Privacy Statement

NOTICE OF PRIVACY PRACTICES

This notice describes how medical information about you may be used and disclosed and how you can get access to the information.

PLEASE REVIEW IT CAREFULLY

The Health Insurance and Portability Act of 1996 (HIPAA) grants individuals the right to adequate notice of the use and disclosures of protected health infomration (PHI) to carry out treatment, payment, healcare operations or other purposes that are permitted or required by law.  It also sescribes your rights to access and control your PHI.  PHI is information about you, including demographic information that may identify you and may relate 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, and will notify you of any such changes before they become effective.  The new notice will be effective for all PHI that we maintain at that time.  Upon your request, we will provide you with any revised Notice of Privacy Practices when you call the office and request that a revised copy be sent to you in the mail or you may ask for one at the time of your next appointment.

Uses and Disclosures of Protected Health Information
Your PHI may be used and disclosed by your physician, our mid-level providers, our office staff and others outside of our office that are directly involved in your care and treatment, for the purpose of providing health care services to you.  Your PHI may also be used and disclosed to enable us to obtain payment for your health care bills and to support the operation of our physician's practice.

Following are examples of uses and disclosures of your PHI that your physician's office is permitted to make once you have been provided a copy of this Notice of Privacy Protection.  These examples are not meant to be exhaustive, but to describe the typical uses and disclosures that may occur.

We may use or disclose your PHI, as necessary, to provide you with information about treatment alternatives or other health related benefits and services that may be of interest to you.  We may also use and disclose your PHI 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 Contact (identified below) in writing to request that these materials not be sent to you.

Uses and Disclosures of PHI Based Upon Your Written Authorization
Other uses and disclosures of your PHI 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 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 Authorization or Opportunity to Object
We may use or disclose your PHI in the following instances.  You have the opportunity to agree or object to the use and disclosure of all or part of your PHI if you are not present or able to agree or object to the use or disclosure of your PHI then your physician may, using professional judgment, determine whether or not the disclosure is in your best interest.  In this case, only the PHI that is relevant to your health care will be disclosed.

Others Involved in Your Health Care
Unless you object, in writing, we may disclose to a member of your family, a relative, a close friend or other person you may identify, your PHI 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 is necessary if we determine that it is in your best interest based upon our professional judgment.  We may use or disclose PHI 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 PHI 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 you health care.

Emergencies
We may use or disclose the minimum necessary of your PHI in an emergency treatment situation.

Food and Drug Administration
We may disclose your PHI to a person or company required by the FDA 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 activities if required.

Legal Proceedings
We may disclose PHI in the course of any judicial or administrative proceeding, in response to an order of the court, subpoena, discover request, or other lawful process.

Law Enforcement
We may also disclose PHI so long as applicable legal requirements are met, for law enforcement purposes.  These law enforcement purposes include (1) legal processes and otherwise as required by law (2) limited information requests for identification and location purposes (3) pertaining to victims of a crime (4) if there is a suspicion that death has occurred as a result of criminal conduct (5) in the event that if 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 PHI 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 PHI 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.  PHI may be used and disclosed for cadaveric organ, eye or tissue donation purposes.

Criminal Activity
Consistent with applicable federal and state laws, we may disclose your PHI if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health and safety of a person or the public.  We may also disclose PHI if it is necessary for law enforcement authorities to identify or apprehend and individual.

You have the right to request a restriction of your PHI
This means that you may ask us not to disclose any part of your PHI for the purposes of treatment, payment or healthcare operations.  You may also request that any part of your PHI not be disclosed to family or friends who may be involved in your care or for purposes described in the Notice of Privacy Practices.  Your written request must state the restriction requested and to whom you want the restriction to apply.

Your physician is not required to agree to a restriction that you might request.  Restricting such usage may mean that your physician may be unable to continue your healthcare.  We are bound only by those restrictions to which we agree in writing.

You have the right to request to receive confidential communications from us by alternative means or at an alternative location
PPN will accommodate all reasonable requests.  We may also condition this accommodation by asking your for information as to how payment will be handled and/or for the specification by you of an alternative address or method of contacting your.  We will not request an explanation from you as to the basis for the request.  Please make this request in writing to our Privacy Contact.

You have the right to have your physician amend your PHI
This means that you may request an amendment of PHI about you in a designated record set for as long as we maintain the information.  In certain cases, we may deny your request.  If we deny your request, you have the right to file and statement of disagreement with us and we may prepare a rebuttal to your statement.  You will receive a copy of the rebuttal to your statement. Please contact our Privacy Contact if you have further questions regarding an amendment to your PHI.

You have the right to receive an accounting of certain disclosures we have made of your PHI
This right applies to disclosures for purposes other than treatment, payment or healthcare operations as explained in this Notice of Privacy Practices.  It excludes disclosures we have made to you, to family members or friends involved in your care or for notification purposes.  You have the right to receive specific information regarding any other 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.

Complaints
Any person may file a complaint with Pioneer Physicians Network, Inc. and/or to the Secretary of Health and Human Services if they believe that their privacy rights under HIPAA have been violated.