspect and copy;
- The information is not part of the designated record set kept by this practice; or it is the opinion of the health care provider that
- The information is accurate and complete.
Request Restrictions. You have the right to request a restriction or limitation of how we use or disclose your medical information for treatment, payment, or health care operations. For example you could request that we not disclose information about a prior treatment to a family member or friend who may be involve in your care or payment for care. Your request must be made it writing to our practice manager. We are not required to agree to your request if we feel it is in your best interest to use or disclose that information. However, if we do agree, we will comply with your request unless that information is needed for emergency treatment.
An accounting of Disclosures. You have the right to request a list of the disclosures of your health information we have made outside of our practice that were not for treatment, payment, or health care operations. You may not request information for any dates prior to April 24, 2003(the compliance date for the federal regulation) nor for a period of time greater than six years (our legal obligation to retain information). You first request for a list of disclosures within a 12-month period will be free. If you request an additional list within 12-months of the first request, we may charge you a fee for the cost of providing the subsequent list. We will notify you of such cost and afford you the opportunity to withdraw your request before any cost is incurred.
Request Confidential Communications. You have the right to request how we communicate with you to reserve you privacy. For example- you may request that we call you only at your work number, or by mail at a special address or postal box. Your request must be made in writing and must specify how or where we are to contact you. We will accommodate all reasonable requests.
File a complaint. If you believe we have violated your medical information privacy rights, you have the right to file a complaint with our practice manager or directly to the secretary of Health and Human Services. To file a complaint with our manager, you must make it in writing within 180 days of the suspected violation. Provide as much detail as you can about the suspected violation and send it to the office of Moataz Giurgius M.D. You should know that there would be no retaliation for your filing a complaint.
Uses or Disclosures Not Covered
Uses or disclosures of your health information not covered by this notice or the laws that apply to us may only be made with your written authorization. You may revoke such authorization in writing at any time and we will no longer disclose health information about you for reason stated in your written authorization prior to the revocation are not affected by the revocation.
We reserve the right to revise or amend this notice of privacy practices. You may request a copy of our most current notice at any time. If you have any questions or would like additional information, you may contact our office at 562.947.8832
Although your health record is the physical property of the health care practitioner or facility that compiled it, the information belongs to you. You have the right to:
A Paper Copy of This Notice. You have the right to receive a paper copy of this notice upon request. You may obtain a copy by asking out receptionist at next visit or by calling and asking us to mail you a copy.
Inspect and Copy. You have the right to inspect and copy the protected health information that we maintain about you in out designated record set for as long as we maintain that information. This designated record set includes your medical and billing records, as well as any other records we use for making decisions about you. Any psychotherapy notes that may have been included in records we received about you are not available for your inspection or copying by law. We may charge you a fee for the cost of copying, mailing, or other supplies used in fulfilling you request. If you wish to inspect or copy your medical information, you must submit your request in writing to the office of Moataz Giurgius, M.D. You may mail in your request, or bring it to our office. We will have 30 days to respond to your request for information that we maintain at our practice site. If the information is stored off-site, we are allowed up to 60 days to respond but must inform you of this delay.
Ways in Which We May Use and Disclose Your Protected Health Information:
The following paragraphs describe different ways that we use and disclose your protected health information. We have provided an example for each category, but these examples are not meant to be exhaustive. We assure you that all of the ways we are permitted to use and disclose your information fall within one of these categories.
Treatment. We might use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. We will also disclose your health information to other physicians who may be treating you. Additional we may from time to time disclose your health information to another physician who we have requested to be involved in you care. For example-we would disclose your information to a diagnosis to help in your treatment.
Payment. We may use and disclose your protected health information to obtain payment for the health care services we provided you. For example-we may include information with a bill to a third-party payer that identifies you, your diagnosis, procedures performed, and supplies used in rendering the service.
Health Care Operations. We may use and disclose your protected health information to support the business activities of our practice. For example- we may use medical information about you to review and evaluate our treatment and services or to evaluate our staff’s performance while caring for you. In addition, we may disclose your health information to third party business associates who perform billing, consulting, or transcription services for our practice.
Law Enforcement. Your health information may be disclose to law enforcement agencies, without your permission, to support government audits and inspections, to facilitate law-enforcement investigations, and to comply with government mandated reporting (such as reporting child abuse or neglect). We may have to respond to a court or administrative order, if you are involved in a lawsuit or similar proceedings (subpoena, discovery request or other lawful process).
Other Ways We May Use and Disclose Your protected Health Information:
Appointment Reminders. We will use and disclose health information to contact you as a reminder about schedule appointments or treatment.
Other involved in Your Care. We may use and disclose your protected health information to a family member, a relative, a close friend, or any other person you identified that is involved in your medical care or payment for care.
Research. We may use and disclose your protected health information to researchers provided the research has been approved by an institutional reviewed the research proposal and established protocols to ensure the privacy of your health information.
As Required By Law. We will use and disclose your protected health information when required to by federal, state, or local law. You will be notified of any such disclosures.
To Avert a Serious Threat to Public Health or Safety. We will use and disclose your protected health information to a public health authority that is permitted to collect or receive the information for the purpose of controlling disease, injury, or disability. If directed by that health authority, we will also disclose your health information to a foreign government agency that is collaborating with the public health authority.
Worker’s compensation. We may use and disclose your protected health information for worker’s compensation or similar programs that provide benefits for work-related injuries or illness.