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CHEYENNE MEDICAL SPECIALISTS
NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

 

Cheyenne Medical Specialists, P.C. understands that your medical information is personal and confidential.  We are committed to protecting your medical information.   This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law.   It also describes your rights to access and control your protected health information.  “Protected health information” (PHI) is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.

 

We are required to abide by the terms of this Notice of Privacy Practices.  We may change the terms of our notice, at any time.  The new notice will be effective for all protected health information that we maintain at that time.  We will provide you with any revised Notice of Privacy Practices by accessing our website www.cmsmed.com, calling the office and requesting that a revised copy be sent to you in the mail, or asking for one at the time of your next appointment.

 

1.             Permitted Uses and Disclosures for Treatment, Payment and Operations Without Consent

 

Your protected health information may be used and disclosed by your physician, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you.  Your protected health information may also be used and disclosed to pay your health care bills and to support the operation of the physician's practice.

 

Following are examples of the types of uses and disclosures of your protected health care information that the physician's office is permitted to make.  These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by our office.

         Treatment:            

We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services.  This includes the coordination or management of your health care with a third party that has already obtained your permission to have access to your protected health information.  For example, we would disclose your protected health information, as necessary, to a home health agency that provides care to you.  We will also disclose protected health information to other physicians who may be treating you.  For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.  In addition, we may disclose your protected health information from time-to-time to another physician or health care provider (e.g., a specialist or laboratory) who, at the request of your physician, becomes involved in your care by providing assistance with your health care diagnosis or treatment to your physician.

      Payment:            

Your protected health information will be used, as needed, to obtain payment for your health care services.  This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we recommend for you such as; making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities.  For example, obtaining approval for a hospital stay may require that your relevant protected health information be disclosed to the health plan to obtain approval for the hospital admission.

    Healthcare Operations:            

We may use or disclose, as-needed, your protected health information in order to support business activities of your physician's practice.  These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, licensing, marketing activities, and conducting or arranging for other business activities.

 

For example, we may disclose your protected health information to medical school students that see patients at our office.  In addition, we may use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your physician.  We may also call you by name in the waiting room when your physician is ready to see you.  We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment.

 

We will share your protected health information with third party "business associates" that perform various activities (e.g., billing or transcription services) for the practice.  Whenever an arrangement between our office and a business associate involves the use or disclosure of your protected health information, we will require the business associate to keep your information safe.

 

We may use or disclose your protected health information, as necessary, to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you.  We may also use and disclose your protected health information for other marketing activities.  For example, your name and address may be used to send you a newsletter about our practice and the services we offer.  We may also send you information about products or services that we believe may be beneficial to you.  You may notify us in writing if you do not want to receive marketing information.

 

2.       Other Permitted and Required Uses and Disclosures That May Be Made Without Your Consent,    Authorization or Opportunity to Object

 

We may use or disclose your protected health information in the following situations without your consent or authorization.   These situations include:

    Required By Law:

We may use or disclose your protected health information to the extent that the use or disclosure is required by law.  The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law.  You will be notified, as required by law, of any such uses or disclosures.

 Public Health:          

We may disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information.   The disclosure will be made for the purpose of controlling disease, injury or disability.  We may also disclose your protected health information, if directed by the public health authority, to a foreign government agency that is collaborating with the public health authority.

 Communicable Diseases:     

We may disclose your protected health information, if authorized by law, 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.

 Health Oversight:

We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections.  Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.

Abuse or Neglect:        

We may disclose your protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect.  In addition, we may disclose your protected health information if we believe that you have been a victim of abuse, neglect or domestic violence to the governmental entity or agency authorized to receive such information.  In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.

Food and Drug Administration:     

We may disclose your protected health information to a person or company required by the Food and Drug Administration to report adverse events, products or problems, biologic product deviations, track products; to enable product recalls; to make repairs to replacements, or to conduct post marketing surveillance, as required.

 Legal Proceedings:        

We may disclose protected health information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request or other lawful process.

 Law Enforcement:         

We may also disclose protected health information, so long as applicable legal requirements are met, for law enforcement purposes.  These law enforcement purposes include (1) legal processes required by law, (2) limited information requests for identification and location purposes, (3) pertaining to victims of a crime, (4) suspicion that death has occurred as a result of criminal conduct, (5) in the event that a crime occurs on the premises of the practice, and (6) medical emergency (not on the Practice's premises) and it is likely that a crime has occurred.

 Coroners, Funeral Directors, and Organ Donation:    

We may disclose protected health information to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law.  We may also disclose protected health information to a funeral director, as authorized by law, in order to permit the funeral director to carry out their duties.  We may disclose such information in reasonable anticipation of death.  Protected health information may be used and disclosed for cadaveric organ, eye or tissue donation purposes.

 Research:    

We may disclose your protected health information to researchers when their research has been approved and protocols established to ensure the privacy of your protected health information.

 Criminal Activity: 

Consistent with applicable federal and state laws, we may disclose your protected health 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 the public.  We may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.

Military Activity and National Security:      

When the appropriate conditions apply, we may use or disclose protected health information of individuals who are Armed Forces personnel (1) for activities deemed necessary by appropriate military command authorities; (2) for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits, or (3) to Foreign military authority if you are a member of that foreign military services.  We may also disclose your protected health information to authorized federal officials for conducting national security and intelligence activities, including for the provision of protective services to the President or others legally authorized.

 Workers' Compensation:      

Your protected health information may be disclosed by us as authorized to comply with workers' compensation laws and other similar legally-established programs.

 Inmates:      

We may use or disclose your protected health information if you are an inmate of a correctional facility and your physician created or received your protected health information in the course of providing care to you

 

3.       Other Permitted and Required Uses and Disclosures That May Be Made With or Without Your Consent, Authorization or Opportunity to Object

We may use and disclose your protected health information in the following instances.  You have the            opportunity to agree or object to the use or disclosure of all or part of your protected health information.           If you are not present or able to agree or object to the use or disclosure of the protected health                  information, then your physician may, using professional judgment, determine whether the disclosure is in your best interest.  In this case, only the protected health information that is relevant to your health care will be disclosed.

Others Involved in Your Healthcare:

Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your protected health information that directly relates to that person's involvement in your health care.  If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment.  We may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death.  Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.

 Emergencies:        

We may use or disclose your protected health information in an emergency treatment situation.   If this happens, your physician shall try to obtain your consent as soon as reasonably practicable after the delivery of treatment.  If your physician or another physician in the practice is required by law to treat you and the physician has attempted to obtain your consent but is unable to obtain your consent, he or she may still use or disclose your protected health information to treat you.

Communication Barriers:       

We may use and disclose your protected health information if your physician or another physician in the practice attempts to obtain consent from you but is unable to do so due to substantial communication barriers and the physician determines, using professional judgment, that you intend to consent to use or disclose under the circumstances.

 

4.         Uses and Disclosures of Protected Health Information Based upon Your Written Authorization

 

Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law as described below.   You may revoke this authorization, at any time, in writing, except to the extent that your physician or the physician's practice has taken an action in reliance on the use or disclosure indicated in the authorization.

 

5.             Required uses and Disclosures:           

Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500 et. Seq.

 

6.             Patient Health Information Rights

 

Following is a statement of your rights with respect to your protected health information and a brief description of how you may exercise these rights.

 

You have the right to:

  • Request a restriction on certain uses and disclosures of your information.  However, Cheyenne Medical Specialists, P.C. is not required to agree to a requested restriction.

 

  • Receive confidential communications of protected health information.

 

  • Obtain a paper copy of the Notice of Privacy Practices upon request.

 

  • Inspect and obtain a copy of your health record.  Cheyenne Medical Specialists, P.C. may charge a reasonable fee to cover costs.

 

  • Request an amendment to your health record.  If you believe that information in your record is incorrect or if important information is missing, you have the right to request that we correct the existing information or add the missing information.  Requests for amendments must be in writing.

 

  • Obtain an accounting of disclosures of your health information.  If you make more than one request in a 12-month period, Cheyenne Medical Specialists, P.C. may charge a reasonable fee to cover costs.

 

  • Request communications of your health information by alternative means or at alternative locations.  For example, only send appointment messages by mail.  No phone messages.

 

  • Revoke your authorization to use or disclose health information except to the extent that action has already been taken.  Revocations must be in writing.

7.          For more information or to make a complaint

 

Questions:             If you have questions or would like additional information, you may contact the Cheyenne Medical Specialists, P.C. Privacy Officer at (307) 634-1311.

 

Complaints:             If you believe your privacy rights have been violated, you can register a complaint with the Cheyenne Medical Specialists, P.C. Privacy Officer at (307) 634-1311, or with the Secretary of Health and Human Services.  There will be no action taken against you for filing a complaint.

 

Effective Date:  01/10/03