NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO YOUR IDENTIFIABLE HEALTH INFORMATION.
Pacific Pulmonary Services (PPS) is required by law to maintain the privacy of your Protected Health Information (PHI) and to provide you with this notice of our legal duties and policies with respect to PHI. This Notice of Privacy Practices describes how we may use and disclose your PHI in the course of rendering treatment, and describes your rights with respect to your PHI. If you have any questions about this policy, please contact our Privacy Officer at 415-893-1518 ext. 2300.
OUR PLEDGE REGARDING INFORMATION:
We are committed to protecting information about you and your health. We create a record of the care and services you receive from us. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of our records.
We are required by law to:
- Maintain the privacy of your information;
- Give you this notice of our legal duties and privacy practices related to your information; and
- Follow the terms of all of our written privacy policies that are in effect at the time.
HOW WE MAY USE AND DISCLOSE INFORMATION ABOUT YOU:
Treatment. We will use and disclose PHI to treat or provide services to you. For example, a physician ordering oxygen therapy may need to be aware that you are also receiving respiratory medications from our Pharmacy, or we may record information obtained from your physician or other healthcare providers to ensure adequate coordination of your care. We may also send you postcards to remind you when supplies should be cleaned or replaced.
Payment. We will use and disclose PHI so that we can bill and be paid by your insurer for services you receive from us. For example, we may need to give information about your treatment and diagnosis to your insurance company so they will pay for your treatment.
Health Care Operations. We may use and disclose PHI as needed to carry out our organizational needs. For example, we may use or review PHI to monitor the performance of staff to improve our quality of care.
Business Associates. Some services such as the delivery of supplies may be provided by us through contracts with business associates. When services are contracted to an associated entity, we require the business associate to follow the same policies that we have implemented to safeguard your PHI.
Those Involved in Your Care. We may release relevant PHI to a friend, family member, or to someone you designate, that is involved in your care or payment related to your care. We may also disclose PHI to those assisting in disaster relief efforts so that your family can be notified about your condition, status and location. If you advise us of any family member that you do not wish to have access to your PHI, we will honor that direction.
Other. We may use or disclose PHI for the following purposes:
- As required by law
- Worker's compensation
- Health oversight activities
- If we believe you are a victim of abuse
- Custodial law enforcement
- If you are an organ donor
- To avert a threat to health or safety
- To public health agencies
- Judicial and administrative proceedings
- To government agencies/ functions
YOU HAVE THE FOLLOWING RIGHTS REGARDING INFORMATION WE MAINTAIN ABOUT YOU:
Right to Inspect and Copy. You have the right to inspect and obtain a copy of the PHI contained in your medical record. You must submit your request in writing to: Pacific Pulmonary Services, ATTN: Privacy Officer, 88 Rowland Way, Suite 300, Novato, CA 94945. In some cases, we may deny your request. There may be a fee for the costs of copying, mailing or supplies involved in granting your request.
Right to Amend. If you believe that your PHI is incorrect or incomplete, you may ask us to amend your PHI. You must submit your request along with the reason for amendment in writing to: Pacific Pulmonary Services, ATTN: Privacy Officer, 88 Rowland Way, Suite 300, Novato, CA 94945. In certain cases, we may deny your request, but you have the right to understand why we are denying the request and to file a statement of disagreement.
Right to an Accounting of Disclosures. You have the right to receive an accounting of disclosures of your PHI made after April 14, 2003 for purposes other than treatment, payment or health care operations unless those disclosures were made to you or as a result of your specific written permission, or were made to government agencies or for governmental functions. You may submit your request in writing to our Privacy Officer. The request must include the time period (not longer than six years) for the disclosures you wish to be listed. The first list you request within a 12 month period will be free, but we may charge you for the costs of providing additional accountings within a 12 month period. We will notify you of the costs involved in advance and you will have the opportunity to withdraw your request.
Right to Request Restrictions. You have the right to request restrictions on the PHI we use or disclose about you in connection with treatment, payment, health care operations. In some cases, we may not agree to your request. You must submit your request for restrictions in writing.
Right to Request Confidential Communications. You have the right to request that we communicate with you in a certain way or at a certain location. You must submit your request for confidential communications in writing. We will honor reasonable requests.
Right to Change Terms/ Copy of This Notice. We reserve the right to change the terms of this notice, and apply any changes to all PHI that we maintain. We will post a current copy of this notice in our facilities and on our website at www.ppsc.com. You also have the right to a copy of this notice at any time. To obtain a paper copy of this notice, please contact our Privacy Officer. A copy may also be requested in writing to: Pacific Pulmonary Services, ATTN: Privacy Officer, 88 Rowland Way, Suite 300, Novato, CA 94945.
If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. To file a complaint with us, contact our Privacy Officer at 415-893-1518 ext. 2300. You will not be penalized for filing a complaint. Complaints or concerns may also be filed with the Office of Inspector General, Dept. of Health & Humans Services at (800) 447-8477, with Accreditation Commission for Health Care at (919) 785-1214, or with your local state licensing board.
OTHER USES AND DISCLOSURES OF INFORMATION
Other uses and disclosures of PHI not covered by this notice will be made only with your authorization. You may also revoke an authorization you make at any time by sending a request in writing. After you revoke your authorization, we will no longer use or disclose your identifiable health information for the reasons described in the authorization, except to the extent we have already taken action in reliance upon your authorization.
Effective Date: April 1, 2006