1635 N. George Mason Drive, Suite 150
Arlington, VA 22205
NOTICE OF PRIVACY PRACTICES
(Effective Date: 1/04/05)
This notice describes how medical information (Protected
Health Information, PHI and/or Electronic Protected Health Information, EPHI)
about you may be used and disclosed and how you may gain access to this
information. Please review it carefully. We are required by Federal
Law to provide you with the information detailed below, according to
specified format and content. If you have any questions about this
notice, please contact our Privacy Officer at the address/phone number
Each time you visit Cardiovascular Care ["The
Practice,"] your medical record is updated to record your symptoms,
exam and test results, diagnosis, treatment and recommendations for future
treatment. We are required by law to ensure that your medical information is
kept private, give you this Notice of Privacy Practices, and follow the
terms of the notice that are currently in effect. We may change the terms of
our notice, at any time. Any revision or amendment to this notice will be
effective for all of your records that our practice has created or
maintained in the past, and for any of your records that we may create or
maintain in the future. Our practice will post a copy of our current Notice
in our offices in a visible location at all times.
HOW THE PRACTICE MAY USE AND DISCLOSE MEDICAL INFORMATION
The following examples provide different ways that The Practice may use and
disclose medical information about you without your authorization. Your
protected health information may be used and disclosed by your physician,
The Practice's staff, and others outside of The Practice involved in
providing health care services to you. Each category below gives examples as
to how The Practice may use and disclose your protected health information.
Treatment: The Practice may use medical information
about you to provide, coordinate or manage your medical treatment or
services. For example, information obtained by your nurse or physician will
be recorded and used to determine the best course of treatment for you. This
information may be shared with other healthcare providers involved in your
healthcare diagnosis or treatment.
Payment: The Practice may use and disclose medical
information about you to receive payment for your healthcare services. For
example, we may send a bill to you, an insurance company, or a third party
such as family members. The information on the bill may include information
that identifies you and the health care services you received. We may also
communicate with your health insurance carrier to get prior approval for a
treatment or to determine if a treatment is covered under your plan.
Health Care Operations: The Practice may use and
disclose medical information about you in order to support the business
activities, which we call "health care operations" of the
practice. For example; Members of the medical staff and/or members of a
quality improvement team may use information in your health record to assess
the care and outcomes in your case and others like it as a means to
continually improve the quality of the healthcare and service we provide.
Business Associates: The Practice may use a third
party to perform various functions necessary to the practice (e.g., billing
and transcription). The Practice requires that third parties sign contracts
stating they will protect your information.
Appointment Reminders: We may use and disclose
medical information when we contact you by phone, to include a message left
on your voicemail, or a mailed postcard to remind you of an appointment.
As Required By Law: The Practice will disclose
medical information when required to do so by federal, state or local law,
in response to a court order, valid subpoena, warrant, summons or similar
Military and Veterans: The Practice may release
medical information of patients in the armed forces as required by military
Workers' Compensation: The Practice may release
medical information about you to comply with workers' compensation laws.
Health Oversight: The Practice may disclose your
health information to a state or federal health oversight agency, which is
authorized by law to oversee our operations.
Public Health: The Practice may disclose medical
information about you for public health reasons. Some common reasons for
disclosure are to prevent or control disease, injury or disability.
Law Enforcement: When legal requirements are met, The
Practice may release medical information about you if asked to do so by a
law enforcement official, for example; for legal processes that are required
by law or concerning victim(s) of a crime.
National Security: The Practice may disclose your
medical information to federal officials for intelligence and national
security activities authorized by law.
Coroners, Medical Examiners and Funeral Directors:
Medical information may be released to a coroner or medical examiner, as
authorized by law, for identification purposes or to determine the cause of
Inmates: If you are an inmate of a correctional
institution or in the custody of a law enforcement official, The Practice
may release medical information about you to the correctional institution or
law enforcement official.
Emergencies/Communication Barriers: The Practice may disclose your
health information in the event of an emergency health situation or if
significant communication barriers exist and the physician determines, using
professional judgment that you intend to consent to use or disclosure under
Family and Others Involved in your Care or Payment for
your Care: Using our best judgment, The Practice may disclose health
information about you to a family member, relative or friend involved in
your medical care or the payment of your care.
Organ and Tissue Donation: If you are an organ donor,
The Practice may release medical information to organizations engaged in the
procurement, banking or transplantation of organs in order to aid in the
organ or tissue donation and transplantation.
Marketing of Treatment Alternatives, Benefits and
Services: We may use and disclose medical information to tell you about
treatment alternatives or other health-related benefits and services that
may be of interest to you. If you do not want to be included in this
service, please notify our Privacy Officer in writing.
Research: The Practice may disclose medical
information to researchers if an institutional review board has approved the
research proposal and protocols are in place to ensure the privacy of your
YOUR MEDICAL INFORMATION AND YOUR RIGHTS
Your health record is the physical property of your healthcare provider. The
information, however, belongs to you. Your legal rights with regard to your
health record are detailed below.
Right to Confidential Communications: You have the
right to request that our practice communicate with you about your health
and related issues in a particular manner or at a certain location. For
instance, you may ask that we contact you at home, rather than work. We will
accommodate reasonable requests. You must make a written request to our
Right to Inspect and Copy: You have the right to
inspect and obtain a copy of your medical record. This typically includes
medical and billing records. Our practice may deny your request to inspect
and/or copy in certain limited circumstances; however, you may request a
review of our denial. If you would like to inspect your medical information,
you must submit your written request to our Privacy Officer. You will be
contacted and an appointment arranged for review of the records in the
presence of an Office Representative. If you would like to request a copy of
your medical information, you must submit your written request to the
Privacy Officer. You will be charged a fee for the cost of copying, mailing
and other costs associated with your request.
Right to Obtain an Accounting of Disclosures: You
have the right to request an accounting of certain disclosures we have made
(if any) of your health information, which do not fall under the routine
disclosures stipulated for payment, treatment and/or healthcare operations
or for which you have not additionally authorized in writing. To request an
accounting of such disclosures, please submit your written request to our
Right to Have Amend your Protected Health Information:
This means you may request an amendment of protected health information
about you in a designated record set if you believe it is incorrect or
incomplete for as long as we maintain this information. In certain cases we
may deny your request for an amendment. If we do so, 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.
Right to Obtain a Paper Copy of This Notice: Upon
request, and at any time, The Practice will provide you with a paper copy of
Right to Provide an Authorization for Other Uses and
Disclosures: The Practice will obtain your written authorization for
uses and disclosures that are not identified by this Notice or permitted by
PRACTICE OBLIGATIONS REGARDING YOUR MEDICAL INFORMATION AND
Pursuant to your written request(s) regarding your medical information and
rights, please be advised that the law requires that The Practice respond to
your request(s) within thirty (30) days.
If you believe your privacy rights have been violated, you may contact our
Privacy Officer at the address/phone number listed above without fear of
retribution. All complaints must be submitted in writing and will be handled
confidentially. The Privacy Officer will contact you within 10 business days
of receipt of your complaint.
Should you feel further assistance is warranted, you may
contact the Office for Civil Rights/U.S. Department of Health and Human
Services at 150 S. Independence Mall West-Suite 372, Philadelphia, PA
19106-3499, or call the Office of Civil Rights (OCR) at (215) 861-4441;
(215) 861-4440 (TDD), (215) 861-4431 FAX.