About Us:

Confidentiality/HIPAA


Effective April 14, 2003

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.

INTRODUCTION

This Notice of Privacy Practices describes how Coastal Women’s Healthcare (CWHC) may use and disclose your protected health information (“PHI”) to provide treatment to you; seek payment for the medical services you receive; and to support the legitimate health care operations of our practice.

“PHI” includes your demographic information such as name, address, telephone number, and family; past, present, or future information about your physical or mental health or condition; and information about the medical services provided to you, including payment information, if any of that information may be used to identify you.

You have the right to receive a paper copy of this notice and may request a paper copy at any time, even if you have previously agreed to receive this notice electronically. A copy of our current notice will always be posted in our reception area. You will also be able to obtain your own copy by accessing our website: http://www.coastalwhc.com.

We may amend this Notice of Privacy Practices periodically and you may obtain a current copy of the Notice by contacting the office staff at any time. The revised notice will be posted in the reception area. You will also be able to obtain your own copy of the revised notice by accessing our website. The effective date will always be located centered on the top of the first page of the Notice.

We are required by law to maintain the privacy of your protected health information. We have in place appropriate administrative, technical, and physical safeguards to protect the privacy of your PHI. We train our staff on the obligation to protect the privacy of your PHI. We hold medical records in a secure area within the office. Only staff members who have a “need to know” are permitted access to your medical records and other PHI. Our staff understands the legal and ethical obligation to protect your PHI and that a violation of this Notice of Privacy Practices will result in discipline in accordance with our personnel policy.

If you have any questions about our Notice of Privacy Practices, please contact our Privacy Officer at 207-885-8400.

Acknowledgment of Notice of Privacy Practices - We will ask you to sign a form that will serve as an acknowledgment that you have received this Notice of Privacy Practices.

HOW SOMEONE MAY ACT ON YOUR BEHALF

You have the right to name a personal representative who may act on your behalf to control the privacy of your protected health information. Parents and guardians will generally have the right to control the privacy of health information about minors unless the minors are permitted by law to act on their own behalf. You should take note that, if you are a parent or legal guardian of a minor, certain portions of the minor’s medical record will not be accessible to you under Maine law (for example, records relating to contraception and/or family planning, sexually transmitted diseases, substance abuse and psychotherapy).

HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION WITH YOUR WRITTEN AUTHORIZATION

We will generally obtain your written authorization before using your protected health information or sharing it with others outside our office. You may also initiate the transfer of your records to another person by completing an authorization form. If you provide us with written authorization, you may revoke that authorization at any time, except to the extent that we have already relied upon it. To revoke an authorization, please write to the Medical Records Supervisor.

SPECIAL PROTECTIONS FOR HIV, SUBSTANCE ABUSE AND MENTAL HEALTH INFORMATION

From time to time, you may request that Coastal Women’s Healthcare disclose limited PHI to specified individuals or companies for a defined purpose and timeframe. These situations may include disclosures of sensitive protected health information, such as HIV status, mental health or psychiatric treatment, or substance abuse services. Also, you may authorize disclosures to individuals who are not involved in treatment, payment, or health care operations, such as attorneys, if you are involved in litigation either on your own or another’s behalf. If you wish us to make disclosures in these situations, we will ask you to sign a specific authorization pertaining to HIV, mental health treatment, or substance abuse services.

HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION WITHOUT YOUR WRITTEN AUTHORIZATION

Below are some situations when we do not need your written authorization before using your health information or sharing it with others:

Treatment. Treatment means the provision, coordination, or management of your health care and related services by Coastal Women’s Healthcare and other health care providers involved in your care. We may use your protected health information with providers or nurses within our practice who are involved in taking care of you. A provider within our practice may share your protected health information with a provider at another health care institution to determine how to diagnose or treat you. A provider in our office may also share your health information with another provider to whom you have been referred for further health care.

Payment. Payment means our activities to obtain reimbursement for the medical services provided to you, including billing, claims management, and collection activities. Payment also may include your insurance carrier’s work in determining eligibility, claims processing, assessing medical necessity, and utilization review.

Health Care Operations. Health care operations means the legitimate business activities of our medical practice. These activities include, for example, quality assessment and improvement activities; practitioner performance evaluation; fraud and abuse compliance; business planning and development; and business management and general administrative activities. Another example of health care operations is when we call you by name in the waiting room when we are ready to serve you. Also, when we involve third parties such as billing services, in our business activities, we will have them sign a “business associate” agreement obligating them to safeguard your PHI according to the same legal standards we follow.

Appointment Reminders, Treatment Alternatives, Benefits and Services. We may leave a reminder of your appointment on your answering machine. We may also use your health information in order to recommend possible treatment alternatives or health-related benefits and services that may be of interest to you.

Family and Friends. If you do not object, we may share your protected health information with family and friends involved in your care. We may also notify a family member, personal representative, or another person responsible for your care about your general condition or disclose such information to an entity assisting in a disaster relief.

Uses and Disclosures of PHI that are permitted or required by law:

In some circumstances, we may use or disclose your PHI in order to treat you in an emergency or to meet important public needs. State and federal law permit or require such use and disclosure regardless of your authorization because it is in the best interest of our society at large that the use and disclosure of PHI be made in these situations.

Required By Law – We may disclose PHI to the extent required by law and in a manner limited to the specific requirements of the law.

Public Health Activities – We may disclose your PHI 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; inform a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition. We will only report to the appropriate government authority if we believe an adult patient has been the victim of abuse, neglect, or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.

To Avert a Serious Threat to Health or Safety – We may use and disclose protected 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.

Health Oversight Activities – We may disclose your protected health information to a health oversight agency for audits, investigations, inspections, and other activities necessary for the appropriate oversight of the health care system and the government benefit programs such as Medicaid and Medicare.

Judicial and Administrative Proceedings – We may disclose your PHI in response to a court or administrative order. We also may disclose your PHI in response to an order expressly directing disclosure and within certain limits in response to a subpoena, discovery request, or other lawful process.

Law Enforcement Activities – We may disclose your protected health information to a law enforcement office 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) regarding 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.

Military and Veterans – We may disclose the protected health information of members of the armed forces for activities deemed necessary by appropriate military command authorities to carry out their military mission. We also may release health information to the appropriate foreign military authority, if you are a member of a foreign military.

National Security and Intelligence Activities – We may release PHI to authorize federal officials for intelligence, counter-intelligence, and other national security activities authorized by law.

Protective Services for the President and Others – We may disclose protected 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.

Workers’ Compensation – We may disclose your protected health information as authorized, by and to the extent necessary to comply with the Maine Workers’ Compensation Act or other similar programs that provide benefits for work-related injuries or illness without regard to fault.

Inmates and Correctional Institutions – If you are an inmate or under the custody of a law enforcement official, we may release protected health information to the correctional institution or law enforcement official. This release would be made 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) for the safety and security of the correctional institution.

Organ and Tissue Donation – If you are an organ donor, we may use or release protected 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.

Coroners, Medical Examiners, and Funeral Directors – We may disclose your PHI to a coroner or medical examiner for the purpose of identifying a deceased person, determining a cause of death, or other lawful duties. We also may disclose your protected health information to enable a funeral director to carry out his or her duties.

Research – Under certain circumstances, we may disclose your PHI for certain medical or scientific research where the researchers have a protocol to ensure the privacy of your PHI.

DHHS – We may disclose your PHI to the Secretary of the U.S. Department of Health and Human Services to investigate or determine CWHC compliance with the privacy laws.

YOUR RIGHTS TO ACCESS AND CONTROL YOUR PROTECTED HEALTH INFORMATION

Right to Inspect and Copy Records. You have the right to inspect and obtain a copy of your protected health information in a “designated record set” (your medical and billing records) as long as we maintain the PHI in such format.

Your request for access to your PHI must be in writing. Please contact our Privacy Officer for the necessary form. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies we use to fulfill your request. We will respond to your request within thirty (30) days when information is maintained on-site and within sixty (60) days when information is maintained off site. An extension of no more than 30 days is allowed if our office notifies you with a written statement of the reason for the delay and the date by which we will complete the action on the request.

Under certain very limited circumstances, we may deny your request to inspect or obtain a copy of your information. You do not have a right of access to psychotherapy notes or information compiled in reasonable anticipation of a civil, criminal, or administrative proceeding. Also, your right of access may be limited if providing certain PHI to you may endanger the health or safety of yourself or others. If we deny all or part of your request, we will provide a written denial that explains our reasons for doing so, and a complete description of your rights to have that decision reviewed and how you can exercise those rights. If we have reason to deny only part of your request, we will provide complete access to the remaining parts, after excluding the information we cannot let you inspect or copy.

Right to Amend Records. If you believe the protected health information we have about you is incorrect or incomplete, you have the right to ask us to amend the information for as long as the information is kept in our records. Your request must be in writing. To request an amendment, please contact our Privacy Officer for the necessary form. Your request should include the reason why you think we should make the amendment. We will respond to your request within 60 days from the date of your request. An extension of no more than 30 days is allowed if our office notifies you with a written statement of the reason for the delay and the date by which we will complete the action on the request. If we deny your request for amendment, you have the right to submit a written statement disagreeing with the denial and we have the right to submit a rebuttal statement. A record of any disagreement about the amendment will become part of your medical record and may be included in subsequent disclosures of your PHI.

Right to Accounting of Disclosure. You have the right to a list of certain disclosures we made regarding your protected health information. Disclosure information must be made available for a 6-year period, for information collected after April 14, 2003. A record of disclosures does not have to be made when those disclosures are:

Disclosures made more than six years prior to the request. Your request for an accounting of disclosures must be in writing. To request an accounting of disclosures, please contact our Privacy Officer for the necessary request form. We will respond to your request within 60 days from the date of your request. An extension of no more than 30 days is allowed if our office notifies you with a written statement of the reason for the delay and the date by which we will complete the action on the request. You have a right to one list within every 12-month period for free. However, we may charge you for the cost of providing any additional lists in that same 12-month period.

Right to Request Restrictions on Certain Uses and Disclosures. You have the right to request a restriction or limitation on the protected health information we use or disclose for treatment, payment, or health care operations. You also have the right to request a limitation on the health information we disclose to someone involved in your care or the payment of 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. Your request for a restriction must be in writing. Please contact our Privacy Officer for the necessary form. We are not required to agree to your request. If we agree, we will be bound by our agreement unless the information is needed to provide you with emergency treatment or comply with the law. Once we have agreed to a restriction, you have the right to revoke the restriction at any time.

Right to Receive Confidential Communications. You have the right to request that we contact you in a way that is more confidential for you, such as at home instead of work. We will accommodate all reasonable requests. Your request for confidential communications must be in writing. Please contact our Privacy Officer for the necessary form. We will not require an explanation of your reason(s) for the request, but we will ask that you specify the alternative address or other method of contact and that you inform us of how payment for our medical services will be handled.

HOW TO FILE A COMPLAINT

If you have a complaint about the denial of any of the specific rights listed above, about our Notice of Privacy Practices, or about our compliance with state and federal privacy law, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services. To file a complaint with our office, please contact our Privacy Officer. All complaints must be in writing. You will not be retaliated against in any way for the filing of a complaint.

This facility is required by law to abide by the terms of this notice currently in effect.