HIPAA Privacy Notice

We are required by the privacy regulations issued under the Health Insurance Portability and Accountability Act of 1996 ("HIPAA") to maintain the privacy of our customers' Medical Information and to provide customers with notice of our legal duties and privacy practices with respect to their Medical Information.

Notice of privacy practices

Highland Plastic Surgery, PLLC

Effective April 13, 2003

As required by the privacy regulations created as a result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

A. Our commitment to your privacy:

Our practice is dedicated to maintaining the privacy of your individually identifiable health information (also called protected health information, or 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 in our offices in a visible location at all times, and you may request a copy of our most current Notice at any time.

B. If you have questions about this Notice, please contact: Dani Moreland  (423) 926-4469

C. We may use and disclose your PHI in the following ways:
 
1. Treatment. Our practice may use your PHI to treat you. For example, we may ask you to have laboratory tests (such as blood or urine tests), and we may use the results to help us reach a diagnosis. We might use your PHI in order to write a prescription for you, or we might disclose your PHI to a pharmacy when we order a prescription for you. Many of the people who work for our practice – including, but not limited to, our doctors and nurses – may use or disclose your PHI in order to treat you or to assist others in your treatment. Additionally, we may disclose your PHI to others who may assist in your care, such as your spouse, children or parents. Finally, we may also disclose your PHI to other health care providers for purposes related to your treatment.

2. Payment. Our practice may use and disclose your PHI in order to bill and collect payment for the services and items you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment. We also may use and disclose your PHI to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your PHI to bill you directly for services and items. We may disclose your PHI to other health care providers and entities to assist in their billing and collection efforts.

3. Health care operations. Our practice may use and disclose your PHI to operate our business. As examples of the ways in which we may use and disclose your information for our operations, our practice may use your PHI to evaluate the quality of care you received from us, or to conduct cost-management and business planning activities for our practice

4.  Appointment reminders. Our practice may use and disclose your PHI to contact you and remind you of an appointment.

5.  Disclosures required by law. Our practice will use and disclose your PHI when we are required to do so by federal, state or local law.

D. 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. Our practice 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.

2. Health oversight activities. Our practice 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. Our practice 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. We 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).

5.  Research. Our practice 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 Internal Review Board or Privacy Board has determined that the waiver of your authorization satisfies all of the following conditions:

(A) The use or disclosure involves no more than a minimal risk to your privacy based on the following: (i) an adequate plan to protect the identifiers from improper use and disclosure; (ii) 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 (iii) 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;
 
(B) The research could not practicably be conducted without the waiver,

(C) The research could not practicably be conducted without access to and use of the PHI.

6. Serious threats to health or safety. Our practice 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.
 
7. Military. Our practice 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.

8. National security. Our practice may disclose your PHI to federal officials for intelligence and national security activities authorized by law. We also may disclose your PHI to federal 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.

9. Inmates. Our practice 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.

10. Workers’ compensation. Our practice may release your PHI for workers’ compensation and similar programs.

E. YOU HAVE SEVERAL RIGHTS REGARDING PHI ABOUT YOU

1. You have the right to request restrictions on uses and disclosures of PHI about you.

You have the right to request that we restrict the use and disclosure of PHI about you to carry out treatment, payment or healthcare operations, or to restrict uses and disclosures to family members, relatives, friends or other persons identified by you who are involved in your care or payment for your care. Your request must be in writing. We are not required to agree to your requested restrictions. However, even if we agree to your request, in certain situations your restrictions may not be followed. These situations include emergency treatment, disclosures to the Secretary of the Department of Health and Human Services, and uses and disclosures described in subsection 4 of the previous section of this Notice. You may obtain a form to request a restriction by contacting the person listed on the cover page of this Notice.

2. You have the right to request different ways to communicate with you.

You have the right to request how and where we contact you about PHI. For example, you may request that we contact you at your work address or phone number or by email. Your request must be in writing. We must accommodate reasonable requests, but, when appropriate, may condition that accommodation on your providing us with information such as how payment, if any, will be handled. You may request confidentiality in our communications to you by contacting the person listed on the cover page of this Notice.

3. You have the right to access and copy PHI about you.

You have the right to request access and receive a copy of PHI contained in clinical, billing and other records used to make decisions about you. Your request must be in writing. In some instances (i.e., multiple requests in a 12 month period), we may charge you a reasonable fee for copying your records. The requested information will be provided to you within 30 days (60 days if the information is maintained offsite). We may obtain a single 30-day extension to do so if we provide you with a written statement advising you of the reason for the delay and when the information will be provided to you. Instead of providing you with a full copy of the PHI, we may give you a summary or explanation of the PHI about you, if you agree in advance to the form and cost of the summary or explanation. There are certain situations in which we are not required to comply with your request. Under these circumstances, we will respond to you in writing, stating why we will not grant your request and describing any rights you may have to request a review of our denial and a description of how you may complain to the Secretary of the U. S. Department of Health and Human Services. You may obtain a form to request access to and receive a copy of PHI by contacting the Office Manager where you are being seen.

4. You have the right to request a change of PHI about you.

You have the right to request that we make changes to clinical, billing and other records used to make decisions about you. Your request must be in writing and must explain your reason(s) for the change. We have 60 days to act on your request. We may obtain a single 30-day extension to do so, if we provide you with a written statement advising you of the reason for the delay and when the information will be provided to you. We may deny your request if: 1) the information was not created by us (unless you prove the creator of the information is no longer available to change the record); 2) the information is not part of the records used to make decisions about you; 3) we believe the information is correct and complete; or 4) you would not have the right to see and copy the record as described in Section C item 3 above. We will tell you in writing the reasons for the denial, in whole or in part, of your request and describe your rights to give us a written statement disagreeing with the denial and have that statement included with any future disclosures of your PHI. If we accept your request to change the information, we will make reasonable efforts to inform others of the change, including persons you name who have received PHI about you and who need the change. You may obtain a form to request a change in your PHI by contacting the person listed on the cover page of this Notice or the Office Manager where you are being seen.

5. You have the right to a listing of disclosures we have made.

You have the right to receive a written list of certain of our disclosures of PHI about you. The request must be in writing. You may ask for disclosures made up to six (6) years before your request (not including disclosures made prior to April 14, 2003). We are required to provide a listing of all disclosures except the following:

For your treatment; For billing and collection of payment for your treatment; For our health care operations; Made to or requested by you, or that you authorized, about you; Occurring as a byproduct of permitted uses and disclosures about you; Made to individuals involved in your care, for directory or notification purposes, or for other purposes (please see Section B item 5 above); Allowed by law when the use and/or disclosure relates to certain specialized government functions or relates to correctional institutions and in other law enforcement custodial situations (please see Section B item 4 above); and NotiAs part of a limited set of information (de-identified) which does not contain certain information which would identify you.

The list will include the date of the disclosure, the name (and address, if available) of the person or organization receiving the PHI, a brief description of the PHI information disclosed, and the purpose of the disclosure. If, under permitted circumstances, PHI about you has been disclosed for certain types of research projects, the list may include different types of information.

We have 60 days to act on your request. We may obtain a single 30-day extension to do so if we provide you with a written statement of the reason for the delay and when the information will be provided to you. If you request a list of disclosures more than once in 12 months, we can charge you a reasonable fee for each subsequent listing of disclosures. You may obtain a form to request a listing of disclosures by contacting the Office Manager where you are being seen.

6. You have the right to a copy of this Notice.

You have the right to request a paper copy of this Notice at any time by contacting the staff at the location where you are being seen.

F. YOU MAY FILE A COMPLAINT ABOUT OUR PRIVACY PRACTICES

If you think we have violated your privacy rights, or you want to complain to us about our privacy practices, you can contact the person listed on the cover page of this Notice to obtain a form to file your complaint.

You may also send a written complaint to the United States Secretary of the Department of Health and Human Services, Hubert H. Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C., 20201.

If you file a complaint, we will not take any action against you or change our treatment of you in any way.