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NASH OB-GYN ASSOCIATES, P.A. NOTICE OF PRIVACY PRACTICES 4/14/2003
This notice describes how medical information about you may be used and disclosed and how you can access this information. Please review it carefully. HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
For Treatment: We may access your health information to provide you with medical treatment or services and may disclose this health information to doctors, nurses, technicians, office staff or other personnel involved in taking care of you and your health. For example, your doctor may be treating you for a medical condition and need to know if you have other health problems that could complicate your treatment. He or she may share this information with another health professional to determine the most appropriate care for you. Personnel in our office may also share information about you and disclose this to people who do not work in our office in order to coordinate your care such as phoning or faxing prescriptions to your pharmacy, scheduling lab work and ordering diagnostic tests. Family members and other healthcare providers may be part of your medical care outside this office and may require information concerning you. For Payment: We may use and disclose health information concerning you so that treatment and services you receive at this office may be billed to, and payment may be collected from you, an insurance company or a third party. For example, we may need to give your health plan information about a service you received to expedite payment or for reimbursement. We may contact your health plan concerning a treatment you are going to receive to obtain prior approval or denial. Appointment Reminders: We may contact you by phone, mail, e-mail, etc, as a reminder that you have or need an appointment for treatment or medical care at this office. Law Enforcement: We may release health information as required by federal and/or state regulations.
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU
Right to Inspect and Copy: You have the right to inspect and copy health information such as medical and billing records that may be used to make decisions about your health care. You must submit a written request to the Privacy Officer in order to inspect and/or receive a copy of your health information. If you request a copy of this information a fee may be involved which would include copying, mailing or other charges. We may deny your request to inspect and/or copy in certain limited circumstances. If you are denied access to your health information you may ask that the denial be reviewed. If such a review is required by law, we will select a licensed healthcare professional to review your request and our denial. The person conducting the review will not be the person who denied your request and we will comply with the outcome of the review. Right to Amend: If you feel that health information we have is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for our office. To request an amendment you must make your request, in writing, to the Privacy Officer. Right to an Accounting of Disclosures: You have the right to request an accounting of disclosures. This is a list of the disclosures we made of medical information about you for purposes other than treatment, payment and healthcare operations. To obtain this list you must submit your request in writing to the Privacy Officer. It must state a time period that may not be longer than six years and may not include dates before April 14, 2003. We may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred. Right to Request Restrictions: You have the right to request a restriction or limitation on the health information we use or disclose for treatment, payment, or health care operations. You also have the right to request a limit on the health information we disclose to someone involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not share information about a particular diagnosis or treatment with your spouse. To request a restriction you must make your request, in writing, to the Privacy Officer. We are not required to agree to your request. If we agree we will comply with your request unless the information is needed to provide you with emergency treatment. Right to Request Confidential Communication: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we contact you only by mail or at work. To request confidential communication you must make your request, in writing, to the Privacy Officer. Your request must specify how or where you wish to be contacted. We will accommodate all reasonable requests. Changes to this Notice: We reserve the right to change this notice and to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post a summary of the current notice in the office with its effective date. You may contact this practice at any time to obtain a current copy of the Notice of Privacy Practices. Questions and/or Concerns: If you believe your privacy rights have been violated you may contact the Privacy Officer listed below. You may also file a written complaint with the U.S. Department of Health and Human Services. Under no circumstances will retaliatory action be taken against you for filing a complaint.
Please direct any questions, concerns or requests to:
Privacy Officer Nash Ob-Gyn Associates, P.A. 200 Nash Medical Arts Mall Rocky Mount, NC 27804 252-443-5941 ext. 241 Toll Free 1-800-521-5199 ext. 241
U.S. Department of Health and Human Services 200 Independence Avenue, S.W. Washington, D.C. 20201 202-619-0257 Toll Free: 1-877-696-6775
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