(256) 464-7855 (Madison) | (256) 660-1315 (Albertville)
(256) 464-7855 (Madison) | (256) 660-1315 (Albertville)
This notice describes how information about you may be used and disclosed and how you can get access to this information.
Our Pledge Regarding Medical Information
We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at this health care entity to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by this entity, whether made by entity personnel or your personal doctor. Any other provider /clinic outside of this practice may have different policies or notices regarding the doctor’s use and disclosure of your medical information created in the doctor’s own office or clinic. This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information. We are required by law to keep private medical information that identifies you, give you this notice of our legal duties and privacy practices with respect to medical information about you; and follow the terms of the Notice of Privacy Rights currently in effect.
Pain & Rehabilitation Consultants has a legal duty to safeguard your protected health information (PHI)
Protected Health Information (PHI) includes information such as name, address etc. that can be used to identify you. It is information about your past, present, or future health condition or payment for healthcare. PRC offers you this notice about our privacy practices that explains how, when, and why PRC uses and discloses your PHI. With only certain exceptions, PRC will not use or disclose any more of your PHI than is necessary to accomplish the intended purpose. PRC is legally required to follow the privacy practices that are described in this notice. Please review it carefully.
Understanding your health record information
Each time you visit the hospital, physician, or other healthcare provider a record of your visit is made. This record contains your symptoms, diagnoses, medications, treatment, and plan for future care or treatment. This information is often referred to as your health information or medical record and serves as a:
• Basis for planning your care and treatment
• Means of communication among the many health professionals who contribute to your care
• A legal document describing the care you received
• A means by which you or a third party payor can verify that services billed were actually provided
• A tool in educating health professionals
• A source of data for medical research and/or studies
• A source of information for public health officials charged with improving and monitoring the health of the nation
• A source of data for our facility planning or
• marketing
• A tool to help PRC assess and continually work to improve
Understanding what is in your record and how your health information is used helps you to:
• Ask that PRC limit how it uses and discloses your PHI, but PRC is not legally required to agree. You may not limit the uses and disclosures that PRC is legally required or allowed to make.
• Choose how PRC sends PHI to you. You may request communication by alternative means and locations.
• View or receive copies of your PHI at PRC. You must make the request in writing. PRC will respond to you within 14 days after receiving your written request. You will be charged a reasonable fee. PRC may provide you with a summary or explanation of PHI as long as you agree. In certain situations, PRC may deny your request to have access to your medical record. You may have your denial reviewed.
• Receive a list of occurrences in which PRC has disclosed your PHI.
This list will not include uses or disclosures that you have authorized or those made for treatment, payment, or healthcare operations. Also, this list will not include uses and disclosures for emergencies, for national security purposes, or before 03/01/2014. This list will include all other disclosures made in the last 7 years unless you request a shorter time frame. PRC will provide the first list to you at no charge.
• Correct your PHI if you believe that there is a mistake in your medical record or important information missing. You must provide the request in writing and PRC will respond within 60 days of receiving your request. PRC may deny your request. Our written denial will state the reason and explain your right to file a written statement of disagreement.
• Obtain a paper copy of this notice.
Contact Pain & Rehabilitation Consultants at256- 464-7855 or view the notice of privacy practices at alpainrehab.com.
• Maintain the privacy of your health information.
• Provide you with a notice about PRC’s legal duties and privacy practices with respect to your PHI.
• Comply with the terms of this notice.
• Notify you if PRC is unable to agree to a request.
PRC reserves the right to change our privacy practices and to make new provisions effective for all health information Should PRC’s notice of privacy practices change, PRC will offer you a revised copy at your next office visit.
The following is a summary of ways that PRC may use and disclose health information about you. Information relating to psychiatric illness, HIV (testing/results), AIDS, or infectious diseases.
Treatment: PRC may disclose your PHI to physicians, nurses, medical students, and other healthcare personnel who provide you with health care services.
Payment: A bill may be sent to you or a third party payor. The information on the accompanying bill may include information that identifies you, as well as your diagnosis, procedures, DME, and supplies used.
Healthcare Operations: PRC may use or disclose your PHI to evaluate the quality of your healthcare services, for process improvement activities, or to evaluate health plan performance. PRC may also provide your PHI to our accountants, attorneys, consultants, health improvement agencies, and others in order to make sure PRC complies with its laws.
Business Associates: There are some services provided at PRC through business associates that may not be covered entities. PRC will have a formal agreement requiring all patient information be maintained in a manner consistent with PRC policies and procedures.
Notification: PRC may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care.
Marketing: PRC may contact you to provide appointment reminders or information about
treatment alternatives or other health-related benefits and services that may be of interest to you.
Food & Drug Administration (FDA): PRC may disclose to the FDA health information related to adverse events with respect to food supplements, products and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacements. Workers’
Compensation: PRC may disclose health information to extent authorized by and to the extent necessary to comply with laws relating to workers’ compensation or other
similar programs established by law.
Public Health: As required by law, PRC may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability. For example, PRC is required to report abuse/neglect of the elderly or children to all relevant entities.
Correctional Institution: Should you be an inmate of a correctional facility, PRC may disclose to the institution or agents any health information necessary for your health and/or the health and safety of other individuals.
Military: PRC may disclose PHI about active or veteran armed forces, personnel to commanding officers, as allowed by law.
Law Enforcement: PRC may disclose health information for law enforcement purposes as
required by law or in response to a valid subpoena and/or court order.
Health Plan: PRC may disclose PHI to the sponsors of your plan for underwriting, premium rating, and other activities related to healthcare claims.
If you have additional questions, or would like additional information, you may contact the office manager at Pain & Rehabilitation Consultants at 256-464-7855.
If you believe you privacy rights have been violated, you may file a complaint with the office manager at PRC. There will be no retaliation for filing a complaint.