Notice of Privacy Practices

Effective Date: June 1, 2006

This Notice Describes How Health Information About You May Be Used and Disclosed and How You Can Get Access to This Information.

Our Responsibilities

We are required by law to maintain the privacy of your health information and provide you a description of our privacy practices. We will abide by the terms of this notice and notify you if we cannot agree to requested restriction. We will accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.

Uses and Disclosures

How we may use and disclose medical information about you.

The following categories describe examples of the way we use and disclose medical information:

For Treatment: We may use medical information about to provide you treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students, or other hospital/long term care personal who are involved in taking care of you at this clinic. For example: a doctor treating you for an injury  may need to know if you have diabetes, because diabetes may slow the healing process, or if your Doctor orders Physical Therapy, the nursing staff will need to discuss your care and treatment with the Physical Therapist. We may share medical information about you in order to coordinate the different things you may need, such as prescriptions, lab work, meals, and x-rays. We may also provide your physician or a subsequent healthcare provider with copies of various reports that should assist him or her in treating you.

For Payment: We may use and disclose your medical information to receive payment for our services from you, an insurance company or a third party. For example, we may need to give your health plan information about a procedure we perform at our office so your health plan will pay us or reimburse you for the procedure. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.

For Health Care Options: Members of the medical staff and/or quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. The results will then be used to continually improve the quality of care for all patients/residents we serve. For example, we may combine medical information about many patients/residents to evaluate the need for new services, treatment, or equipment. We may disclose information to doctors nurses, and other students for educational purposes.

We may also use and disclose medical information:

·          To business associates we have contracted with to perform the agreed upon service and billing for it;

·          To remind you that you have an appointment for medical care

·          To assess your satisfaction with our services;

·          To tell you about possible treatment alternatives.

·          To tell you about health-related benefits or services.

·          To contact you as part of fund raising efforts

·          For population based activities relating to improving health or reducing health care costs;

·          For conducting training programs and reviewing competence of health care professionals.

Business Associates: We may disclose health information to “business associates” with which we contract to perform services on our behalf. 

Individuals Involved In Your Care or Payment for Your Care: We may disclose to a family member, close personal friend, or other person you identify certain health information that is needed for that person’s involvement in your care or payment for your care. Except in limited situations, such as an emergency, we will ask you or determine if you object. We may use professional judgment and experience when allowing a person to pick up prescriptions, medical supplies, x-rays, or other similar health information on your behalf. We also may disclose your health information, directly or through a disaster relief entity, to find and tell those close to you of your location or condition.

Research: We may disclose health information to researchers when an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information has approved their research.

Future Communications: We may communicate to you via newsletters, mail outs, or other means regarding treatment options, health related information, disease-management programs, wellness programs, or other community based initiatives or activities our facility is participating in.

Affiliated Covered Entity: Protected health information will be made available to your physician as necessary to carry out treatment, payment and health care operations.

As Required by Law:

Coroners, Medical Examiners, and Funeral Directors: We may disclose health information to a medical examiner or coroner as necessary or required to identify a deceased person or determine the cause of death. We also may disclose health information to funeral directors so they can perform their duties.

Organ or Tissue Donation. We may disclose your medical information to organizations involved in procuring, banking or transplanting organs, eyes and tissues, as necessary to facilitate organ or tissues donation or transplantation.

Food and Drug Administration (FDA): Your medical information may be used or disclosed for public health activities such as assisting public health authorities or other legal authorities prevent or control disease, injury, or disability; to report birth defects or infant eye infections; to report cancer diagnoses and tumors; to report child abuse or neglect or a child born with alcohol or other substances in its system; to report reactions to medications or problems with products; to notify you of recalls of products you may be using; to notify the Oklahoma State Department of Health that a person may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition such as HIV, Syphilis, or other sexually transmitted diseases; or to notify the appropriate governmental authority if we believe a patient has been the victim of abuse, neglect, or domestic violence, if the victim agrees to our reporting or if we are required to do so by law. Your medical information may be disclosed to appropriate persons in order to prevent or lessen a serious and imminent threat to you or to the health and safety of a particular person or the general public.

Workers’ Compensation. Your medical information may be used or disclosed as required by law related to workers’ compensation.

Law Enforcement Activities: We may disclose health information if asked to do so by a law enforcement official: as required by a law that mandates certain types of reporting; in response to court orders, subpoenas, warrants, summons, grand jury subpoenas, certain administrative requests, or similar processes; to identify or locate a suspect, fugitive, material witness, or missing person (but we will give only limited information); about the victim of a crime in certain circumstances; about a death we believe may be the result of criminal conduct; about criminal conduct on our premises; and, in emergencies, to report a crime, the location of the crime or victims, or the identity, description, or location of the person who committed the crime.

National Security, Intelligence Activities, Protective Services, and Military Personnel: We may disclose health information about you to authorized federal officials for intelligence, counterintelligence, special investigations, and other national security activities authorized by law or to protect the President or other authorized persons. If you are a member of the armed forces, we may disclose health information about you as required by your military command authorities.

Organized Health Care Arrangement: Solely for purposes of complying with federal privacy laws, PeaceHealth and its medical staff characterize themselves as an “organized health care arrangement” and have agreed to follow this Notice for services by, at, or through PeaceHealth. These providers may share health information with each other for treatment, payment, and the health care operations of the organized health care arrangement and as described in this Notice. PeaceHealth is not responsible for actions by independent medical staff members.

Incidental Disclosures: Certain incidental disclosures of your health information may occur as a by-product of permitted uses and disclosures. For example, a roommate may inadvertently overhear a discussion about your care if you share a room.

By Oklahoma law we are required to notify you . . . that your medical information used or disclosed as described in this Notice of Privacy Practices may include records which may indicate the presence of a communicable or venereal disease which may include, but are not limited to, diseases such as hepatitis, syphilis, gonorrhea and the human immunodeficiency virus, also known as Acquired Immune Deficiency Syndrome (AIDS).

Although your health record is our property, you have the rights described below:

Right to Inspect and Copy: You have the right to inspect and obtain copies of health information that we may use to make decisions about your care. We may deny your request in certain limited circumstances. To inspect or obtain a copy of your health information, you must submit your request on our designated form to the Health Information Management (“HIM”)/Medical Records Department or the Regional Privacy Officer. CMB may charge you a reasonable fee for the costs of copying, mailing, or other supplies related to your request.

Right to Amend: If you feel that health information we have about you is incorrect or incomplete, then you have the right to request a reasonable amendment for as long as we keep this information. We may deny your request in certain situations. To request an amendment, you must submit your request on our designated form to the HIM/Medical Records Department or the Regional Privacy Officer.

Right to an Accounting of Disclosures: You have the right to request an accounting of certain disclosures of your health information made by us. This accounting will not include disclosures: for treatment, payment, or health care operations; to you under your right of access to your records; that you authorized; to persons involved in your care or for facility directory and notification purposes; incidental to an otherwise permitted use or disclosure; as part of a limited data set; for national security or intelligence purposes; to correctional institutions or other custodial law enforcement officials; or that occurred before April 14, 2003. To request this list or accounting, you must submit your request on our designated form to the Regional Privacy Officer.

Right to Request Restrictions: You have the right to request a restriction or limitation on the health information we use about you for treatment, payment, or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care. To request a restriction, you must submit your request on our designated form to the Admitting/Patient Registration Department or the Regional 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 with emergency treatment.

Right to Request Confidential Communications: You have the right to request that we communicate with you about health matters in a certain way or at a certain location. To request confidential communications regarding billing, you must submit our designated form to Patient Financial Services or the Regional Privacy Officer. To request confidential communications regarding your health information, you must submit our designated form to the Admitting/Patient Registration Department or the Regional Privacy Officer. We will agree to the request if it is reasonable for us to do so.

Right to a Copy of this Notice: You have the right to receive a written copy of this Notice (even if you agreed to receive this Notice electronically). Copies of the Notice are available from our Regional Privacy Officer/Office Manager Jennifer Warren. You may print a copy of this Notice from our website WWW.drboxell.com, or submit your request in writing.

We reserve the right to change this Notice. The revised Notice will be effective for information we already have about you as well as any information we receive in the future. Unless required by law, the revised Notice will be effective on the new effective date of the Notice. The current Notice will be available in our registration areas or on our websites and will be posted in our facilities. The Notice will state an effective date.

If you believe that your privacy rights have been violated, you may complain to the Privacy Officer by calling the office at (918) 392-9670, by emailing to jenniferwarren@drboxell.com or by faxing to (918) 392-9670.

You may also submit a complaint to the Secretary of the Department of Health and Human Services.

YOU WILL NOT BE PENALIZED FOR FILING A COMPLAINT.

OTHER USES OF MEDICAL INFORMATION

Other uses and disclosures of medical information not covered by this notice are the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing at an time. If you revoke your permission, we will n longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our reactors of the care that we provided you.