Notice of Privacy Practices

of

CANCER CARE GROUP, P.C.

 

Effective Date: 04/14/03

 

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.

 

A.        WE HAVE A LEGAL DUTY TO PROTECT HEALTH INFORMATION ABOUT YOU.

We are required by law to maintain the privacy of your health information and to provide you with notice of our legal duties and privacy practices.  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 you 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 follow the procedures in this Notice.  We reserve the right to change the terms of this notice and to make the new notice provisions effective for medical information we already have about you as well as any information we receive in the future.  We will provide you with any revised Notice of Privacy Practices by posting a copy on our website (www.cancercaregroup.com).  In addition, each time you register at or are admitted for treatment or health care services we will make a copy of the current notice available to you.  All copies of the Notice of Privacy Practices will contain the effective date, which will not be earlier than the date on which the Notice is printed or published.

 

B.        WE MAY USE AND DISCLOSE PHI ABOUT YOU WITHOUT YOUR AUTHORIZATION IN THE

FOLLOWING CIRCUMSTANCES.

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.  Your PHI may also be used and disclosed to pay your health care bills and to support the operation of the physician’s practice.

 

The following categories describe different ways that we use and disclose medical information.  Not every use or disclosure in a category will be listed.  Information may be disclosed in writing, orally, or electronically.

 

Treatment:  We may use and disclose PHI about you to provide, coordinate or manage your health care and related services.  This may include communicating with other health care providers regarding your treatment and coordinating and managing your health care with others.  We may disclose your medical information to doctors, nurses, technicians, medical students, or other personnel who are involved in your care.

 

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.

 

EXAMPLE:  Your doctor may share PHI about you with a pharmacy when calling in a prescription.

 

Payment:  Your protected health information will be used, as needed, to obtain payment for you 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.  We may also share portions of your medical information with billing departments, collection departments or agencies, insurance companies, health plans, and consumer reporting agencies (e.g., credit bureaus).

 

EXAMPLE:  Your protected health information may be given to our billing department and your insurance company (or health plan) so we can be paid or you can be reimbursed. 

 

EXAMPLE:  We may tell your insurance about treatment you are going to receive to obtain prior approval for the services.    

 

Healthcare Operations:  We may use and disclose your PHI in order to support our business activities.  These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, licensing, marketing and fundraising activities, and conducting or arranging for other business activities.

 

EXAMPLE:  We may use medical information to review our treatment and services and to evaluate our performance.  We may combine medical information about many patients to decide what additional services we should offer, what services are not needed, and whether certain new treatments are effective.

 

EXAMPLE:  We may disclose information to doctors, nurses, technicians, medical students, and other personnel for review and learning purposes.  We may combine the medical information we have with medical information from other hospitals to compare how we are doing and see where we can make improvements in the care and services we offer.

 

EXAMPLE:  We may remove information that identifies you from this set of medical information so others may use it to study health care and health care delivery without learning who the specific patients are.

 

Business Associates:  We contract with outside organizations, called business associates, to perform some of our operational tasks on our behalf.  Examples would include billing agencies and a copy service we use when making copies of your health record.  When these services are performed, we disclose the necessary health information to these companies so that they can perform the tasks we have asked them to do and bill you or your third-party payor for services rendered.  To protect your health information, however, we require the business associate to appropriately safeguard your information.

 

Appointment Reminders:  We may use and disclose your medical information to remind you of appointments, annual exams, or prescription refills. 

 

Treatment Alternatives:  We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that you may be of interest to you. 

 

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 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 necessary if we determine that it is in your best interest based on our professional judgement.  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. 

 

Other Permitted and Required Uses and Disclosures That May Be Made Without Your Consent, Authorization or Opportunity to Object Are Listed Below

 

Medical Research:  Under certain circumstances, we may disclose PHI about you for medical research.

 

EXAMPLE:  We may release information about you to researchers preparing to conduct a research project who need to know how many patients have a specific health problem.

 

EXAMPLE:  We may also use and disclose medical information about you for research purposes if the research has been subjected to a careful review process conducted by a specially selected and trained committee and received this committee’s approval.  This process evaluates a proposed research project and its use of medical information, and balances the potential benefit of the research against individual patients’ need for privacy of their medical information. 

 

EXAMPLE:  A research project may involve comparing the health and recovery of all patients who received one medication to those who received another for the same condition.  In that situation, you would not be identified or contacted, but your medical information may be used but kept confidential. 

 

EXAMPLE:  In other studies, if a doctor caring for you believes you may be interested in, or benefit from, a research study, your doctor and the committee will approve someone to contact you to see if you are interested in the study.  At that time, you would be contacted with more information and you would have the right to authorize continued contact or refuse further contact. 

 

Avert Threat to Health or Safety:  We may disclose PHI about you to prevent or lessen a serious and eminent threat to the health or safety of a person or the public. 

 

Cadaveric Organ/Tissue Donation:  If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.

 

Military and Veterans:  We may use or disclose PHI 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.

 

National Security and Intelligence Activities:  We may also disclose your PHI to authorized federal officials for conducting national security and intelligence activities, including the provision of protective services to the President or others legally authorized.

 

Workers’ Compensation:  We may release medical information about you for workers’ compensation or similar programs.  These programs provide benefits for work-related injuries or illness. 

 

Legal Proceedings:  We may disclose PHI 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.

 

Health Oversight Activities:  We may disclose PHI about you to a state or federal health oversight agency which is authorized by law to oversee our operations.  These oversight activities include audits, investigations, inspections, and licensure.

 

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. 

 

Inmates:  We may use or disclose your PHI to a correctional institution having lawful custody of you. 

 

Coroners, Medical Examiners and Funeral Directors:  We may release medical information to a coroner or medical examiner.  This may be necessary, for example, to identify a deceased person or to determine the cause of death.  We may also release medical information about patients of the hospital to funeral directors as necessary to carry out their duties.

                                       

Public Health:  We may disclose your PHI 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. 

 

Abuse or Neglect:  We may disclose your PHI 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.

 

C.        YOU HAVE SEVERAL RIGHTS REGARDING PHI ABOUT YOU.

You have the right to request restrictions on uses and disclosures of PHI about you.  You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend.  In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply.  Requests must be made in writing and submitted to the Privacy Officer.

 

We are not required to agree to your request.  If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. 

 

You have the right to request confidential communications.  You have the right to request that we communicate with you about medical matters in a certain way or at a certain location.  We will not request an explanation from you as to the basis for the request.  We must accommodate reasonable requests.  But 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.  Your request must be in writing and can be submitted to the Privacy Officer. 

 

You have the right to inspect and copy your protected health information.  You have the right to request to see and receive a copy of medical information that may be used to make decisions about your care.  This includes medical and billing records, but does not include psychotherapy notes.  Your request must be in writing and can be submitted to the Office Manager of the treatment site (clinic).  If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.

 

There are certain situations in which we are not required to comply with your request.  In such an instance, we will respond to you in writing stating why we will not grant your request.  In some circumstances, you may have a right to have this decision reviewed.  Please contact the Privacy Officer if you have questions about access to your medical record.

 

You have the right to request an amendment of protected health information about you.  You have the right to request that we make amendments to clinical, billing and other records used to make decisions about you.  To request an amendment, your request must be made in writing and submitted to the Privacy Officer.  In addition, you must provide a reason that supports your request. 

 

We may deny your request if: 1) the information was not created by us (unless you proved the creator of the information is no longer available to amend the record); 2) the information is not part of the records used to make decisions about you; 3) we believe the information is correct; or 4) the information is not part of the information which you would be permitted to inspect and copy.  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 your statement and will provide you with a copy of any such rebuttal.

 

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 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 may ask for disclosures made up to six (6) years before your request (not including disclosures made prior to April 14, 2003).  The list will include the date of the disclosure, the name (and address, if available) of the person or organization receiving the information, a brief description of the information disclosed, and the purpose of the disclosure.  If you request a list of disclosures more than once in 12 months, we can charge you a reasonable fee.  Your request for an accounting of disclosures must be made in writing and submitted to the Privacy Officer.

 

You have the right to receive a paper copy of this Notice from us upon request.  We will provide a copy of this Notice no later than the date you first receive service from us (except for emergency services, and then we will provide the Notice to you as soon as possible).  You may ask us to give you a copy of this notice at any time.  Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.

 

D.        YOU MAY FILE A COMPLAINT ABOUT OUR PRIVACY PRACTICES.

If you believe your privacy rights have been violated, you may file a complaint with us by contacting the person listed below:

            Portia Frecker, Privacy Officer

            950 N. Meridian Street, Suite 920

            Indianapolis, Indiana 46204

            317/925-7730 (Phone)

            317/921-4109 (Fax)

            Portia.Frecker@ccg.meddir.com

 

All complaints must be submitted in writing.  You may also send a written complaint to the United States Secretary of the Department of Health and Human Services.  You will not be penalized or retaliated against for filing a complaint. 

 

This notice was published and becomes effective on April 14, 2003.