Trinity Medical Associates, PC Notice of Privacy Practices for Protected Health Information
This Notice was most recently revised on January 17, 2019.
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.
IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE OR IF YOU NEED MORE INFORMATION, PLEASE CONTACT OUR PRIVACY OFFICER:
Jason Brown (865) 539-0270 OR firstname.lastname@example.org
We are required by law to maintain the privacy of Protected Health Information (PHI) and to give you this Notice explaining our privacy practices with regard to that information. You have certain rights – and we have certain legal obligations – regarding the privacy of your PHI, and this Notice explains your rights and our obligations. We are required to abide by the terms of this Notice.
Protected Health Information (PHI) is information that individually identifies you and that we create or get from you or from another health care provider, a health plan, your employer, or a health care clearinghouse and that relates to (1) your past, present, or future physical or mental health or conditions, (2) the provision of health care to you, or (3) the past, present, or future payment for your health care.
We may use and disclose your PHI in the following circumstances:
For Treatment and Appointment Reminders:
- A nurse obtains information about you and records it in your medical record.
- During the course of your treatment, the physician determines that he will need to consult with another specialist in the area. He will share the information with such specialist and obtain his or her input.
- We may use and disclose PHI to contact you to remind you that you have an appointment for medical care.
- We submit requests for payment to your insurance company. The insurance company or business associate helping us obtain payment requests information from us regarding your medical care. We will provide information to them about you and the care that was given.
- We may also tell your health plan about a treatment you are going to receive to find out if your plan will cover the treatment.
For Health Care Operations and Business Associates:
- We may obtain services from business associates such as credentialing, medical review, legal services, and insurance. We will share information about you with such business associates as necessary to obtain these services. All of our business associates are obligated, under contract with us, to protect the privacy of your PHI.
- We may disclose the PHI of a minor child to their parents or guardians unless such disclosure is otherwise prohibited by law.
Personal Representative or Medical Power of Attorney
- If you have a personal representative, such as a legal guardian, we will treat that person as if that person is you with respect to disclosures of your PHI.
Medical Residents and Medical Students
- Medical residents or students may observe or participate in your treatment or use your PHI to assist in their training. You have the right to refuse to be examined, observed, or treated by medical residents or students.
To Avert a Serious Threat to Health and/or Safety
- When necessary to prevent a serious threat to your health or safety or to the health or safety of others. But we will only disclose the information to someone who may be able to help prevent the threat.
Organ and Tissue Donation
- If you are an organ or tissue donor, we may use or disclose your PHI to organizations that handle organ procurement or transplantation – such as an organ donation bank – as necessary to facilitate organ or tissue donation and transplantation.
Coroners, Medical Examiners, and Funeral Directors
- We may release PHI so that they can carry out their duties.
Military and Veterans
- If you are a member of the armed forces, we may release PHI as required by military command authorities. We also may release PHI to the appropriate foreign military authority if you are a member of a foreign military.
- If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may disclose PHI to the correctional institution or law enforcement official if the disclose is necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) the safety and security of the correctional institution.
Public Health Risks
- This includes disclosures to (1) the Food & Drug Administration (FDA) for purposes related to the quality, safety or effectiveness of an FDA-regulated product or activity; (2) prevent or control disease, injury or disability; (3) report births and deaths; (4) report child abuse or neglect; (5) report reactions to medications or problems with products; (6) notify people of recalls of products they may be using; (7) a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and (8) appropriate government authority if we believe a patient has been a victim of abuse, neglect, or domestic violence and the patient agrees or we are required or authorized by law to make that disclosure.
Health Oversight Activities
- For activities authorized by law that may include, for example, audits, investigations, inspections, licensure, and similar activities that are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
Lawsuits and Disputes
- We may disclose PHI in response to a court or administrative order or in response to a subpoena, discovery request, or other legal processes from someone else involved in the dispute, but only if efforts have been made to tell you about the request or to get an order protecting the information requested. We may also use or disclose your PHI to defend ourselves if you sue us.
Law Enforcement and National Security
- We may release PHI if asked by a law enforcement official for the following reasons: in response to a court order, subpoena, warrant, summons or similar process; to identify or locate a suspect, fugitive, material witness, or missing person; about the victim of a crime if; about a death we believe may be the result of criminal conduct; about criminal conduct on our premises; and in emergency circumstances to report a crime, the location of the crime or victims, or the identity, description, or location of the person who committed the crime.
- We may release PHI to authorized federal officials for national security activities authorized by law. For example, we may disclose to those officials so they may protect the President.
Special Protections for HIV, Alcohol and Substance Abuse, Mental Health, and Genetic Information
Special privacy protections apply to HIV-related information, alcohol and substance abuse, mental health, and genetic information. Some parts of this general Notice of Privacy Practices may not apply to these kinds of PHI. For example, if we give you a test to determine if you have been exposed to HIV, we will not disclose the fact that you have taken the test to anyone without your written consent unless otherwise required by law.
Your Rights Regarding Your PHI
The health and billing records we maintain are the physical property of the Doctors/Practice. You have the following rights with respect to your Protected Health Information.
- You have the right to inspect and/or receive a copy of PHI that may be used to make decisions about your care or payment for your care. But you do not have a right to inspect or copy psychotherapy notes. We may charge you a fee for the costs of copying, mailing or other supplies associated with your request. We may not charge you a fee if you need the information for a claim for benefits under the Social Security Act or any other state or federal needs-based benefit program. We may deny your request in certain limited circumstances. If we do deny your request, you have the right to have the denial reviewed by a licensed healthcare professional who was not directly involved in the denial of your request, and we will comply with the outcome of the review.
- You have the right to request an electronic copy of your records be given to you or transmitted to another individual or entity. We may charge you a reasonable, cost-based fee for the labor associated with copying or transmitting the electronic PHI. If you choose to have your PHI transmitted electronically, you will need to provide, in writing, a request to this office listing the contact information of the individual or entity who should receive your electronic PHI.
- We are required to notify you by first-class mail of any breach of your unsecured PHI.
- If you feel that PHI 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 us. A request for amendment must be made in writing to the Privacy Officer and it must tell us the reason for your request. We may deny your request 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, (2) is not part of the medical information kept by or for us, (3) is not information that you would be permitted to inspect or copy, or (4) is accurate or complete. If we deny your request, you may submit a written statement of disagreement of reasonable length. Your statement of disagreement will be included in your medical record, but we may also include a rebuttal statement.
- You have the right to ask for an “accounting of disclosures, “which is a list of the disclosures we made of your PHI. We are not required to list certain disclosures, including (1) disclosures made for treatment, payment and health care operations purposes, (2) disclosures made with your authorization, (3) disclosures made to create a limited data set, and (4) disclosures made directly to you. Your request must state a time period which may not be longer than 6 years before your request. The first accounting of disclosures you request within any 12-month period will be free of charge.
- You have the right to request a restriction or limitation on the PHI we use or disclose for treatment, payment, or health care operations. You also have the right to request a limit on the PHI we disclose about you to someone who is involved in your care or the payment of your care, like a family member or friend. We are not required to agree to your request. If we agree, we will comply with your request unless we terminate our agreement or the information is needed to provide you with emergency treatment.
- You have the right to restrict certain disclosures of PHI to a health plan if the disclosure is for payment or health care operations and pertains to a health care item or service for which you have paid out of pocket in full. We will honor this request unless we are otherwise required by law to disclose this information. This request must be made at the time of service.
- You have the right to request that we communicate with you only in certain ways to preserve your privacy. You must make any such request in writing and you must specify how or where we are to contact you. We will accommodate all reasonable requests. We will not ask you the reason for your request.
- You have the right to a paper copy of this Notice. You may request a copy of this Notice at any time. You can get a copy of this Notice at our website: http://www.trinitymedical.net.
If you want to exercise any of the above rights, please contact Jason Brown, our Privacy Officer at (865)539-0270, in person, or in writing, during normal business hours. He will provide you with assistance on the steps to take to exercise your rights.
The office is required to:
- Maintain the privacy of your health information as required by law
- Provide you with a notice as to our duties and privacy practices as to the information we collect and maintain about you
- Abide by the terms of this notice
- Notify you if we cannot accommodate a requested restriction or request
- Accommodate your reasonable requests regarding methods to communicate health information with you
- Accommodate your request for an accounting of disclosures.
We reserve the right to amend, change, or eliminate provisions in our privacy practices and access practices and to enact new provisions regarding the protected health information we maintain. If our information practices change, we will amend our Notice. You are entitled to receive a revised copy of the Notice by calling and requesting a copy of our “Notice” or by visiting our office and requesting a copy in person.
To Request Information or File a Complaint
If you have questions, would like additional information, or want to report a problem regarding the handling of your information, you may contact Jason Brown, Privacy Officer at (865)539-0270, or in person during normal business hours.
Additionally, if you believe your privacy rights have been violated, you may file a written complaint within 180 days of when you knew or should have known of the suspected violation at our office by delivering the written request to Mr. Brown.
- We cannot, and will not, require you to waive the right to file a complaint with the Secretary of Health and Human Services as a condition of receiving treatment at this office.
- We cannot, and will not, retaliate against you for filing a complaint with the Secretary of Health and Human Services.
Following is a List of Other Uses and Disclosures Allowed by the Privacy Rule
Notification – Opportunity to Agree or Object:
Unless you object, we may use or disclose your protected health information to notify, or assist in notifying, a family member, personal representative, or another person responsible for your care, about your location, general condition, or death.
Communication with family – Using our best judgment, we may disclose to a family member, another relative, close personal friend, or any other person that you identify, health information relevant to that person’s involvement in your care or in payment of such care if you do not object or in an emergency.
Opportunity to object or agree is Not Required
Controlling Disease – As required by law, we may disclose your protected health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.
Child Abuse and Neglect – We may disclose protected health information to public authorities as allowed by law to report child abuse or neglect.
Food and Drug Administration (FDA) – We may disclose to the FDA your protected health information relating to adverse events with respect to food, supplements, products and product defects, or post-marketing surveillance information to enable product recalls, repairs or replacement.
Victims of Abuse, Neglect, or Domestic Violence
We can disclose protected health information to governmental authorities to the extent the disclosure is authorized by statute or regulation and in the exercise of professional judgment the doctor believes the disclosure is necessary to prevent serious harm to the individual or another potential victim.
Federal law allows us to relate your protected health information to appropriate health oversight agencies or for health oversight activities to include audits, civil, administrative or criminal investigations, inspections, licenses or disciplinary actions, and for similar reasons related to the administration of healthcare.
We may disclose your protected health information in the course of any judicial or administrative proceeding as allowed or required by law, with your consent, or as directed by a proper court order or administrative tribunal, provided that only the protected health information released is expressly authorized by such order, or in response to a subpoena, discovery request or another lawful process.
We may disclose your protected health information for law enforcement purposes as required by law, such as when required by court order, including laws that require reporting certain types of wounds or other physical injury.
Coroners, Medical Examiners, And Funeral Directors
We may disclose your protected health information to funeral directors or coroners consistent with applicable law to allow them to carry out their duties.
Threat to Health and Safety
To avert a serious threat to health and safety, we may disclose your protected health information consistent with applicable law to prevent or lessen a serious, imminent threat to the health or safety of a person or the public.
If you are an inmate of a correctional institution, we may disclose to the institution or it’s agents the protected health information necessary for your health and the health and safety of other individuals.
If you are seeking compensation through Workers Compensation, we may disclose your protected health information to the extent necessary to comply with laws relating to Workers Compensation.
Other Uses and Disclosures
- Other uses and disclosures besides those identified in this notice will be made only as otherwise authorized by law or with your written authorization which you may revoke except to the extent information or action has already been taken.
- We maintain a website that provides information about our practice. This notice will also be published on that website.
Effective Date: This notice becomes effective January 1, 2003