The Department of Internal Medicine

HIPAA Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT A PATIENT MAY BE USED AND DISCLOSED AND HOW THE PATIENT CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Understanding Personal Health Information

Each time a person visits University Family Physicians (UFP) or is seen by one of the providers in a hospital, faculty practice clinic, doctor's office, nursing home, or other facility, a record of the patient's visit is made. This record contains information about the patient's symptoms, examinations, test results, medications he or she takes, his or her allergies and the plan for the patient's care. This information is referred to as a health or medical record. It is an essential part of the healthcare provided for the patient. A health record contains personal health information, and state and federal laws are in place to protect the privacy of every patient's health information.

Uses and Disclosures of Health Information

Patient information will be used for treatment:
The physicians, nurses and clinical staff involved in a patient's care will document information in his or her record about the examination and the care planned for the patient. If the patient was referred to this facility by another provider, this team may send copies of the patient's medical records to the doctor who referred him or her, so that doctor will have updated treatment information about the patient's care.

Copies of various reports will be sent to the patient's doctors and healthcare providers. These reports should assist those people in treating the patient.

Using the patient's health information allows the staff here to call the patient or send them a letter reminding him or her about an appointment, follow up with diagnostic results, or to provide the patient with information about other treatment that could be beneficial to the patient's health

A patient's health information will be used for payment:
A bill will be sent to the patient or to his or her insurance provider. When the information is sent, the staff may include information that identifies the patient as well as the patient's diagnoses, procedures, healthcare providers, and the supplies used. The staff may also contact the patient's insurance company to determine if the company will pay for the patient's medical care as part of the company's certification process. The staff will use a patient's healthcare information for regular healthcare operations: UFP physicians, nurses, managers and staff may look at a patient's health information to assess the care and results in his or her case and others like the patient's. UFP is a teaching facility, so we may use a patient's information in the process of educating and training students and resident physicians. Patients have the right to request a restriction on the above uses and disclosures of their protected health information for treatment, payment and health care operations; however, this facility is not required to agree to any patient's request. If the staff does agree, they will comply with the patient's request unless the information is needed to provide his or her emergency treatment. The staff may, however, also end the agreement at any time after informing the patient of such.

Other Disclosures

Business Associates

There are some services provided by this organization through contacts with business associates. To protect every patient's health information, however, the staff requires the business associate protects the patient's information.

Communication with Others Involved with Your Care

If a family member, closer personal friend, or any other person a patient has identified is directly involved in the care or payment of treatment of the patient, the staff may disclose directly relevant health information to that person.

The disclosure will only be done if the patient agrees, or is silent when given the opportunity to disagree, or the staff believes, based on the circumstances and their professional judgment that the patient does not object.

If a patient is incapacitated or in an emergency circumstance, the staff may disclose to a family member, other relative, close personal friend, or any other person accompanying the patient, health information directly relevant to that person's involvement in the patient's care or payment.

Research

Under certain circumstances, the staff may use and disclose health information about a patient from his or her medical record for research purposes. All research projects, however, are subject to a special approval process designed to protect the privacy of the patient's health information.

Required by Law

The staff may disclose health information required by law to the following entities or type of entities that includes, but is not limited to:

• Food and Drug Administration
• Public Health or legal authorities charged with disease prevention
• Correctional Institutions
• Workers Compensation Agents
• Organ and Tissue Donation Organizations
• Military Command Authorities
• Health Oversight Agencies
• Funeral Directors, Coroners and Medical Examiners
• National Security and Intelligence Agencies
• Protective services for the President and others
• Law enforcement as required by law or in accordance with a valid subpoena

Marketing

The staff will not use information in any patient's records for marketing purposes. Other uses and disclosures from a patient's medical record will be made only with his or her written authorization or approval.

Patient Rights

A patient has the right to

• Inspect and obtain a copy of his or her health record. However, a charge may be involved to cover the copying of the patient's record.
• Request an amendment of his or her health records.
• Obtain an accounting of disclosures of his or her protected health information.
• Request communication of his or her health information in a certain way or at a certain location. For example, a patient can ask that the staff contacts him or her by mail and not by telephone, or that the staff contacts him or her at a specific telephone number, or that the staff use an alternative address for billing purposes, or that the staff does not leave messages on certain answering machines.
• Revoke an employer's authorization to use or disclose health information except to the extent that action has already been taken.

The staff's duties are to

• By law, maintain the privacy of the patient's health information.
• Provide the patient with a notice as to the staff's legal duties and privacy practices with respect to information this team collects about the patient through this notice.
• Abide by the terms of the notice currently in effect.
• Notify the patient if the staff is unable to agree to a requested restriction.
• Follow reasonable requests the patient makes regarding contact preferences. For example, the patient may request that the staff contacts him or her by letter instead of by telephone.
• Provide the patient a paper copy of this notice of privacy practices upon request.

To exercise any of these rights, the patient's request must be in writing.

Please obtain the required form from the Privacy Office at 865-305-9352 or by fax at 865-305-8681.

UFP is not required to act immediately and will investigate its abilities to comply with all requests prior to agreeing to the request.

University Family Physicians reserves the right to change this Notice of Privacy Practices and its policies and procedures for privacy practices at any time and to make the changes effective for all protected health information created or received prior to the new effective date and then currently maintained by the practice location. The revised Notice will be posted in waiting room or patient lobby and reasonable efforts will be made to advise patients of the change(s) in the Notice, policies and procedures at their next service visit. Patients may also obtain a copy of the revised Notice upon request.

For More Information or to Report a Problem

If a patient has any questions about his or her rights or duties or this organization's practices and procedures regarding protected health information, please call University Family Physicians' Privacy Office at the number below.

If any patient believes his or her privacy rights have been or are being violated, patients may complain to University Family Physicians and to the Secretary of the Department of Health and Human Services. Complaints to the Secretary must be filed in writing on paper or electronically and must be made within 180 days of when the patient became aware of, or should have been aware of, the incident giving rise to his or her complaints.

At University Family Physicians, patients may contact this organization's Privacy Office at 865-305-9352. By law, patients cannot be penalized for filing a complaint.

Effective Date: April 14, 2003
Version 1: UFP Notice of Privacy Practices