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.
Introduction. Each of Advanced Spine And Pain, LLC/Advanced Spine And Pain of PA, LLC (each of which from time to time conducts its practice under the name “Relievus”) is required by both federal and state law to limit the manner in which it uses or discloses information about a patient or a patient’s health information. In addition, we are required to notify you of our legal obligations with respect to our privacy practices concerning your protected health information and to abide by the notice then in effect. This notice is intended to describe both the obligations of this practice with respect to information that it has about you and your rights with respect to that information. References to “Relievus” or to the “practice” in this notice refer to whichever of the entities involved in the practice is applicable to your care or has protected health information about you, and the entities comprising Relievus may share information with each other for the purposes described in this notice. Our employees and agents and the other health care professionals providing services to you in our office are subject to this notice.
Kelly Treppiedi is serving as the Company’s HIPAA Privacy Officer. She can reached at 888-985-2727, x 173 or at email@example.com
What is Protected Health Information? Health information is broadly defined as any information, whether oral or recorded in any form or medium that is created or received by this practice whether the information relates to your past, present or future physical or mental health or condition, the provision of healthcare to you, or the past, present or future payment for the provision of healthcare to you. Individually identifiable healthcare information is information that includes health information and also includes demographic information collected from you that identifies you or which reasonably can be used to identify you. This is generally referred to throughout this notice as protected health information or “PHI.” Relievus is required by law to maintain the privacy of your PHI and to provide you with this privacy notice setting forth our legal duties with respect to your PHI. This practice is required to abide by the terms of its privacy notice in effect from time to time.
Uses and Disclosures of Your PHI. If you are an existing patient, you have already signed a consent. If you are a new patient, you will be asked to sign a consent. The consent will allow Relievus to use and disclose your PHI for your treatment, to obtain payment for the services we render to you and to assist us in our healthcare operations.
Treatment. We may use or disclose your PHI for your treatment. For example:
Our medical records personnel may review your chart to ensure that all lab and other tests results have been properly placed in your chart prior to your visit.
Our nurse practitioners, physician assistants, or physicians may communicate with laboratory or other testing facilities to review test results prior to your visit.
Doctors in this office may discuss your case among themselves or may review your medical treatment with referring physicians or physicians to whom they have referred you for care.
Personnel in this office may discuss your medical information with a hospital or other healthcare facility where you are being admitted or being treated or we may discuss this information with another healthcare provider who is treating you at such a facility.
This practice may use a sign in sheet in the waiting area which other patients may see.
This practice may announce the names of patients in the waiting area, and other people in that area may hear your name.
This practice may leave voice messages on your home answering machine or send postcard or other appointment reminders.
This practice may disclose health information to a pharmacy when we order a prescription for you.
This practice may send you information about treatment alternatives or other health-related benefits and services that may be of interest to you.
Other types of treatment uses or disclosures may be made even if not listed above.
Payment. We may use and disclose your PHI in order to obtain payment for the services we render to you. For example:
This practice may submit your PHI to your insurance company in order to receive reimbursement for services rendered to you.
This practice may submit your PHI to an electronic data interchange company in order to codify information for submission to a third party payor.
To facilitate reimbursement, this practice may provide supplemental information to your health insurance company in order to verify the medical necessity of the care that you have obtained.
We may submit information to your health insurer in order to coordinate benefits with other health insurance or public benefits that may be available to you.
This practice may provide consumer reporting agencies with credit information regarding your payment history.
This practice may provide information to collection agencies or our attorneys for purposes of obtaining payment of delinquent accounts.
Your PHI may be disclosed in a legal action for purposes of securing payment of delinquent accounts.