Notice of Privacy Practices
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.We understand the importance of privacy and are committed to maintaining the confidentiality of your medical information. We make a record of the medical care we provide and may receive such records from others. We use these records to provide or enable other healthcare providers to provide quality medical care to obtain payment for services provided to you as allowed by your health plan and enable us to meet our professional and legal obligations to operate this medical practice properly. We are required by law to maintain the privacy of protected health information, to provide individuals with notice of our legal duties and privacy practices with respect to protected health information, and to notify affected individuals following a breach of unsecured protected health information, and to notify affected individuals following a breach of unsecured protected health information.
This notice describes how we may use and disclose your medical information. It also describes your rights and our legal obligations with respect to your medical information. If you have any questions about this notice, please contact our Administrative Officer. This Notice of Privacy Practices is NOT an authorization. This Notice of Privacy Practices describes how we, our Business Associates and their subcontractors, may use and disclose your protected health information (hereafter “PHI”) to carry out treatment, payment or health care operations (TPO) and for other purposes that are permitted or required by law. This notice also describes your rights to access and control your PHI. “Protected Health Information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health condition and related healthcare services.
OUR PLEDGE REGARDING MEDICAL INFORMATION:
We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at Four Peaks Neurology. We need this record to provide you with quality care and to comply with certain legal requirements.
This notice applies to all of the records of your care generated by our Practice. This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information. We are required by law to:
- 1. Make sure that medical information that identifies you is kept private;
- 2. Give you this notice of our legal duties and privacy practices concerning medical information about you
- 3. and Follow the terms of the notice that is currently in effect.
When you obtain services from Four Peaks Neurology, certain uses and disclosures of your health information are necessary and permitted by law in order to treat you, to process payments for your treatment and to support the operations of the entity and other involved providers. This medical practice collects health information about you and stores it in an electronic medical record. This medical record is the property of this medical practice, but the information in the medical record belongs to you. All of the ways your health information is used or disclosed should fall within one of the categories listed below. The law permits Four Peaks Neurology to use or disclose your health information for the following purposes:
Your health information will be used for treatment: Four Peaks Neurology uses medical information about you to provide your medical care. We disclose medical information to our employees and others who are involved in providing the care you need. For example, disclosure may be made to doctors, nurses, technicians, or others who are involved in taking care of you at Four Peaks Neurology, or other physicians or other health care providers who provide services that we do not provide. Or we may share this information with a pharmacist who needs it to dispense medical information to members of your family or others who can help you when you are sick or injured. This information may be disclosed to any physician that our office refers you to see for continued care. Information may be shared with pharmacies, laboratories or radiology centers for the coordination of different treatments.
Your health information will be used for payment: Health information about you may be disclosed so that services provided to you may be billed to an insurance company or third party. Information may be provided to your health plan about treatment you are going to receive in order to obtain prior approval or to determine if your health plan will cover the treatment.
Your health information will be used for health care operations: We may use and disclose medical information about you to operate this medical practice. For example: The information in your health record may be used to evaluate and improve the quality of the care and services we provide. Or we may use and disclose this information for the purpose of securing authorization of services. We may also use and disclose this information as necessary for medical reviews, legal services and audits, including but not limited to, compliance programs and business planning or management.
Business Associates: There are some services that we provide through contracts with third party business associates. Examples include external laboratories, transcription agencies and copying services. To protect your health information, Four Peaks Neurology requires these business associates to appropriately protect your information.
Disclosures Required by Law: We may use or disclose your PHI to the extent that law requires the use or disclosure. We can use or share health information about you for worker’s compensation claims, for law enforcement purposes or with a law enforcement official, with health oversight agencies for activities authorized by law, and for special government functions such as military, national security, and presidential protective services. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, if required by law, of any such uses or disclosures.
Help with public health and safety issues: We may disclose health information about you for certain situations, such as preventing disease, helping with product recalls, reporting adverse reactions to medications, reporting suspected abuse, neglect, or domestic violence, and preventing or reducing a serious threat to anyone’s health or safety.
Respond to organ and tissue donation requests: We can share health information about you with organ procurement organizations.
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), or in certain conditions in response to a subpoena, discovery request or other lawful process. We will respond to subpoenas in compliance with Arizona law, we comply with federal law requirements for disclosure of records protected by 42 CFR part 2, which protects substance use disorder records. We comply with Arizona law for disclosure of records with HIV, Mental Health, Communicable Disease, and Generic Testing information and will not disclose it to a third party without your authorization unless permitted or required by law.
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 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 our practice, and
- 6. medical emergency (not on our practice’s premises) and it is likely that a crime has occurred.
If the use or disclosure of health information described above in this notice is prohibited or materially limited by other laws that apply to us, it is our intent to meet the requirements of the more stringent law. Except for uses and disclosures described and limited as set forth in this notice, we will use and disclose your health information only with a written authorization from you. This includes, except for limited circumstances allowed by federal privacy law, not using or disclosing psychotherapy notes about you, selling your health information to others, or using or disclosing your health information for certain promotional communications that are prohibited marketing communications under federal law, without your written authorization. Once you give us authorization to release your health information, we cannot guarantee that the recipient to whom the information is provided will not disclose the information. You may take back or "revoke" your written authorization at any time in writing, except if we have already acted based on your authorization.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU
You have the following rights regarding medical information we maintain about you:
Right to Inspect and Copy: You have the right to inspect and copy medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes. To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to our Administrative Officer. Our practice may charge a fee for the costs of copying, mailing, labor and supplies associated with your request.
We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, you may request, in writing, that the denial be reviewed. Another licensed health care professional chosen by Four Peaks Neurology will review your request and the denial. The person conducting the review will not be the person who previously denied your request. We will comply with the outcome of the review.
Right to Amend: If you feel that medical information, we have about you is incorrect or incomplete, you may ask us to include additional information in your medical record. You have the right to request an amendment as long as all of the information, both old and new, is kept by or for Four Peaks Neurology. To request an amendment, your request must be made in writing and submitted to our office administrator. Furthermore, you must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
- 1. Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
- 2. Is not part of the medical information kept by or for our Practice;
- 3. Is not part of the information which you would be permitted to inspect and copy; or
- 4. or Is accurate and complete.
Right to Request Restrictions: You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations. You 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. 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 emergency treatment. To request restrictions, you must make your request in writing to our Privacy Officer. 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, for example, disclosures to your spouse.
Right To Restrict Release of Information for Certain Services: You have the right to restrict the disclosure of information regarding services for which you have paid in full or on an out-of-pocket basis. This information can be released only upon your written authorization.
Right to a Paper Copy of This Notice: You have the right to a paper copy of this notice. 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. To obtain a paper copy of this notice, ask any of our office staff or you may write to our Practice at Four Peaks Neurology, 9746 N 90th Pl STE 203, Scottsdale, AZ 85258.
Right To Breach Notification: You have the right to be notified of any breach of your unsecured healthcare information.
CHANGES TO THIS NOTICE
We reserve the right to change this notice. We reserve the right 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 retain a copy of the current notice in our office for reference.
COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with our practice or with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775 or visiting https://www.hhs.gov/hipaa/filing-a-complaint/.
To file a complaint with Four Peaks Neurology, please write to the Administrative Officer at 9746 N 90th Pl STE 203, Scottsdale, AZ 85258. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
Four Peaks Neurology, P.C.
