BUFFALO RHEUMATOLOGY, BUFFALO INFUSION CENTER
BUFFALO OSTEOPOROSIS INSTITUTE AND PINNACLE RESEARCH
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.
OUR COMMITMENT REGARDING YOUR PERSONAL HEALTH INFORMATION
Buffalo Rheumatology, Buffalo Infusion Center, Buffalo Osteoporosis Institute, and Pinnacle Research (Buffalo Rheumatology et al.) are committed to maintaining and protecting the confidentiality of our patients’ health information. This Notice of Privacy Practices applies to Buffalo Rheumatology et al. We are required to provide you with this notice. When Buffalo Rheumatology et al. uses or discloses your PHI, we are bound by the terms of this notice, or the revised notice if applicable.
The Health Insurance Portability & Accountability Act (HIPAA) is a federal program that requires that all medical records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper, or orally are kept properly confidential. HIPAA gives you, the patient, rights to understand and control how your health information is used. HIPAA provides penalties for covered entities that misuse personal health information (PHI). We are required by law to maintain the privacy of your protected health information.
We have prepared this explanation of how Buffalo Rheumatology et al. is required to maintain the privacy of your health information and how we may use and disclose your health information.
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION:
The following describes the ways Buffalo Rheumatology et al. may use and disclose Protected Health Information (PHI) that identifies you, our patient. Except for the purposes described below, we will use and disclose PHI only with your written permission. You may revoke such permission at any time by writing to our practice Privacy Officer.
For Treatment. Buffalo Rheumatology et al. may use and disclose PHI for your treatment and to provide you with treatment-related health care services. For example, we may disclose Health Information to doctors, nurses, technicians, or other personnel, including people outside our office, who are involved in your medical care and need the information to provide you with medical care.
For Payment. Buffalo Rheumatology et al. may use and disclose Health Information so that we or others may bill and receive payment from you, such as an insurance company or a third party, for the treatment and services you received. For example, we may send a bill for your visit to your insurance company for payment.
Health Care Operations. Buffalo Rheumatology et al. may use and disclose Health Information for health care operations purposes. These uses and disclosures are necessary to make sure that all of our patients receive quality care and to operate and manage our office. For example, we may use and disclose information to make sure the care you receive from our office is of the highest quality. We also may share information with other entities that have a relationship with you (for example, your health plan) for their health care operation activities.
Appointment Reminders. Buffalo Rheumatology et al. may contact you to provide appointment reminders and it is the policy of our office to leave messages on your answering machine or with another family member should we be unable to reach you. You have the right to restrict how and where we communicate with you.
Individuals Involved in Your Care or Payment for Your Care. When appropriate, Buffalo Rheumatology et al. may share your PHI with a person who is involved in your medical care or payment for your care, such as a family member, friend, or other person if it helps with your healthcare or with payment for your healthcare. We may also use or disclose your PHI so that your family can be notified about your location and general condition or disclose such information to an entity assisting in a disaster relief effort.
Research. Under certain circumstances, Buffalo Rheumatology et al. may use and disclose Health Information for research. For example, a research project may involve comparing the health of patients who received one treatment to those who received another treatment for the same condition. Before we use or disclose Health Information for research, the project will go through a special approval process. Even without special approval, we may permit researchers to look at records to help them identify patients who may be included in their research project or for other similar purposes as long as they do not remove or take a copy of any Health Information.
As Required by Law. Buffalo Rheumatology et al. will disclose Health Information about you when required to do so by international, federal, state or local law.
To Avert a Serious Threat to Health or Safety. Buffalo Rheumatology et al. may use and disclose Health Information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Disclosures, however, will be made only to someone who may be able to help prevent the threat.
Business Associates. Buffalo Rheumatology et al. works with Business Associates who perform various functions on our behalf or provide certain types of services for us. To perform these functions or to provide these services, Business Associates may receive, create, maintain, use or disclose PHI but only after the Business Associate enters into a written agreement with us in which the Business Associate agrees to appropriately safeguard your PHI in accordance with the HIPAA Privacy Rules.
Organ and Tissue Donation. If you are an organ donor, Buffalo Rheumatology et al. may use or release Health Information to organizations that handle organ procurement or other entities engaged in procurement, banking or transportation of organs, eyes or tissues to facilitate organ, eye or tissue donation and transplantation.
Military and Veterans. If you are a member of the armed forces, Buffalo Rheumatology et al. may release Health Information as required by military command authorities. We also may release Health Information to the appropriate foreign military authority if you are a member of a foreign military.
Workers’ Compensation. Buffalo Rheumatology et al. may release Health Information about you for Workers’ Compensation or similar programs. These programs provide benefits for work-related injuries or illnesses.
Public Health Risks. Buffalo Rheumatology et al. may disclose Health Information for public health activities. These activities generally include disclosures to prevent or control disease, injury or disability; report births and deaths; report child abuse or neglect; report reactions to medications or problems with products; notify people of recalls of products they may be using; a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. Buffalo Rheumatology et al. will only make this disclosure if you agree or when required or authorized by law.
Health Oversight Activities. Buffalo Rheumatology et al. may disclose Health Information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws. Patient medications are electronically sent to the pharmacy of your choice.
Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, Buffalo Rheumatology et al. may disclose Health Information in response to a court or administrative order. We also may disclose Health Information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
Law Enforcement. Buffalo Rheumatology et al. may release Health Information if asked by a law enforcement official if the information is: (1) in response to a court order, subpoena, warrant, summons or similar process; (2) limited information to identify or locate a suspect, fugitive, material witness, or missing person; (3) about the victim of a crime even if, under certain very limited circumstances, we are unable to obtain the person’s agreement; (4) about a death we believe may be the result of criminal conduct; (5) about criminal conduct on our premises; and (6) in an emergency to report a crime, the location of the crime or victims, or the identity, description or location of the person who committed the crime.
Coroners, Medical Examiners and Funeral Directors. Buffalo Rheumatology et al. may release Health Information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We also may release Health Information to funeral directors as necessary for their duties.
National Security and Intelligence Activities. Buffalo Rheumatology et al. may release Health Information to authorized federal officials for intelligence, counter-intelligence, and other national security activities authorized by law.
Protective Services for the President and Others. Buffalo Rheumatology et al. may disclose Health Information to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state, or to conduct special investigations.
Inmates or Individuals in Custody. If you are an inmate of a correctional institution or under the custody of a law enforcement official, Buffalo Rheumatology et al. may release Health Information to the correctional institution or law enforcement official. This release would be if 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.
Fundraising Activities. With the exception of mental health and substance abuse PHI, Buffalo Rheumatology et al. may use some of your PHI for certain fundraising activities. You have a right to “opt out” of receiving fundraising communications. Buffalo Rheumatology et al. does not participate in fundraising activities driven by patient participation.
Data Breach Notification. Buffalo Rheumatology et al. will notify you if a breach of your Protected Health Information occurs.
Any other uses and disclosures will be made only with your written authorization. You may revoke such authorization in writing and we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization.
USES AND DISCLOSURES THAT REQUIRE US TO GIVE YOU AN OPPORTUNITY TO OBJECT AND OPT
Individuals Involved in Your Care or Payment for Your Care. Unless you object, Buffalo Rheumatology et al. may disclose to a member of your family, a relative, a close friend or any other person you identify, your Protected Health Information that directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment.
Disaster Relief. Buffalo Rheumatology et al. may disclose your Protected Health Information to disaster relief organizations that seek your Protected Health Information to coordinate your care, or notify family and friends of your location or condition in a disaster. We will provide you with an opportunity to agree or object to such a disclosure whenever we practically can do so.
YOUR WRITTEN AUTHORIZATION IS REQUIRED FOR OTHER USES AND DISCLOSURES
The following uses and disclosures of your Protected Health Information will be made only with your written authorization:
- Uses and disclosures of Protected Health Information for marketing purposes;
- Disclosures that constitute a sale of your Protected Health Information; and
- Psychotherapy notes. These are the notes of a mental health professional that are kept separate from the record itself.
Other uses and disclosures of Protected Health Information not covered by this Notice or the laws that apply to us will be made only with your written authorization. If you do give us an authorization, you may revoke it at any time by submitting a written revocation to our Privacy Officer and we will no longer disclose Protected Health Information under the authorization. But disclosure that we made in reliance on your authorization before you revoked it will not be affected by the revocation.
You have the following rights with respect to your protected health information, which you can exercise by presenting a written request to the Privacy Officer at Buffalo Rheumatology et al. (these forms are available to you upon request):
Right to Inspect and Copy. You have a right to inspect and copy your Health Information that may be used to make decisions about your care or payment for your care. This includes medical and billing records, other than psychotherapy notes. To inspect and copy this Health Information, you must make your request, in writing, to our Privacy Officer. We have up to 30 days to make your Protected Health Information available to you and we may charge you a reasonable 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.
Right to Request Restrictions. 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 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 our Privacy Officer. We are not required to agree to your request unless you are asking us to restrict the use and disclosure of your Protected Health Information to a health plan for payment or health care operation purposes and such information you wish to restrict pertains solely to a health care item or service for which you have paid us out of pocket in full prior to the procedure. If we agree, we will comply with your request unless the information is needed to provide you with emergency treatment.
If you paid out of pocket in full for a specific item or service prior to the procedure, you have the right to ask that your Protected Health Information with respect to that item or service not be disclosed to a health plan for purposes of payment or health care operations and we will honor that request. The request has to be in writing and has to identify what information is to be restricted and what insurance company is not to receive it.
Right to Request Confidential Communications. You have the right to request to receive confidential communications of protected health information from us by alternative means or at alternative locations. For example, if you would like for us only to communicate with you at home, and never at your workplace, or to send information to you on your workplace e-mail, you may request this of our practice. We will attempt to accommodate all reasonable requests and you do not need to disclose the reason for your request. Please be specific as to how or where you wish us to communicate with you.
Right to an Electronic Copy of Electronic Medical Records. If your Protected Health Information is maintained in an electronic format (known as an electronic medical record or an electronic health record), you have the right to request that an electronic copy of your record be given to you or transmitted to another individual or entity. We will make every effort to provide access to your Protected Health Information in the form or format you request, if it is readily producible in such form or format. If your Protected Health Information is not readily producible in the form or format you request, your record will be provided in either our standard electronic format or a readable hard copy form. To request an electronic copy of your record, please contact our Privacy Officer. We may charge you a reasonable, cost-based fee for the labor associated with transmitting the electronic medical record.
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. You may obtain a copy of this notice at our website, www.BuffaloRheumatology.com. To obtain a paper copy of this notice, please ask the receptionist at your office visit or contact our Privacy Officer.
Right to Receive Notice of a Breach. You have the right to be notified in writing of a breach of any of your Protected Health Information.
Right to Amend. If you feel that your 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 our Privacy Officer.
This Notice of Privacy Practices for Buffalo Rheumatology et al. was reviewed and updated in September 2013 and is reviewed periodically. We reserve the right to change the terms of our Notice of Privacy Practices and to make the new notice provisions effective for all Protected Health Information that we maintain. We will post the amended copy in our waiting room and you may request a written copy of our amended Notice of Privacy Practices from our office. The most current version of our Notice of Privacy Practices is also posted on our website.
If you feel that your privacy protections have been violated, you have the right to file a written complaint with the Privacy Officer designated by Buffalo Rheumatology et al. and/or with the Department of Health and Human Services, Office of Civil Rights, about violations of the provisions of this notice or the policies and procedures of our office which you feel have violated your privacy as a patient of ours. To file a complaint with our practice, contact our Privacy Officer who will direct you on how to file an office complaint. All complaints must be submitted in writing and all complaints shall be investigated without repercussion to you.
Buffalo Rheumatology et al.’s HIPAA Privacy Officer is Ellen Carlo, 3055 Southwestern Blvd., Suite 100, Orchard Park, NY 14127, (716) 675-2500. Please contact us if you need more information.
Christine Czech-Mann, Buffalo Rheumatology et al. Practice Administrator
Effective Date: April 14, 2003
Revised: September 23, 2013