McFarland Clinic PC

NOTICE OF PRIVACY PRACTICES - MCFARLAND CLINIC PC

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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.

Date of Notice - April 14, 2003

OUR COMMITMENT TO YOUR PRIVACY
McFarland Clinic PC is dedicated to maintaining the privacy of your identifiable health information. In conducting our business, we will create records regarding you and the treatment and services we provide to you. We are required by law to maintain the confidentiality of health information that identifies you. We also are required by law to provide you with this notice of our legal duties and privacy practices concerning your identifiable health information. By law, we must follow the terms of the notice of privacy practices that we have in effect at the time.

This notice provides you with the following important information:

· How we may use and disclose your identifiable health information

· Your privacy rights in your identifiable health information

· Our obligations concerning the use and disclosed of your identifiable health information.

The terms of this notice apply to all records containing your identifiable health information that are created or retained by our practice. We reserve the right to revise or amend our notice of privacy practices. Any revision or amendment to this notice will be effective for all of your records our practice has created or maintained in the past, and for any of your records we may create or maintain in the future. Our practice will post a copy of our current notices in our offices in a prominent location, and you may request a copy of our most current notice during any office visit. This notice will also be listed on our web site at www.mcfarlandclinic.com.

WHO WILL FOLLOW THIS NOTICE
This notice describes our facility’s practices and that of any programs associated with McFarland Clinic PC. Any health care professional authorized to enter information into your file or record and all employees, staff and other personnel will follow the terms of this notice. In addition, these entities, sites and locations may share medical information with each other for treatment, payment or facility operation purposes described in this notice.

HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION:
1. TREATMENT: Every visit you make to McFarland Clinic is recorded. Usually, this record contains your symptoms, examination and test results, diagnoses, treatment and a plan for future care or treatment. This is referred to as your medical record. We might use your identifiable health information to:

· Plan your medical care and treatment

· Communicate with other health professionals who may contribute to your care

· Provide to you or a third-party payer that services billed were actually provided

We may disclose your identifiable health information to a pharmacy, to physicians, nurses and other healthcare personnel who may use or disclose this information in order to treat you or to assist others in your treatment. Additionally, we may disclose your identifiable health information to others who may assist in your care, such as your spouse, children or parents.

2. PAYMENT: McFarland Clinic PC may use and disclose your identifiable health information in order to bill and collect payment for the services and items you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits, and we may provide your insurer with details regarding your treatment to determine if your insurer will cover or pay for, your treatment. We may also use and disclose your identifiable health information to obtain payment from third parties that may be responsible for these costs, such as family members. We may also use your identifiable health information to bill your directly for services and items.

3. HEALTHCARE OPERATIONS: McFarland Clinic PC may use and disclose your identifiable health information to operate our business. These uses and disclosures are necessary for our business and to make sure our patients are receiving quality services. As examples, our practice may use your health information to evaluate the quality of care you receive from us, or to conduct cost-management and business planning activities for our practice.

4 APPOINTMENT REMINDERS: McFarland Clinic PC may use and disclose your identifiable health information to contact you and remind you of an appointment.

5. TREATMENT OPTIONS: McFarland Clinic PC may use and disclose your identifiable health information to inform you of potential treatment options and alternatives.

6. HEALTH-RELATED BENEFITS AND SERVICES: McFarland Clinic PC may use and disclose your identifiable health information to inform you of health-related benefits or services that may be of interest to you.

7. RELEASE OF INFORMATION TO FAMILY/FRIENDS: McFarland Clinic PC may disclose to a family member, other relative or close personal friend of the patient, or any other person identified by the patient, the identifiable health information directly relevant to such person’s involvement with the patient’s care or payment purposes.

8. DISCLOSURES REQUIRED BY LAW: McFarland Clinic PC will use and disclose your identifiable health information when we are required to do so by federal, state or local law.

9. PUBLIC HEALTH RISKS: McFarland Clinic PC may disclose your identifiable health information to public health authorities that are authorized by law to collect information to prevent or control disease, injury or disability, report births and deaths, report child abuse or neglect and notify a person who may be at risk for contacting or spreading a disease or condition.

10. HEALTH OVERSIGHT ACTIVITIES: McFarland Clinic PC may disclose your identifiable health information to a health oversight agency for activities authorized by law. This can include investigations, inspections, audits, survey, licensure and disciplinary actions; civil, administrative and criminal procedures or actions; or other activities necessary for the government to monitor governmental programs, compliance with civil rights laws and healthcare system in general.

11. LAWSUITS AND SIMILAR PROCEEDINGS: McFarland Clinic PC may use and disclose your identifiable health information in response to a court or administrative order if you are involved in a lawsuit or similar proceeding. We may also disclose your identifiable health information in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.

12. LAW ENFORCEMENT: We may release identifiable health information if asked to do so by a law enforcement official in response to a court order, subpoena, warrant, summons or similar process. We may also release information about your health to law enforcement or other governmental authorities regarding a crime victim in certain situations, if we are unable to obtain the person’s agreement, or to identify or locate a suspect, material witness, fugitive or missing person; or to protect us against perpetration of fraud or other illegal activities.

13. DECEASED PATIENTS: McFarland Clinic PC may release identifiable health information to a medical examiner or coroner to identify a deceased individual or to identify the cause of death. If necessary, we may also release information to funeral directors as necessary to carry out their duties.

14. ORGAN AND TISSUE DONATION: McFarland Clinic PC may release your identifiable health information to organizations that handle organ, eye or tissue procurement of transplantation, including organ donation banks, as necessary to facilitate organ or tissue donation and transplantation if you are an organ donor.

15. RESEARCH: McFarland Clinic PC may use and disclose your identifiable health information for research purposes in certain limited circumstances. We will obtain your written authorization to use your health information for research purposes except when:

(a) our use or disclosure was approved by an Institutional Review Board or Privacy Board, (b) we obtain the oral or written agreement of a researcher that the information is necessary for the research, solely to prepare a research protocol or preparator research, or the information will not be removed from our premises; or (c) the health information sought by the researcher only relates to decedents and the researcher agrees that the use or disclosure is necessary for the research and, if we request, to provide us with the proof of death prior to access of the identifiable health information of the decedents.

16. SERIOUS THREATS TO HEALTH OR SAFETY : McFarland Clinic PC may use and disclose your identifiable health information when necessary to reduce or prevent a serious threats to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosure to a person or organization able to help prevent the threat.

17. MILITARY: McFarland Clinic PC may disclose your identifiable health information if your are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate military command authorities.

18. NATIONAL SECURITY: McFarland Clinic PC may disclose your identifiable health information to federal officials for intelligence and national security activities authorized by law. We may also disclose your identifiable health information to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.

19. INMATES: McFarland Clinic PC may disclose your identifiable health information to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. Disclosure for these purposes would be necessary (a) for the institution to provide health care services to you, (b) for the safety and security of the institution and/or (c) to protect your health and safety or the health and safety of other individuals.

20. WORKERS’ COMPENSATION: McFarland Clinic PC may disclose your identifiable health information to comply with laws relating workers’ compensation or similar programs.

YOUR RIGHTS REGARDING YOUR IDENTIFIABLE HEALTH INFORMATION

You have the following rights regarding the identifiable health information that we maintain about you:

1. CONFIDENTIAL COMMUNICATIONS: You have the right to request that your protected health information be provided by alternative means or at alternative locations. Any such request should be submitted in writing to: Privacy Office, McFarland Clinic PC, , PO Box 3014, Ames, IA. 50010.

2. REQUESTING RESTRICTIONS: You have a right to request a restriction on the information about your identifiable health information that we disclose for treatment, payment or health care operations. You also have the right to request a limit on the information we disclose about your identifiable health information to someone who is involved in your care or the payment for your care, like a family member. Your request must describe in a clear and concise manner, (a) the information you wish restricted; (b) whether you are requesting to limit our practice’s use, disclosure or both; and (c) to whom you want the limits to apply. This request must be submitted in writing to : Privacy Office, McFarland Clinic PC, P O Box 3014, Ames, IA 50010. We are not required to agree to your requested restriction or limitation, but if we do agree, we are bound by our agreement except when otherwise required bylaw, in emergencies or when the information is necessary to treat you. Our organization is required to contact and notify you if we are unable to agree to a requested restriction.

3. INSPECTION AND COPIES: You have the right to inspect and obtain a copy of the identifiable health information that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes. You must submit your request in writing or use our Release of Information form. Our practice may charge a fee for the costs of copying, mailing, labor and supplies associated with your request. Our practice may deny your request to inspect and copy in certain limited circumstances, such as where disclosure would reasonably endanger the life or physical safety of your or another person. If you are denied access to information about your health, you may request that the denial be reviewed.

4. AMENDMENT: You may ask to amend your health information if you believe it is incorrect or incomplete. You have the right to request an amendment for as long as the information is kept by or for our practice. The request must be in writing and submitted to Privacy Office, McFarland Clinic PC, P O Box 3014, Ames, IA 50010. You must provide us with a reason that supports your request for amendment. 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 is: (a) accurate and complete, (b) not part of the identifiable health information kept by or for our practice, (c) not part of the identifiable health information which you would be permitted to inspect and copy (d) not created by us, unless the person or entity that created the information is no longer available to make the amendment.

5. ACCOUNTING OF DISCLOSURES: You have the right to request an accounting of certain disclosures of information about your health that we have made, if any. This right applies to disclosures for purposed other than treatment, payment of health care operations, or as otherwise permitted or required by law. This request must be in writing and submitted to: Privacy Office, McFarland Clinic PC, P O Box 3014, Ames, IA 50010. You have a right to receive specific information about these disclosures that occur after April 14, 2003. The first list you request within a 12-month period is free of charge, but our practice may charge you for additional lists within the same 12-month period. We will notify you of the cost involved with additional requests and you may withdraw your request before you incur any costs.

6. RIGHT TO A PAPER COPY OF THIS NOTICE: You have the right to obtain a copy of this notice at any time.

7. RIGHT TO PROVIDE AUTHORIZATION FOR OTHER USES AND DISCLOSURES: McFarland Clinic PC will obtain your written authorization for uses and disclosures not identified by this notice or permitted by applicable law. You may revoke such authorization as described in this notice in writing, at any time. After you revoke your authorization, we will no longer use or disclose your identifiable health information for the reason described in the authorization. This will only apple to future releases and cannot apply if the provider has taken action on it. Please note, we are required to retain copies of your care.

FOR MORE INFORMATION AND TO FILE A COMPLAINT
If you have questions and would like additional information, or if you want to file a complaint with our practice contact Administration at 515-239-4452 and ask for the Privacy Officer. If you believe your privacy rights have been violated, you may file a written complaint with our privacy office and with the Secretary of the Department of Health and Human Services. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

OUR DUTIES REGARDING INFORMATION ABOUT YOUR HEALTH
We are required by law to maintain the privacy of your health, provide you with this notice of our legal duties and health information privacy practices and abide by the terms of this notice.

McFarland Clinic PC - Privacy Notice