QUEENS MEDICAL ASSOCIATES
NOTICE OF PRIVACY PRACTICES
Effective Date: April 14, 2003
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
This notice applies to Queens Medical Associates, P.C.
We are required by law to maintain the privacy of you health information; to provide you this detailed Notice of our legal duties and privacy practices relating to your health information; and to abide by the terms of Notice that are currently in effect. With respect of the Q.M.A. Staff, this Notice applies to used and disclosures of your health information by the Q.M.A. staff in relation to services you receive at Q.M.A. Your health information will be shared among the entities covered by this Notice for treatment, payment and health care operations purposes.
USES AND DISCLOSURES FOR TREATMENT, PAYMENT & HEALTH CARE OPERATIONS.
The following lists various ways in which we may us or disclose your health information for purposes of treatment, payment and health care operations without your written permission.
FOR TREATMENT. We will use and disclose your health information in providing you with treatment and services and coordinating your care and may disclose information to other providers involved in your care. Your health information may be used by doctors and nursed, as well as by lab technicians, dieticians, physical therapists or other personnel involved in your care. For example your respective pharmacy.
FOR PAYMENT. We may use and disclose your health information for billing and payment purposes. We may disclose your health information to an insurance or managed care company, Medicare, Medicaid or another third party payor. For example, we may contact Medicare or your health plan to confirm your coverage or to request prior approval for services that will be provided to you.
FOR HEALTH CARE OPERATIONS. We may use and disclose your health information as necessary for health care operation, such as management, personnel evaluation, education and t raining and to monitor our quality of care. We may disclose your health information to another entity with which you have or had a relationship if that entity requests your information for certain of its health care fraud and abuse detection or compliance activities. For example, heath information of patients may be combined and analyzed for purposes such as evaluating and improving quality of care and planning for services.
SPECIFIC USES AND DISCLOSURES OF YOUR HEALTH INFORMATION
The following lists various ways in which we may use or disclose your health information.
To request an accounting of disclosures, you must submit a request in writing, stating a time period beginning after April 13, 2003 that is within seven years from the date of your request. We may charge you our costs.
REQUEST CONFIDENTIAL COMMUNICATIONS. You have the right to request that we communicate with you concerning your health matters in a certain manner such as calling you at work rather than at home. We will accommodate your reasonable requests.
SPECIAL RULES REGARDING DISCLOSURE OF PSYCHIATRIC, SUBSTANCE ABUSE AND HIV-RELATED INFORMATION.
For disclosures concerning health information relating to care for psychiatric conditions, substance abuse or HIV-related testing and treatment, special restrictions may apply. In general, health information relating to care for psychiatric conditions, substance abuse or HIV-related testing and treatment may not be disclosed without your permission or a court order. There are some exceptions, including the following:
HIV-RELATED INFORMATION. HIV-related information may be disclosed for purposes of treatment or payment.
SUBSTANCE ABUSE TREATMENT. If you are treated in a specialized substance abuse program, your written permission will be needed for most disclosures, not including emergencies.
FOR FURTHER INFORMATION OR TO FILE A COMPLAINT
If you have any questions about this Notice or would like further information about our privacy practices, please contact the Q.M.A. Privacy Officer at (718) 460-2300.
If you believe that your privacy rights have been violated, you may file a complaint in writing with us or with the Office of Civil Rights in the U.S. Department of Health and Human Services.
To file a complaint with us, contact Privacy Officer.
We will not retaliate against you if you file a complaint.
CHANGES TO THIS NOTICE
We reserve the right to change this Notice and to make the revised or new Notice provisions effective for all health information already received and maintained by us as well as for all health information we receive in the future. We will provide a copy of the revised Notice upon request.