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Health
Insurance Portability and Accountability Act of 1996 (“HIPAA”)
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 applies to Bay Valley Medical Group,
Inc. (“BVMG”), a multi-specialty medical group and IPA. The
notice 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 (PHI) 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 www.bayvalleymedicalgroup.com,
calling the Customer Service Department 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
Federal and state law allows BVMG to use and disclose your PHI for
treatment, payment and health care operations. Your PHI may be used
and disclosed by your physician, our office staff and others outside
of our office that are involved in your care and treatment for the
purpose of providing health care services to you. The examples below
are provided to illustrate the types of uses and disclosures we may
make without your consent for treatment, payment and health care
operations purposes.
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. We will also disclose protected health
information to other physicians who may be treating you. 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, marketing activities, and conducting or
arranging for other business activities.
For
example, we may disclose your protected health information to
medical school students that see patients at our office. In
addition, we may use a sign-in sheet at the registration desk where
you would be asked to sign your name and indicate your physician. 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 benefits and services that may be of interest to you.
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 the BVMG Customer Service
Department to request that these materials not be sent to you.
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 must disclose your PHI when required to do so 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.
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, inspections, and licensing activities. 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 governmental entity or agency
authorized to receive such information.
Food
and Drug Administration:
We may disclose your protected 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.
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 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 services. 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.
Workers’
Compensation:
Your protected health information may be disclosed by us as
authorized to comply with workers’ 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 to 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.
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 BVMG 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.
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 but has been 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
disclosure under the circumstances.
Uses
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. You may revoke an 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.
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.
Right
to Inspect and Copy Your Protected Health Information
You have the right to review or obtain copies of your
protected health information records maintained by BVMG, with some
limited exceptions. Your request to review and/or obtain a copy of
your protected health information records must be submitted in
writing to the BVMG Customer Service Department at the address
listed in section 5. We may charge a reasonable fee to cover any
administrative costs accrued by BVMG in producing the copies, to the
extent permitted under applicable law. If your request is denied,
BVMG will document the denial in writing.
Right
to Request a Restriction of Your Protected Health Information
You have the right to request restrictions on how we use and
disclose your PHI for our treatment, payment and health care
operations. All requests must be submitted in writing to the BVMG
Customer Service Department at the address listed in section 5. The
request should cite the specific restriction requested and to whom
it should apply. Upon receipt, we will review your request and
notify you whether it has been accepted or denied.
BVMG is not required to agree to such a restriction. Your PHI is critical
for providing you with quality health care. We believe we have taken
appropriate safeguards to protect your PHI and believe that
additional restrictions may be harmful to your care. Please keep
this in mind when submitting a request to restrict access to your
PHI.
Right
to Confidential Communications
You have the right to request that we provide your PHI to you in a
confidential manner. For example, you may request that we send our
patient mailers to an alternative address or that our appointment
reminder calls be directed to an alternate telephone number.
We
will accommodate all reasonable requests unless they are
administratively burdensome or prohibited by law. Such requests must
be submitted in writing to the BVMG
Customer Service Department at the address listed in section 5.
Right
to Amend Your PHI
You have the right to request amendments to your PHI. This
means you may request an amendment of your protected health
information 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, we will explain
why. Amendment requests must be submitted in writing to the BVMG
Customer Service Department at the address listed in section 5.
The request should include the specific detail you want changed and
your reasons for such a change.
Right
to Receive an Accounting of Disclosures of Your PHI
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, to family members or friends involved in your care, or
for notification purposes. The right to receive this information is
subject to certain exceptions, restrictions and limitations. You
have the right to receive specific information regarding these
disclosures that occurred on or after April 14, 2003 and no farther
than 6 years in the past. All
such requests must be submitted in writing to the BVMG Customer Service Department at the address listed in section 5. All
requests must state a time period for which you want an accounting.
Right
to Obtain a Paper Copy of This Notice
You have the right to request and receive a paper copy of this
Notice. Copies are available at each of the BVMG offices and/or can
be requested by contacting the BVMG Customer Service Department
listed in section 5 of this notice.
3.
How we protect your Protected Health Information
Access to your PHI is restricted to those employees who need such
access to provide services to our members. In addition, BVMG has
established appropriate procedural and technical safeguards to
protect your PHI against unauthorized use or disclosure. BVMG has
also implemented a training program to educate our staff on how to
protect the PHI of our membership.
4.
Complaints
If you believe that your privacy rights have been violated, you may
file a complaint directly with BVMG and/or with the Secretary of the
Department of Health and Human Services. We may not retaliate
against you for filing such a complaint. All complaints to BVMG must
be submitted in writing to the following address:
Bay
Valley Medical Group
Attn: Privacy Office
27212 Calaroga Avenue
Hayward, CA 94545-4349
(510) 785-5000
5.
Contact Information
Any questions not specifically addressed by this notice should be
sent to the following address.
Bay
Valley Medical Group
Attn: Customer Service Department
27212 Calaroga Avenue
Hayward, CA 94545-4349
(510) 785-5000
This
notice was published and becomes effective on April
14, 2003.
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