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Privacy Policy

The Health Insurance Portability and Accounting Act of 1996 (HIPAA) was passed by the U.S. Congress to address several issues related to health insurance. One of the concerns was assuring privacy and control of patient health information by medical professionals.

Please read this policy. You will be asked to sign this HIPAA Privacy Statement at your first office visit as part of our policy to comply with HIPAA requirements.

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CAPITAL INTERNAL MEDICINE ASSOCIATES, P.C.
NOTICE OF PRIVACY PRACTICES
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.
Effective Date: April 14, 2003

This Notice of Privacy Practices is being provided to you as a requirement of the Health Insurance Portability and Accountability Act (HIPAA). It describes your rights to access and control your protected health information along with our legal duties to these rights. Your "protected health information" means any of your written and oral health information, including demographic data that can be used to identify you. This is health information that is created or received by your health care provider, and that relates to your past, present or future physical or mental health or condition.

USES AND DISCLOSURES OF HEALTH INFORMATION
The practice may used your protected health information for purposes of providing treatment, obtaining payment, and conducting healthcare operations without prior authorization from you. Disclosures of your protected health information for purposes described in this Notice may be made in writing, orally, or by facsimile. For example:

TREATMENT
We will use and disclose your health information to a physician or other healthcare provider involved in your care, to a pharmacist to fill a prescription, to a laboratory to order a blood test, or a home health agency that is providing care within your home.

PAYMENT
We will use your protected health information, as needed, to receive payment for services we provide to you.

HEALTHCARE OPERATIONS
We may use and disclose your protected health information, as necessary, for our own health care operations. This includes quality assessment and improvement activities, employee review activities, training programs in which students, trainees, or practitioners in health care learn under supervision, or accreditation, certification, licensing or credentialing activities.

OTHER USES AND DISCLOSURES
We may use or disclose your protected health information for the following: To remind you of an appointment by mail via postcard, phone messages, e-mail, voicemail messages), to inform you of health-related benefits or services that may be of interest to you, sign-in sheets, computerized appointments, encounter forms, or newsletters.

REQUIRED BY LAW
We will disclose your protected health information when we are required to do so by any Federal, State or local law.

RISKS TO PUBLIC HEALTH
We may disclose your protected health information for the following purposes:

• to prevent, control or report disease, injury or disability as permitted by law
• to conduct public health surveillance, investigations and interventions as permitted or required by law
• to collect or report adverse events and product defects such as product recalls
• to notify a person who has been exposed to a communicable disease or who may be at risk of contracting or spreading a disease as authorized by law
• to report to an employer information about an individual who is a member of the workforce as legally permitted or required.

ABUSE OR NEGLECT
We may notify government authorities if we believe that a patient is the victim of abuse or neglect only when specifically required or authorized by law or when the patient agrees to the disclosure.

SPECIFIED GOVERNMENT FUNCTIONS
In certain circumstances, the Federal regulations authorize us to use or disclose your protected health information to specified government functions relating to military and veterans, national security and intelligence activities, protective services for the President and others, medical suitability determinations, correctional institutions, and law enforcement custodial situations.

YOUR FAMILY AND FRIENDS
We may disclose your protected health information to your family member or close friend if it is directly relevant to involvement in your care or payment related to your care. You may object from these disclosures, however in the exercise of our professional judgment, if we feel that it is in the best interest of your care, we may disclose your protected health information.

Other than as stated above, we will not disclose your health information other than with your written authorization. You may revoke your authorization at any time, however it will not affect any use of disclosure permitted by your authorization while it was in effect.

YOUR RIGHTS
You have the following rights regarding your health information:

TO INSPECT AND COPY
You may inspect and obtain a copy of your protected health information that is contained in a designated record set for as long as we maintain it. This contains medical and billing records and any other records that your physician and the practice uses for making decisions about you. You must submit a written request to the Privacy Officer noted on the last page of this Notice. There may be a fee involved for the costs of copying, mailing or other costs incurred by the practice. Inspection and copying of your medical information will only take place during normal business hours.

Under Federal law, you may NOT inspect or copy the following: psychotherapy notes; any information related to a civil, criminal or administrative action or preceding; and protected health information that is subject to a law that prohibits access to protected health information. You may have the right to have a decision to deny access reviewed.

We may deny your request if, in our professional judgment, we determine that the access requested is likely to endanger your life or safety or that of another person, or that is likely to cause substantial harm to another person referenced within the information. You have the right to request a review of this decision.

TO REQUEST RESTRICTIONS
You have the right to request restrictions be placed on your protected health information as to what can be used and disclosed and restrictions as to who we may or may not disclose to. We are not required to agree to these disclosures, but if we do, we will abide by our agreement, except in an emergency situation. Under certain situations, we may terminate our agreement to a restriction.

ALTERNATIVE COMMUNICATION
You may request that we communicate with you by alternative means or alternative locations. You must request this in writing to the Privacy Officer. If requesting an alternative location, you must provide explanation of how payments will be handled under the alternative location you requested.

AMENDMENT
You may request to have your protected health information in a designated set amended. We may deny your request. If we deny your request for amendment, you have the right to file a statement of disagreement with us and prepare a rebuttal. You must make these requests in writing, providing a reason to support the request, and address your request to the Privacy Officer.

DISCLOSURE ACCOUNTING
You have the right to request a list of instances in which we disclosed your protected health information to another party. This applies to disclosures made for purposes other than for treatment, payment or healthcare operations as described in this Notice. We are not required to account for disclosures you requested or authorized by signing a form. Requests must be made to the Privacy Officer in writing and should specify the time period for the accounting. We are not required to provide an accounting for disclosures that take place prior to April 14, 2003. Accounting periods must not exceed six years. We will provide the first accounting during any 12-month period without charge. Subsequent requests may be subject to a reasonable fee.

OUR DUTIES
The practice is required by law to maintain the privacy of your health information and to provide you with this Notice of our duties and privacy practices. We reserve the right to change the terms of this Notice and to make the new Notice provisions effective for all protective health information that we maintain. If the practice changes its Notice, we will provide a copy of the revised Notice either by mail or in-person contact.

QUESTIONS AND COMPLAINTS
You have the right to express complaints to the practice and to the Secretary of Health and Human Services if you believe your rights have been violated. You may make complaints to the practice by contacting the Privacy Officer verbally or in writing or to the Secretary of Health and Human Services in writing. We will provide you with this address upon request. We encourage you to express any concerns you may have regarding the privacy of your information. You will not be retaliated against in any way for filing a complaint.

CONTACT PERSON
The practice's contact person for all issues regarding patient privacy and your rights under the Federal privacy standard is the Privacy Officer.

Privacy Officer: Amit Ghose M.D.

Telephone: (517) 374-7600 | Fax: (517) 374-1142

Address: 3955 Patient Care Dr., Suite A, Lansing, MI 48911

Capital Internal Medicine Associates, P.C.