Privacy Practices

Woodward & Associates, P.C.

Notice of Privacy Practices

Effective Date September 1, 2013

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW TO GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.

If you have any questions regarding this notice, you may contact our privacy office at:

Woodward & Associates, P.C.

ATTN: Privacy Officer

8105 Adams Drive, Suite B

Hummelstown, PA 17036

Phone 717-482-8115 Fax 717-482-8364

I. USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION

A. Treatment, payment and health care operations

We may use and disclose your protected health information for treatment, payment, and health care operation purposes. Not every potential use or disclosures for treatment, payment, and health care operations will be listed.

1. Treatment

We may use and disclose your protected health information to help us with your treatment. We may also release your protected health information to help other health care providers treat you. Treatment includes the provision, coordination, or management of health care services to you by one or more health care providers. Some examples of treatment uses and disclosures include:

  • During an office visit, our physicians and other staff involved in your care may review your medical record and share and discuss your medical information with each other.
  • We may share and discuss your medical information with an outside physician to whom we have referred you for care.
  • We may share and discuss your medical information with an outside physician with whom we are y
  • We may share and discuss your medical information with an outside laboratory, radiology center, or other health care facility where we have referred you for testing.
  • We may share and discuss your medical information with an outside home health agency, durable medical equipment agency, or other health care provider to whom we have referred you for health care services and products.
  • We may share and discuss your medical information with a hospital or other health care facility where we are admitting or treating you.
  • We may share and discuss your medical information with another healthcare provider who seeks this information for the purpose of treating you.

2. Payment

We may use and disclose your protected health information for our payment purposes, as well as the payment purposes of other health care providers and health plans. Payment uses and disclosures include activities conducted to obtain payment for the care provided to you or so that you can obtain reimbursement for that care.

Some examples of payment uses and disclosures include:

  • Sharing information with your health insurer to determine whether you are eligible for coverage or whether proposed treatment is a covered service.
  • Submission of a claim to your health insurance.
  • Providing medical records and other documentation to your health insurer to support the medical necessity of a health service.
  • Allowing your health insurer access to your medical record for a medical necessity or quality review audit.
  • Providing information to a collection agency or attorney for purposes of securing payment of a delinquent account.
  • Disclosing information in a legal action for purposes of securing payment of a delinquent account.

3. Health Care Operations

We may use and disclose your protected health information for our health care operation purposes as well as certain health care operations purposes of other health care provider and health plans. Some examples of health care operation purposes include:

  • Quality assessment and improvement activities.
  • Activities relating to improving health or reducing health care costs.
  • Reviewing the competence, qualifications, or performance of health care professionals.
  • Conducting training programs for medical and other students.
  • Accreditation, certification, licensing, and credentialing activities.
  • Health care fraud and abuse detection and compliance programs.
  • Conducting other medical review, legal services, and auditing functions.
  • Business planning and development activities, such as conducting cost management and planning related analysis.

• Other business management and general administrative activities, such as compliance with the federal privacy rule and resolution of patient grievances.

B. Uses and disclosures for other purposes

We may use and disclose your protected health information for other purposes. This section generally describes those purposes by category. Each category includes one or more examples. Not every potential use or disclosure in a category will be listed. Some examples fall into more than one category, not just the category under which they are listed.

1. Individuals involved in care or payment for care

We may disclose your protected health information o someone involved in your care or payment for your care, such as a spouse, a family member, or close friend. For example, if you have surgery, we may discuss your physical limitations with a family member assisting in your post-operative care.

2. Notification purposes

We may use and disclose your protected health information to notify, or to assist in the notification of, a family member, a personal representative, or another person responsible for your care regarding your location, or general condition. For example, if you are hospitalized, we may notify a family member of your hospitalization and general condition.

3. Required by Law

We may use and disclose protected health information when required by federal, state, or local law. For example, we may disclose protected health information to comply with mandatory reporting requirements involving births and deaths, child abuse, disease prevention and control, vaccine-related injuries, and medical device-related injuries.

4. Other Public Health Activities

We may use and disclose protected health information for public health activities including:

  • Public Health reporting, for example, communicable disease reports.
  • Child abuse and neglect reports.
  • FDA-related reports and disclosures, for example, adverse event reports.
  • Public health warnings to third parties at risk of a communicable disease or condition.
  • OSHA requirements for workplace surveillance and injury reports.

5. Victims of abuse, neglect, or domestic violence

We may use and disclose protected health information for purposes of reporting of abuse, neglect, or domestic violence in addition to child abuse, for example, reports of elder abuse to the Department of Aging or abuse of a nursing home patient to the Department of Public Welfare.

6. Health Oversight Activities

We may use and disclose protected health information for purposes of health oversight activities authorized by law. These activities could include audits, inspections, investigations, licensure actions, and legal proceedings. For example, we may comply with a Drug Enforcement Agency inspection of patient records.

7. Judicial and Administrative Proceedings

We may use and disclose protected health information disclosures in judicial and administrative proceedings in response to a court order or subpoena, discovery request or other lawful process. For example, we may comply with a court order to testify in a case at which your medical condition is at issue.

8. Law Enforcement Purposes

We may use and disclose protected health information for certain law enforcement purposes including to:

  • Comply with a legal process, for example, a search warrant.
  • Comply with a legal requirement, for example, mandatory reporting of gun-shot wounds.
  • Respond to a request for information for identification/location purposes.
  • Respond to a request for information about a crime victim.
  • Report a death suspected to have resulted from criminal activity.
  • Provide information regarding a crime on the premises.

9. Government Function

We may disclose your health information for specialized government functions, such as protection of public officials or reporting to various branches of the armed services that may require use or disclosure of the information.

10. Workers Compensation

Your health information may be used or disclosed in order to comply with laws and regulations related to Workers’ Compensation.

11. Incidental Disclosures

We may disclose protected health information to an otherwise permitted use or disclosure. For example, other patients may overhear your name being called in the waiting room.

12. Business Associates

Our Business Associates are entities that provide services to our practice and that require access to protected health information of our patients in order to provide those services. A Business Associate of our practice may create, receive, maintain, or transmit protected health information while performing a function on our behalf. For example, our attorneys may need access to protected information to provide legal service to us. Our Business Associates may use and disclose your protected health information consistent with this notice as otherwise permitted by law. To protect your protected health information, we require our Business Associates to enter into written agreements that they will appropriately safeguard the protected health information they require to provide the services they have agreed to provide.

C. Uses and Disclosures with Authorization

For all other purposes that do not fall under a category listed under sections I.A and I.B, we must obtain your written authorization to use or disclose your protected health information.

In addition, we are required to obtain your authorization:

  • For most uses and disclosures of psychotherapy notes

Your authorization can be revoked at any time. However, we are not able to retract uses and disclosures made with your authorization prior to this effective date of the revocation.

II. Patient Rights

A. Further Restriction on Use and Disclosure

You have a right to request that we restrict a use and disclosure of your protected health information, which we are otherwise permitted to make, for treatment, payment, or health care operations, to someone who is involved in your care or payment for your care, or for notification purposes.

We are not required to agree to a request to such a restriction, with one exception involving self-pay services. We must agree to a request not to disclose your protected health information to a health plan for payment or health care operation purposes if the information pertains to solely to a health care item or service for which we have been paid in full by you or someone other than the health plan and the disclosure is not required by lab.

To request a further restriction as outlined in this section, you must submit a written request to our privacy officer. The request must tell us: (a) what information you want restricted; (b) how you want the information restricted; and (c) to whom you want the restriction to apply.

B. Confidential Communication

You have the right to request that we communicate your protected health information to you by a certain means or at a certain location. For example, you might request that we only contact you by mail or at work. We will accommodate requests for confidential communications as long as they are reasonable.

To make a request for confidential communications, you must submit a written request to our privacy office. The request must tell us how or where you want to be contacted. In addition, if another individual or entity is responsible for payment, the request must explain how payment will be handled. You have the right to request that we communicate your protected health information to you by a certain means or at a certain location. For example, you might request that we only contact you by mail or at work. We will accommodate requests for confidential communications as long as they are reasonable.

To make a request for confidential communications, you must submit a written request to our privacy office. The request must tell us how or where you want to be contacted. In addition, if another individual or entity is responsible for payment, the request must explain how payment will be handled.

C. Accounting of Disclosures

You have a right to obtain, upon request, an “accounting” of certain disclosures of your protected health information. This right is subject to limitations, such as how far back the accounting must cover and the scope of the covered disclosures.

In addition, in some circumstances we may charge you for providing the accounting. To request an accounting, you must submit a written request to our privacy officer. The request should designate the applicable time period.

D. Inspection and Copying

You have the right to inspect and obtain a copy of your protected health information that we maintain in a designated record set. Generally, this includes your medical and billing records. This right is subject to limitation. In certain cases, we may deny your request. We also may impose charges for the cost involved in providing copies, such as labor, supplies, and postage, as permitted by law. If your records are maintained electronically, you have the right to specify that the records be provided in electronic form. We will accommodate your request for a specific electronic form or format as long as we are able to readily produce a copy in the requested form or format. If we cannot do so, we will work with you to reach agreement on an alternate readable electronic media (such as a CD). We may charge you for the cost of that media.

To exercise your right to access your protected health information, you must submit written request to our privacy officer.

The request must: (a) describe the health information to which access is requested; (b) state how you want to access the information, such as inspection, pick-up of copy, mailing of copy; (c) specify any requested form or format, such as paper copy of an electronic means; and, (d) include the mailing address, if applicable.

You may also request that your protected health information be directly transmitted to another person or entity. To exercise this right, you must submit a request to our privacy officer. The request must: (a) be in writing and signed by you; and (b) clearly identify both the designated person or entity and where the information should be sent.

E. Right to Amendment

You have the right to request that we amend protected health information that we maintain about you in a designated record set if the information is incorrect or incomplete. This right is subject to limitations. In certain cases, we may deny your request to our privacy officer. The request must specify each change that you want and provide a reason to support each requested change.

F. Copy of Privacy Notice

You have a right to receive, upon request, a copy of our Notice of Privacy Practices. Copies are available in our office reception area, on our website, or by contacting our privacy office. Requests for special accommodation regarding this notice should be directed to our privacy officer.

G. Breach Notification

You have a right to receive timely written notice of a breach of your unsecured protected health information.

III. Changes to this Notice

We reserve the right to change this notice at any time. We further reserve the right to make any change effective for all protected health information that we or our business associates’ maintain, including information that we or our business associates created or received prior to the effective date of the change.

We will post a copy of our current notice in the waiting room for the practice. At any time, patients may review the current notice by contacting the privacy office. Patients also may access the current notice at our web site at

www.woodwardassociates.com

IV. Complaints

If you believe that we have violated your privacy rights, you may submit a complaint to our privacy officer at:

Woodward & Associates, P.C.

ATTN: Privacy Officer

8105 Adams Drive, Suite B

Hummelstown, PA 17036

Phone (717)482-8115

Fax (717)482-8364

You may also submit a complaint to the Office of Civil Rights at:

Office of Civil Rights

US Department of Health and Human Services

150 S. Independence Mall West, Suite 371

Public Ledger Building

Philadelphia, PA 19106-9111

(215)861-4441

Hotline: (800)368-1019

Fax: (215)8614431

TDD: (215)861-4440

You will not be retaliated against for filing a complaint.

V. Legal Effect of this Notice

This notice is not intended to create contractual or other rights independent of those crated in the federal privacy rule.