Notice of Privacy Practices
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here
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 is federally mandated.
If you have any questions about this Notice please contact our Privacy Officer:
Gary M. Evans, Administrator, Anne Arundel Gastroenterology Associates, PA
Anne Arundel Gastroenterology
Bestgate Medical Clinic
820 Bestgate Road, Suite 2B
Annapolis, Maryland 21401
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 protected health information that we maintain at
that time. Upon your request, we will provide you with any revised Notice
of Privacy Practices by accessing our website aagastro.com, 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 next appointment.
1. Uses and Disclosures of Protected Health Information
Uses and Disclosures of Protected Health Information Based
Upon Your Written Consent
You will be asked by your physician to sign a consent form.
Once you have consented to the use and disclosure of your protected health
information for treatment, payment and health care operations by signing the
consent form, your physician will use or disclose your protected health information
as described in this Section 1. Your protected health information may be used
and disclosed by your physician, nurses, medical assistants, and our administrative
office staff, as well as others outside of our office that are involved in
your care and treatment for the purpose of providing health care services
to you. Your protected health information may also be used and disclosed to
pay your health care bills and to support the operation of your physician's
practice.
Following are examples of the types of uses and disclosures
of your protected health care information that the physician's office is permitted
to make once you have signed our consent form. These examples are not meant
to be exhaustive, but to describe the types of uses and disclosures that may
be made by our office once you have provided consent.
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 that has already obtained your permission to have access
to your protected health information. For example, we would disclose your
protected health information, as necessary, to a home health agency that provides
care to you. We will also disclose protected health information to other physicians
who may be treating you when we have the necessary permission from you to
disclose your protected health information. For example, your protected health
information may be provided to a physician to whom you have been referred
to ensure that the physician has the necessary information to diagnose or
treat you.
In addition, we may disclose your protected health information
from time-to-time to another physician or health care provider (e.g., a specialist
or laboratory) who, at the request of your physician, becomes involved in
your care by providing assistance with your health care diagnosis or treatment
to your physician.
Payment: Your protected health information will be used,
as needed, to obtain payment for your health care services. This may include
certain activities that your health insurance plan may undertake before it
approves or pays for the health care services we recommend for you such as:
making a determination of eligibility or coverage for insurance benefits,
reviewing services provided to you for medical necessity, and undertaking
utilization review activities. 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, training of
medical students, licensing, and direct marketing to you only.
For example, we may disclose your protected health information
to medical assistants that assist in your care at our office. In addition,
we may also call you by name in the waiting room when your physician is ready
to see you. We may use or disclose your protected health information, as necessary,
to contact you to remind you of your appointment.
We will share your protected health information with third
party "business associates" that perform various activities (e.g., billing,
transcription services) for the practice. Whenever an arrangement between
our office and a business associate involves the use or disclosure of your
protected health information, we will have a written contract that contains
terms that will protect the privacy of your protected health information.
We may use or disclose your protected health information, as
necessary, to provide you with information about treatment alternatives or
other health-related information for other marketing activities. For example,
your name and address may be used to send you a newsletter about our practice
and the services we offer. We may also send you information about products
or services that we believe may be beneficial to you. You may contact our
Privacy Officer to request that these materials not be sent to you.
Use and Disclosures of Protected Health Information Based upon
Your Written Authorization
Other uses and disclosures of your protected health information
will be made only with your written authorization, unless otherwise permitted
or required by law, as described below. You may revoke this authorization,
at any time, 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.
Other Permitted and Required Uses and Disclosures That May
Be Made With Your Consent, Authorization or Opportunity to Object
We may use and disclose your protected health information in
the following instances. You have the opportunity to agree or object to the
use or disclosure of all or part of your protected health information. If
you are not present or able to agree or object to the use or disclosure of
the protected health information, then your physician may, using professional
judgment, determine whether the disclosure is in your best interest. In this
case, only the protected health information that is relevant to your health
care will be disclosed.
However, should you not consent to the use and
disclosure of your protected health information for treatment, payment and
healthcare operations; we will be unable to provide you medical services.
Facility Directories (Maryland Center for Digestive Health):
Unless you object, we will use and disclose in our facility directory or schedule
your name, the location at which you are receiving care, your physician, and
your current discharge status (in general terms). All of this information
will be disclosed to people that ask for you by name and inquire as to your
discharge status.
Others Involved in Your Healthcare: Unless you object,
we may disclose to a member of your family, a relative, a close friend or
any other person you identify, your protected health information that directly
relates to that person's involvement in your health care. If you are unable
to agree or object to such a disclosure, we may disclose such information
as necessary, if we determine that it is in your best interest based on our
professional judgment. We may use or disclose protected health information
to notify or assist in notifying a family member, personal representative
or any other person that is responsible for your care, of your location, general
condition or death. Finally, we may use or disclose your protected health
information to an authorized public or private entity to assist in disaster
relief efforts and to coordinate uses and disclosures to family or other individuals
involved in your health care.
Emergencies: We may use or disclose your protected health
information in an emergency treatment situation. If this happens, your physician
shall try to obtain your consent as soon as reasonably practicable after the
delivery of treatment. If your physician or another physician in the practice
is required by law to treat you and the physician has attempted to obtain
your consent but is unable to obtain your consent, he or she may still use
or disclose your protected health information to treat you.
Communication Barriers: We may use and disclose your
protected health information if your physician or another physician in the
practice attempts to obtain consent from you but is unable to do so due to
substantial communication barriers and the physician determines, using professional
judgment, that you intend to consent to use or disclosures under the circumstances.
Other Permitted and Required Uses and Disclosures That May
Be Made Without Your Consent, Authorization or Opportunity to Object
We may use or disclose your protected health information in
the following situations without your consent or authorization. These situations
include:
Required By Law: We may use or disclose your protected
health information to the extent that the use or disclosure is required by
law. The use or disclosure will be made in compliance with the law and will
be limited to the relevant requirements of the law. You will be notified,
as required by law, of any such uses or disclosures.
Public Health: We may disclose your protected health
information for public health activities and 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 protected health information, if directed by the
public health authority, to a foreign government agency that is collaborating
with the public health authority.
Communicable Diseases: We may disclose your protected
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 or condition.
Health Oversight: We may disclose protected 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 protected 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 protected
health information if we believe that you have been a victim of abuse, neglect
or domestic violence to the government entity or agency authorized to receive
such information. In this case, the disclosure will be made consistent with
the requirements of applicable federal and state laws.
Food and Drug Administration: We may disclose your protected
health information to a person or a 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.
Legal Proceedings: We may disclose protected health
information in the course of any judicial or administrative proceeding, in
response to an order of a court or administrative tribunal (to the extent
such disclosure is expressly authorized), in certain conditions in response
to a subpoena, discovery request or other lawful process.
Law Enforcement: We may also disclose protected health
information, so long as applicable legal requirements are met, for law enforcement
purposes. These law enforcement purposes include (1) legal processes and otherwise
required by law, (2) limited information requests for identification and location
purposes, (3) pertaining to victims of a crime, (4) suspicion that death has
occurred as a result of criminal conduct, (5) in the event that a crime occurs
on the premises of the practice, and (6) medical emergency (not on the Practice's
premises) and it is likely that a crime has occurred.
Coroners, Funeral Directors, and Organ Donation: We
may disclose protected health information to a coroner or medical examiner
for identification purposes, determining cause of death or for the coroner
or medical examiner to perform other duties authorized by law. We may also
disclose protected health information to a funeral director, as authorized
by law, in order to permit the funeral director to carry out their duties.
We may disclose such information in reasonable anticipation of death. Protected
health information may be used and disclosed for cadaveric organ, eye or tissue
donation purposes.
Research: We may disclose your protected health information
to researchers when their research has been approved by an institutional review
board that has reviewed the research proposal and established protocols to
ensure the privacy of your protected health information.
Criminal Activity: Consistent with the applicable federal
and state laws, we may disclose your protected health information, if we believe
that the use or disclosure is necessary to prevent or lessen a serious and
imminent threat to the health or safety of a person or the public. We may
also disclose protected health information if it is necessary for law enforcement
authorities to identify or apprehend an individual.
Military Activity and National Security: When the appropriate
conditions apply, we may use or disclose protected 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 service.
We may also disclose your protected 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.
Worker's Compensation: Your protected health information
may be disclosed by us as authorized to comply with worker's compensation
laws and other similar legally-established programs.
Inmates: We may use or disclose your protected health
information if you are an inmate of a correctional facility and your physician
created or received your protected health information in the course of providing
care for you.
Required Uses and Disclosures: Under the law, we must
make disclosures to you and when required by the Secretary of the Department
of Health and Human Services to investigate or determine our compliance with
the requirements of Section 164.500 et. seq.
2. Your Rights
Following is a statement of your rights with respect to your
protected health information and a brief description of how you may exercise
these rights.
You have the right to inspect and copy your protected health
information. This means you may inspect and obtain a copy of protected
health information about you that is contained in a designated record set
for as long as we maintain the protected health information. A "designated
record set" contains medical and billing records and any other records that
your physician and the practice uses for making decisions about you.
Under federal law, however, you may not inspect or copy the
following records: psychotherapy notes; information compiled in reasonable
anticipation of, or 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. Depending on the circumstances, a
decision to deny access may be reviewable. In some circumstances, you may
have a right to have this decision reviewed. Please contact our Privacy Officer
if you have questions about access to your medical record.
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 purposes of treatment, payment
or healthcare operations. You may also request that any part of your protected
health information not 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.
Your physician is not required to agree to a restriction that
you may request. If your physician believes it is in your best interest to
permit use and disclosure of your protected health information, your protected
health information will not be restricted. If your physician does agree to
the requested restriction, we may not use or disclose your protected health
information in violation of that restriction unless it is needed to provide
emergency treatment. With this in mind, please discuss any restriction you
wish to request with your physician. You may request a restriction by requesting
and completing the Protect Health Information Restriction Form from your physician's
staff.
You have the right to request to receive confidential communications
from us by alternative means or at an alternative location. We will accommodate
reasonable requests. We may also condition this accommodation by asking you
for information as to how payment will be handled or specification of an alternative
address or other method of contact. We will not request an explanation from
you as to the basis for that request. Please make this request in writing
to our Privacy Officer.
You may have the right to have your physician amend your
protected health information. This means you may request an amendment
of protected health information about you in a designated record set for as
long as we maintain this information. In certain cases, we may deny your request
for an amendment. If we deny your request for amendment, you have the right
to file a statement of disagreement with us and we may prepare a rebuttal
to our statement and will provide you with a copy of any such rebuttal. Please
contact our Privacy Officer, in writing, if you have any questions about amending
your medical record.
You have the right to receive an accounting of certain disclosures
we have made, if any, of your protected health information. This right
applies to disclosures for purposes other than treatment, payment or healthcare
operations as described in this Notice of Privacy Practices. It excludes disclosures
we may have made to you, for a facility directory, to family members or friends
involved in your care, or for notification purposes. You have the right to
receive specific information regarding these disclosures that occurred after
April 14, 2003. You may request a shorter time frame. The right to receive
this information is subject to certain exceptions, restrictions and limitations.
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 electronically.
3. Complaints
You may complain to us or to the Secretary of Health and Human
Services if you believe your privacy rights have been violated by us. You
may file a complaint with us by notifying our Privacy Officer of your complaint.
We will not retaliate against you for filing a complaint.
You may contact our Privacy Officer:
Gary M. Evans, Administrator, Anne Arundel Gastroenterology Associates, PA
Anne Arundel Gastroenterology
Bestgate Medical Clinic
820 Bestgate Road, Suite 2B
Annapolis, Maryland 21401
for further information about the complaint process.
This notice was published and becomes effective on
April 14, 2003.
Download this document
and associated forms here