R & R PEDIATRICS, PLLC
3100 NC HWY 55, Cary, NC 27519
Phone (919) 367-9833 Fax (919) 367-9832
HIPAA Notice of Privacy Practices
This notice describes about how Protected Health Information (PHI) about you may be used and disclosed by R & R PEDIATRICS, PLLC and how you can get access to this information. Please review it carefully.
Who will follow this Notice?
Requirement for Written Authorization
Exceptions to Written Authorization
Your Rights to Access and Control your PHI
How to File a Complaint
Change of ownership
North Carolina State Law
The U.S. Department of Health and Human Services (HHS) issued the “Privacy Rule” to implement the requirement of the HIPAA of 1996. The Health Insurance Portability and Accountability Act (HIPAA) of 1996 is a federal program that requires all medical records and other individually identifiable health information used or disclosed by PACE in any form are kept confidential.
The major goal of the “Privacy Rule” is to assure that individuals’ health information is properly protected while allowing the flow of health information needed to provide and promote high quality health care and to protect the public’s health and well being.
Protected Health Information (PHI) – The Privacy Rule protects all “Individually Identifiable Health Information” held or transmitted by a covered entity or its business associate, in any form or media, whether electronic, paper, or oral. “Individually Identifiable Health Information” is information, including demographic data, that relates to:
The individual’s past, present, or future physical or mental health or condition
The provision of health care to the individual, or
The past, present, or future payment for the provision of health care to the individual
and that identifies the individual or for which there is a reasonable basis to believe can be used to identify the individual. “Individually Identifiable Health information” includes many common identifiers such as name, address, birth date, and Social Security Number.
This Privacy Rule is effective April 14, 2003 and will remain in effect unless changed by HHS.
We are required by law to protect the privacy of your PHI, and to provide you with a copy of this notice. R & R PEDIATRICS, PLLC is dedicated to protecting your PHI. R & R PEDIATRICS, PLLC is required by law to abide by the terms of this notice.
Who Will Follow This Notice?
The staff (medical and non-medical) of R & R PEDIATRICS, PLLC, any health care professional who treats you at our practice.
Requirement for Written Authorization:
Except as described in this notice of Privacy Practices, R & R PEDIATRICS, PLLC will not use or disclose your PHI without your prior written authorization. We generally obtain your written authorization before using your PHI or sharing it with others out side our practice. You may alsorequest transfer of your records to another practice or person by submitting a written authorization form.
Exceptions to Written Authorization:
There are some situations when we do not need your written authorization before using your PHI. These are:
• We may share your PHI with doctors, nurses and other healthcare professionals whoare involved in taking care of you, and they may in turn use that information to diagnose or treat you. our health care professional may alsoshare your PHI with another health care professional to whom you have been referred for further health care.
• We are permitted to use your PHI or share it with others sothat we may obtain payment for your health care services provided by us. For example, we may share your PHI with your insurance company in order to obtain reimbursement after we have provided services to you, or to determine whether it will cover your treatment. We may share your information with billing department, collection department or agencies, Consumer reporting agencies (credit bureaus). We might alsoneed to inform your health insurance company about your health condition in order to obtain pre-approval for your treatment, such as admitting to hospital for surgery.
• We may use your PHI or share it with others in order to conduct our business operations which include internal administration, planning, and other activities that improve the quality and cost-effectiveness of care that we deliver it to you, such as performance improvement, utilization review, internal auditing, licensing, credentialing, and educational activities. We may alsouse your information for training of trainees, students, employees of our practice, and other health care providers. We may alsouse your information to remind you about your appointments, or let you know about treatment alternatives, or other health related services or benefits that you may be of interest to you. We may use your PHI to mail you an informative newsletter about our organization, staffing changes, new services or facilities, and other matters of general interest.
• We may list your name, where you are located in our facilities, your general medical condition and your religious affiliation in our directory.
Disclosure to Family and Friends
• We may disclose your PHI to notify or to assist in notifying a family member, your personal representative or other person responsible for your care about your location, your general condition, or in the event of your death. If you are able and available to agree or object, we will give you an opportunity to object prior to making this notification. If you are unable or unavailable to agree or object, our healthcare professionals use their best judgment in communication with you family member and others.
The Privacy Rule permits use and disclosure of PHI, without an individual’s authorization or permission, for 12 national priority purposes, such as:
Required by law (including by statue, regulation, or court orders)
Public Health Activities
a. Public health authorities authorized by law to collect or receive such information for preventing or controlling disease, injury, or disability and to public health or other government authorities authorized to receive reports of child abuse and neglect.
b. Individuals whomay have contracted or been exposed to a communicable disease when notification is authorized by law.
c. Employers, regarding employees, when requested by employees, for information concerning a work-related illness or injury, or workplace related medical surveillance, because such information is needed by the employer to comply with the oSHA.
Victims of Abuse, Neglect, or Domestic Violence
We may disclose your PHI to appropriate government authorities
regarding victims of abuse, neglect, or domestic violence.
Health oversight Activities
We may disclose your PHI to health oversight agencies for purposes of
legally authorized health oversight activities, such as audits and
investigations necessary for oversight of the health care system and
government benefit programs.
Judicial and Administrative Proceedings
We may disclose your PHI in a judicial or administrative proceeding if
the request for the information is through an order from a court or
administrative tribunal Law Enforcement Purposes
d. As required by law
e. To identify or locate a suspect, fugitive, material witness, or missing person
f. In response to law enforcement official’s request for information about a victim, or suspected victim of a crime
g. If we suspect that your death resulted from criminal conduct
h. If we believe that PHI is evidence of a crime that occurred on our premises
In the unfortunate event of your death we may disclose your PHI to funeral directors as needed, and or to coroners or medical examiners to identify a deceased person, determine cause of death, or perform other
functions authorized by law.
Cadaveric organ, Eye, or Tissue Donation
May use or disclose your PHI to facilitate the donation and
transplantation of cadaveric organs, eyes, and tissue.
We may disclose your PHI to researchers conducting research previously
approved by an Institutional Review Board (IRB) or R&R PEDIATRICS,
PLLC privacy board. In some instances, we may combine your PHI with
information on other patients or in combination with information on you
or other patients from other hospitals or providers for learning purposes.
When appropriate, we may remove identifying information about you sothat others may use it to study health care issues without learning your
Serious Threat to Health or Safety
We disclose your PHI, if we believe it is necessary to prevent or lessen a serious and imminent threat to a person or public, when such disclosure is made to someone we believe can prevent or lessen the threat.
Essential Government Functions
We may not need you authorization to release your PHI for certain essential government functions such as: assuring execution of proper military operation, conducting intelligence and national security activities that are authorized by law, providing protective services to the President, Making medical suitability determinations for U.S. State Department employees, protecting the health and safety of inmates or employees in a correctional institution, and to determining eligibility for or conducting enrollment in certain government programs.
And Workers’ Compensation
We may disclose your PHI as necessary to comply with worker’s compensation laws.
Your Rights to Access and Control your PHI:
You have the following rights to access and control your PHI:
Right to Inspect and Copy records
• Any patient, parent or legal guardian has the right to inspect and obtain copies of their medical record that may be used to make decisions about you and your treatment for as long as we maintain this information in our records. To inspect or obtain copy of the record, please submit your request in writing to our practice privacy officer. We may charge you a fee of $10.00 for copying, mailing, or other supplies we use to fulfill your request. The fee generally must be paid in full before or at the time we give the copies to you. We generally respond to your request within 10 days to inspect your record, 14 days for copying the record.
Right to revoke written authorization
• R & R PEDIATRICS, PLLC will not make any other use or disclose your PHI without the individual’s written consent or authorization. Such authorization maybe revoked at any time. Revocation must be written to our privacy officer.
Right to accounting of disclosures
• You have the right to request a six-year accounting of all disclosures of your medical record. The accounting will be provided within 60 days of the written request and a reasonable charge may be assessed for any copies after the first requested in a 12-month period. An accounting of disclosure will not include information regarding disclosures we made to you, your family members or your personal representative involved in your payment or health care, we made pursuant to your written authorization, we made for treatment, payment, or business operations, we made from the patient directory, made to public need and law enforcement authorities.
Right to amend records
• If you believe that the health information we have about you is incorrect or incomplete, you or your representative may ask us to amend the information. You have the right to request an amendment for as long as the information is kept in our records. Your request should be in written to our privacy officer and alsoinclude reasons why you think we should make amendment. ordinarily we will respond to your request within 60 days. We may deny all or part of your request. If we deny, we will provide you a written notice that explains our reasons for doing so. If you disagree with our decision, you will have an opportunity to submit a statement explaining your disagreement, which we will include in your record.
Right to request confidential communications
• You have the right to request that we communicate with you about your medical matters in a more confidential way by requesting that we communicate with you by alternative means or at alternative locations. For example you may ask that we contact your cell phone than your home or work phone. To request for confidential communications please write to our privacy officer. We will not ask you the reason for the request, and we will try to accommodate all reasonable requests.
Right to request restrictions
• You have the right to request restrictions as to how their PHI may be used or disclosed to carry out treatment, payment, or healthcare operations. However the practice is not required to agree to the restrictions requested, but if the practice does agree, the practice must abide by those restrictions.
Right to obtain a copy of this notice
• You have the right to a paper copy of this notice of Privacy Practices upon request, even if you agreed to accept this notice electronically.
Right to report
• Any patient/person may file a complaint to the practice privacy officer and to the Secretary of Health and Human Services if they believe their privacy rights have been violated. To file a complaint with the practice, please contact the privacy officer at the following address and or phone number R & R PEDIATRICS, PLLC 3100 NC HIGHWAY 55, SUITE 202, NC 27519, Telephone (919) 367-9833 Fax (919) 367-9832.
• It is the policy of R & R PEDIATRICS, PLLC that noretaliatory action will be made against any individual whosubmits or conveys a complaint of suspected or actual non-compliance of the privacy statement.
Raveendra B. Orugunta, M.D
3100 NC HWY 55, Suite 202
Cary, NC 27519
Phone (919) 367-9833 Fax (919) 367-9832
© 2008-2009 R & R Pediatrics | 3100 NC HWY 55, Suite 202, Cary NC 27519 | Phone:(919) 367-9833 | Fax:(919) 367-9832