NOTICE OF PRIVACY PRACTICES
Alaska Family Doctor (AFD) is committed to protecting your private health information (PHI) as a part of an ongoing trusted relationship between you and your provider. In order to provide complete healthcare, your provider may need to share private health information about you with other professionals using verbal, written, or electronic means. Every effort will be made to ensure this information is transferred in a manner that safeguards your privacy.
AFD is required by law to notify you of our legal duties and privacy practices regarding your medical information, and abide by the practices of this Notice, unless more stringent laws or regulations apply. This Notice applies to all credentialed Alaska Family Doctor staff in regard to services used to provide healthcare to you.
This Notice becomes effective June 1, 2008. We reserve the right to update this notice as new business operations or services are developed.
Disclosures of Your Medical Information
Treatment: In most cases your treatment will be coordinated between you and your physician alone. When necessary, your provider will use and disclose your protected health information in correspondence with others in order to provide, coordinate, or manage your health care and any related services. For example, your personal health information may be shared with other physicians, physical therapists, radiology technicians, or nurses as needed to ensure the necessary information is available for appropriate treatment. We may also share your medical information with a family member or friend who is involved in assisting with your healthcare, including clergy, if requested by you. We will only do this if you agree, and will only share with them the information they need in order to help you. If you are unable to either agree or object to such a disclosure, we may disclose your healthcare information as necessary if we determine that it is in your best interest based on professional judgment.
Payment: In most cases payment for services will be made by you directly to Alaska Family Doctor. AFD may disclose health information as needed to obtain payment for your health care services or to assist you in being reimbursed by your insurance company for services for which you have paid.
Healthcare Operations: Your medical information may be used by us in order to support the business activities of AFD and to ensure that quality healthcare services are being provided. These activities include, but are not limited to, quality assessment activities, employee reviews, training of medical personnel, licensure and accreditation support, data aggregation and audits by regulatory agencies. We may share your protected health information with third parties who perform services such as transcription or billing. In those cases we have written agreements with the third parties that they will not use or disclose your information for any other purposes, except as required by law.
Other Disclosures
There are a number of ways that your medical information may be used without your authorization, either because disclosure is required by law or for public health and safety purposes. These include:
Required by Law: Your medical information may be used or disclosed by us when required by law. If this happens, we will comply with the law and will only disclose the information necessary. You will be notified, as required by law, of any such uses or disclosures.
Public Health: Your medical information may be used for public health activities. Public health authorities are authorized to collect or receive the information for purposes such as controlling disease, injury or disability.
Disaster Relief: We may disclose healthcare information about you to an entity assisting in a disaster relief effort so that your family and friends can be notified about your condition, status, and location.
Communicable Diseases: If required by law to do so, we may disclose your medical information to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.
Abuse or Neglect: We may disclose your medical information to a public health authority that is authorized by law to receive reports of child abuse or neglect. We may also disclose your protected health information to the governmental agency authorized to receive such information if we believe that you have been a victim of abuse, neglect or domestic violence. Any disclosures of this nature will be made consistent with state and federal law. Food and Drug Administration: We may disclose your medical information to a person or agency required by the Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations, or for product recalls, repairs or replacements.
Legal Proceedings: We may disclose your medical information if required to by a court or administrative order to do so for an administrative or judicial proceeding, or in some cases in response to a subpoena, discovery request or other legal process. Law Enforcement: We may disclose your medical information, so long as applicable legal requirements are met, for law enforcement purposes. Examples of these purposes would be: (1) legal processes and otherwise required by law; (2) limited information requests for identification and location purposes; (3) pertaining to crime victims; (4) suspicion that death has occurred as a result of criminal conduct; (5) if crime occurs on the premises; and (6) for medical emergencies where it appears likely a crime occurred.
Research: Your medical information may be disclosed to researchers, provided that the research has been approved by an Institutional Review Board and the research protocols have been approved to ensure your privacy. You will be notified prior to any disclosure of this nature.
Criminal Activity: As required by state and federal laws, we may disclose your medical information if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or of the public. We may also disclose your medical information if it is necessary for law enforcement authorities to identify or apprehend an individual.
Workers’ Compensation: Your medical information may be used or disclosed as necessary to comply with workers’ compensation laws and other similar legally established programs.
Inmates: Your medical information may be used or disclosed by us if you are an inmate of a correctional facility and your physician created or received your medical information in the course of providing care to you.
Your Rights Regarding Private Health Information
Other uses and disclosures of your medical information will be made only with your written authorization, unless otherwise permitted or required by law. You may revoke the authorization, at any time, in writing, except to the extent that we have already taken an action in reliance on the use or disclosure indicated in the authorization.
If you need for us to share your medical information with someone for purposes other than those listed here, you should acquire and complete an Authorization Form.
Your Rights
The following information describes your rights with respect to your medical information that we maintain.
Right to Request Restrictions: You may request that your protected health information not be used or disclosed for the purposes of treatment, payment, or healthcare operations. You may also request that your protected health information not be shared with family members or friends who may be involved with your care. Your request should be in writing and must state the specific restriction requested and to whom you want that restriction to apply. Your physician may decline this request if the disclosure is deemed to be in your best interest. You then have the right to use another healthcare provider.
Confidential Communications: We will accommodate reasonable requests to communicate with you about your medical information by unconventional methods or by correspondence to alternative locations.
Access to Your Medical Information: You have the right to receive a copy of your medical information that we maintain, except where prohibited by federal or state law.
Amendment of Your Medical Information: You have the right to ask us to change or correct any of your medical information. You need to request this amendment in writing. In certain situations we may have to deny your request, such as when the medical information in your records was created by another provider. Any denials will be in writing. You have the right to appeal our denial by filing a written statement of disagreement.
Accounting of Certain Disclosures: You have a right to a listing of the disclosures we make, if any, of your medical information.
Questions and Complaints
You may file a complaint directly with AFD or with the Secretary of Health and Human Services if you believe your privacy rights have been violated.
You will not be retaliated against for filing a complaint.
Alaska Family Doctor (AFD) is committed to protecting your private health information (PHI) as a part of an ongoing trusted relationship between you and your provider. In order to provide complete healthcare, your provider may need to share private health information about you with other professionals using verbal, written, or electronic means. Every effort will be made to ensure this information is transferred in a manner that safeguards your privacy.
AFD is required by law to notify you of our legal duties and privacy practices regarding your medical information, and abide by the practices of this Notice, unless more stringent laws or regulations apply. This Notice applies to all credentialed Alaska Family Doctor staff in regard to services used to provide healthcare to you.
This Notice becomes effective June 1, 2008. We reserve the right to update this notice as new business operations or services are developed.
Disclosures of Your Medical Information
Treatment: In most cases your treatment will be coordinated between you and your physician alone. When necessary, your provider will use and disclose your protected health information in correspondence with others in order to provide, coordinate, or manage your health care and any related services. For example, your personal health information may be shared with other physicians, physical therapists, radiology technicians, or nurses as needed to ensure the necessary information is available for appropriate treatment. We may also share your medical information with a family member or friend who is involved in assisting with your healthcare, including clergy, if requested by you. We will only do this if you agree, and will only share with them the information they need in order to help you. If you are unable to either agree or object to such a disclosure, we may disclose your healthcare information as necessary if we determine that it is in your best interest based on professional judgment.
Payment: In most cases payment for services will be made by you directly to Alaska Family Doctor. AFD may disclose health information as needed to obtain payment for your health care services or to assist you in being reimbursed by your insurance company for services for which you have paid.
Healthcare Operations: Your medical information may be used by us in order to support the business activities of AFD and to ensure that quality healthcare services are being provided. These activities include, but are not limited to, quality assessment activities, employee reviews, training of medical personnel, licensure and accreditation support, data aggregation and audits by regulatory agencies. We may share your protected health information with third parties who perform services such as transcription or billing. In those cases we have written agreements with the third parties that they will not use or disclose your information for any other purposes, except as required by law.
Other Disclosures
There are a number of ways that your medical information may be used without your authorization, either because disclosure is required by law or for public health and safety purposes. These include:
Required by Law: Your medical information may be used or disclosed by us when required by law. If this happens, we will comply with the law and will only disclose the information necessary. You will be notified, as required by law, of any such uses or disclosures.
Public Health: Your medical information may be used for public health activities. Public health authorities are authorized to collect or receive the information for purposes such as controlling disease, injury or disability.
Disaster Relief: We may disclose healthcare information about you to an entity assisting in a disaster relief effort so that your family and friends can be notified about your condition, status, and location.
Communicable Diseases: If required by law to do so, we may disclose your medical information to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.
Abuse or Neglect: We may disclose your medical information to a public health authority that is authorized by law to receive reports of child abuse or neglect. We may also disclose your protected health information to the governmental agency authorized to receive such information if we believe that you have been a victim of abuse, neglect or domestic violence. Any disclosures of this nature will be made consistent with state and federal law. Food and Drug Administration: We may disclose your medical information to a person or agency required by the Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations, or for product recalls, repairs or replacements.
Legal Proceedings: We may disclose your medical information if required to by a court or administrative order to do so for an administrative or judicial proceeding, or in some cases in response to a subpoena, discovery request or other legal process. Law Enforcement: We may disclose your medical information, so long as applicable legal requirements are met, for law enforcement purposes. Examples of these purposes would be: (1) legal processes and otherwise required by law; (2) limited information requests for identification and location purposes; (3) pertaining to crime victims; (4) suspicion that death has occurred as a result of criminal conduct; (5) if crime occurs on the premises; and (6) for medical emergencies where it appears likely a crime occurred.
Research: Your medical information may be disclosed to researchers, provided that the research has been approved by an Institutional Review Board and the research protocols have been approved to ensure your privacy. You will be notified prior to any disclosure of this nature.
Criminal Activity: As required by state and federal laws, we may disclose your medical information if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or of the public. We may also disclose your medical information if it is necessary for law enforcement authorities to identify or apprehend an individual.
Workers’ Compensation: Your medical information may be used or disclosed as necessary to comply with workers’ compensation laws and other similar legally established programs.
Inmates: Your medical information may be used or disclosed by us if you are an inmate of a correctional facility and your physician created or received your medical information in the course of providing care to you.
Your Rights Regarding Private Health Information
Other uses and disclosures of your medical information will be made only with your written authorization, unless otherwise permitted or required by law. You may revoke the authorization, at any time, in writing, except to the extent that we have already taken an action in reliance on the use or disclosure indicated in the authorization.
If you need for us to share your medical information with someone for purposes other than those listed here, you should acquire and complete an Authorization Form.
Your Rights
The following information describes your rights with respect to your medical information that we maintain.
Right to Request Restrictions: You may request that your protected health information not be used or disclosed for the purposes of treatment, payment, or healthcare operations. You may also request that your protected health information not be shared with family members or friends who may be involved with your care. Your request should be in writing and must state the specific restriction requested and to whom you want that restriction to apply. Your physician may decline this request if the disclosure is deemed to be in your best interest. You then have the right to use another healthcare provider.
Confidential Communications: We will accommodate reasonable requests to communicate with you about your medical information by unconventional methods or by correspondence to alternative locations.
Access to Your Medical Information: You have the right to receive a copy of your medical information that we maintain, except where prohibited by federal or state law.
Amendment of Your Medical Information: You have the right to ask us to change or correct any of your medical information. You need to request this amendment in writing. In certain situations we may have to deny your request, such as when the medical information in your records was created by another provider. Any denials will be in writing. You have the right to appeal our denial by filing a written statement of disagreement.
Accounting of Certain Disclosures: You have a right to a listing of the disclosures we make, if any, of your medical information.
Questions and Complaints
You may file a complaint directly with AFD or with the Secretary of Health and Human Services if you believe your privacy rights have been violated.
You will not be retaliated against for filing a complaint.