HIPAA

ANTHONY BOHAN, M.D., INC. IN ACCORDANCE WITH THE HEALTH INSURANCE ACCOUNTABILITY AND PORTABILITY ACT (HIPAA), 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. If you have any questions about this Notice, please contact our Privacy Officer/Contact Person, Ms. Jane Stracner, RNP, PA-C, J.D. at (949) 645-7172. The address is 320 Superior Ave., Suite 340, Newport Beach, CA 92663. A. Who Will Follow This Notice This Notice describes the privacy practices relating to protected health information (A PHI@ ) followed by Doctor Bohan and all of his employees and staff. Doctor Bohan, the office employees and staff may share your medical information with each other for treatment, payment or health care operations purposes described in this Notice. B. Understanding Your Health Record/Information Each time you visit a physician, hospital, or other healthcare provider, a record of your visit is typically made. This record generally contains your symptoms, examination and test results, diagnoses, treatment, and plan for future care or treatment. This information serves as a basis for planning your care and treatment; a means of communication among the doctors and other healthcare providers that are involved in your care; a medical-legal document describing the care your have received; a means by which you or a third-party can verify that services billed were actually provided; a source of data for medical research, education, and data collection; a source of information for public health officials charged with improving community health; and other healthcare operations. C. Our Policy Regarding Medical Information We understand that medical information about you and your health (A PHI@ ) is personal. Our commitment to you is to protect medical information about you. Our office creates a record describing the care and services you receive at our office. This record is necessary in order to provide medical care to you and to comply with certain legal requirements. This notice applies to all of the records created in our office in connection with your care and treatment, whether made by Doctor Bohan and/or his employees and staff. This notice describes the ways in which we may use and disclose medical information about you. It also tells you what your rights are and certain obligations we have regarding the use and disclosure of medical information. The law requires our office to: (a) make sure that medical information that identifies you is kept private; (b) give you this notice of our legal duties and privacy practices with respect o medical information about you; and, (c) follow the terms of the notice that is currently in effect. D. Our Responsibilities to You. Our responsibilities include maintaining the privacy of your health information and providing you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about you. We will abide by the terms of this notice and notify you if we are unable to agree about a requested restriction. We will accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations. We reserve the right to change our practices and to make the new provisions for all protected health information maintained. Should our information practices change, we will mail a revised notice to your then-current address. We will not use or disclose your health information without your authorization, except as described in this notice. E. How Your Medical Information May Be Used And/Or Disclosed The ways that we use and disclose your medical information are described below. Some examples are given to help explain these uses and disclosures. Not every use or disclosure is listed, but all of the ways our office uses or discloses your information falls into one or more of the categories listed below: For Treatment. We may use your medical information to provide you with medical treatment and services. We may disclose your medical information to other doctors, nurses, technicians, and other personnel that are involved in taking care of you at other doctors= offices, hospitals, laboratories, x-ray and imaging facilities, and other facilities that provide health care services. Different health care providers and different health care facilities may share medical information about you in order to coordinate your care and provide medical services to you such as laboratory testing, x-rays, imaging studies (such as MRI scans), prescriptions from pharmacies, and so forth. For example, if you are being treated for arthritis, other doctors that are taking care of you may need to know what medications your are taking for arthritis because these medications may affect what other medications they would prescribe for other medical conditions that you may have, such as high blood pressure. Similarly, when you are sent for a diagnostic procedure such as a bone scan, the doctors and technicians performing your bone scan may need to know your diagnoses and what we are specifically looking for on the bone scan. For Payment. We may use and disclose medical information about you so that the treatment and services you receive at our office may be billed to and payment collected from your insurance company, from a third party, or from you. For example, we may need to give information about your diagnoses, the medications that you are taking, and your medical history in order to get your insurance carrier to pay for medical services that we have provided or to pay for medications that you need. In some cases, we may need to tell your insurance carrier or your health plan about what treatment you are going to receive to obtain prior approval or pre-certification so that you will know whether or not your plan will cover the proposed treatment. For Health Care Operations. We may use and disclose medical information about you for health care operations. These uses and disclosures are necessary to run our office and to make sure that all of our patients receive quality medical care and services. For example, we may use medical information about you to review the effectiveness of our treatment and services and to evaluate the performance of our staff in caring for you. We may disclose information about you to our employees and staff in order to coordinate your care. We may remove information that identifies you from data that we then use to evaluate the effectiveness of certain medications that we use, such as Remicade (infliximab), as a treatment for rheumatoid arthritis. We may use and disclose information about you to health plans or insurance carriers to authorize services or referrals; or for medical reviews, legal services, audits, including fraud and abuse detection, compliance programs, or for business planning and management. We may also share information with our A business associates@ , such as a billing service or collection agency, that perform administrative services necessary to the proper functioning of this office. Although federal law does not protect health information disclosed to a A business associate@ , under California law, all recipients of health information may not re-disclose it except as specifically required or permitted by law. Appointment Reminders. We may use and disclose medical information to contact you as a reminder that you have an appointment scheduled at our office, or in coordinating appointments for you with other doctors= offices, hospitals, labs, x-ray and imaging facilities, and other health care providers. For example, we may need to give information about your diagnoses, the medications that you are taking, your medical history, your name and telephone number, your age, when scheduling appointments for you. Treatment Alternatives. We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you. For example, if there are new medications or treatments that we believe may be of benefit to you, we may wish to notify you of their availability. Health-Related Benefits and Services. We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you. For example, if there is new information about medications or treatments, or new information about side effects or adverse reactions from medications that we believe you should know about. Individuals Involved in Your Care or Payment for Your Care. We may release medical information about you to a family member or a friend, guardian, or care-giver who is involved in your medical care. We may give information to someone who helps pay for your care. We may also tell your family, friend, guardian, or care-giver who is involved in your medical care, your condition and if you are in the hospital. For example, if your spouse calls our office to find out about how you are doing or to check on your medications, we may disclose health information about you. If you are unavailable or unable to agree or object, we will use our best judgment under the circumstances to communicate with members of your family or other persons involved with your care about you. Research. Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research project may involve comparing the health benefits of all patients who received one medication to those who received another, for the same condition. All research projects, however, are subject to a special approval process through an Institutional Review Board (A IRB@ ) that evaluates a proposed research project and its use of medical information, trying to balance the research needs with the patients= need for privacy of their medical information. We may disclose your health information to researchers conducting research with respect to which your written authorization is not required as approved by an Institutional Review Board or privacy board, in compliance with governing law. As Required By Law. We will disclose medical information about you when required to do so by federal, state or local law. For example, we may disclose your health information in response to a lawful subpoena that requires disclosure of your records. To Avert a Serious Threat to Health or Safety. We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat. For example, we may release health information about you in the event of a serious communicable infection, such as tuberculosis or meningitis. 11. Business Associates: There are some services that are provided by business associates that we work with. For example and not by way of limitation, business associates include accountants, attorneys, billing and collections services, copy service, and transcription services. When these services are utilized, we may disclose your health information to our business associates to that they can perform the job we have asked them to do on out behalf. To protect your health information, however, we require the business associate to appropriately safeguard your information. 12. Notification: Unless you notify us that you object, we may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location and general condition. 13. Communication With Family: We will use our best judgment when communicating with family members, other relatives, close personal friends or any other person involved in your health care with respect to disclosure of your health information related to your care or payment for your care. 14. Food and Drug Administration (F.D.A.): We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects, or post-marketing surveillance information to enable product recalls, repairs or replacement or other similar FDA action. F. Special Situations Workers= Compensation. We may release medical information about you for workers= compensation or similar programs to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs.. These programs provide benefits for work-related injuries or illness. For example, to the extent that your care at this is office is covered by workers compensation, we will make periodic reports to your employer about your condition, and report occupational injury or illness to the employer or workers= compensation carrier as required by law. Military and Veterans. If you are a member of the armed forces, we may release medical information about you as required by military command authorities. Public Health Risks. We may disclose medical information about you for public health activities, including but not limited to: Preventing or controlling disease, injury or disability; Reporting births and deaths; Reporting child abuse or neglect; Reporting reactions to medications or problems with products; Notification of people of recalls of products they may be using; Notification of a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; Notification of the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. Health Oversight Activities. We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs such as Medicare, and compliance with civil rights laws. Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested. Law Enforcement. We may release medical information about you if asked to do so by a law enforcement official: In response to a court order, subpoena, warrant, summons or similar process; To identify or locate a suspect, fugitive, material witness, or missing person; About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person= s agreement; About a death we believe may be the result of criminal conduct; and, In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime. Coroners, Medical Examiners and Funeral Directors. We may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information to funeral directors as necessary to carry out their duties. National Security and Intelligence Activities. We may release medical information about you to authorized federal officials for intelligence, protection to the President, and other national security activities authorized by law. Fundraising. We may use or disclose your demographic information and the dates that you received treatment in order to contact you for fundraising activities. Change of Ownership. Should this medical practice be wold or merged with another health care organization, your health information will become the property of the new owner. However, you will have the right to request that copies of your health information be transferred to another physician(s), should you so desire. G. When Your Health Information May Not Be Disclosed: Unless you specifically give us written authorization to do so, this office will not use or disclose your health information only in accordance with this Notice of Privacy Practices, and not for another purpose. H. Your Rights Regarding Medical Information About You: Although your health record is the physical property of this office, the information belongs to you. You have the following rights regarding medical information we maintain about you: Right to Inspect and Copy. You have the right to inspect and copy medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes, if any. To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing by registered mail to the Privacy Officer/Contact Person whose name, address, and phone number are noted above. If you request a copy of the information, we may charge a fee for the costs of copying, mailing, or other supplies associated with your request. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. The person conducting the review will not be the person who denied your request but will be another physician selected by our office in our sole discretion. We will comply with the outcome of the review. Right to Amend. If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for a long as the information is kept by or for our office. To request an amendment, your request must be made in writing and submitted by registered mail to the Privacy Officer/Contact Person whose name, address, and phone number are noted above. In addition, you must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that: Was not created by us, unless the person or entity that created the information is no longer available to make the amendment; Is not part of the medical information kept by or for our office; Is not part of the information which you would be permitted to inspect and copy; or Is accurate and complete. Right to an Accounting of Disclosures. You have the right to request an A accounting of disclosures@ . This is a list of the disclosures we made of medical information about you. Disclosures exempt from the accounting requirement include those: (a) to carry out treatment, payment, or health care operations; (b) to you or your personal representatives; (c) for incidental purposes such as the office sign-in sheet; (d) to family members and others involved in your care; (e) for national security or intelligence purposes; and (f) correctional institutions and other law enforcement agencies under the custodial exception. To request this list or accounting of disclosures, you must submit your request in writing by registered mail to the Privacy Officer/Contact Person whose name, address, and phone number are noted above. Your request must state a time period which may not be longer than six (6) years and may not include dates before February 26, 2003. Your request should indicate in what form you want the list (for example, on paper or electronically). The first list you request within a 12 month period will be free. For additional lists, we may charge your for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred. Right to Request Restrictions. You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member. For example, you could ask that we not use or disclose information about a surgery you had. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request restrictions, you must make your request in writing and submit your request by registered mail to the Privacy Officer/Contact Person whose name, address, and phone number are noted above. In your request, you must tell us (a) what information you want to limit; (b) whether you want to limit our use, disclosure or both; and (c) to whom you want the limits to apply, for example, disclosures to your spouse. Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing and submit my registered mail to the Privacy Officer/Contact Person whose name, address, and phone number are noted above. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted. Right to Receive Notice of Privacy Practices. You have the right to receive a notice of our office= s privacy practices that describe the uses and disclosures of PHI, your rights under the Privacy Standards, and our legal duties regarding PHI. We are required to inform you of your right to complain to our office or the Department of Health and Human Services (DHSS) Secretary, if you believe that your privacy rights have been violated. If you have any questions, or if you wish to register a complaint, the person at our office to contact is the Privacy Officer/Contact Person whose name, address, and phone number are noted above. Our office reserves the right to change its privacy practice in its privacy notice, but we will first publish a revised notice prior to any change in practices. Our office will provide its notice to patients upon request, at first service, and on our Web Site. Right to Consent to or Authorize Certain Uses and Disclosures. As discussed in the section on uses and disclosures of PHI, infra, certain uses or disclosures will require your permission, whether consent, authorization, or advance notice with an opportunity to object. In each of these circumstances, you have the right to grant or withhold that permission. Right to Complain of Privacy Violations. You have the right to complain if your privacy rights have been violated. You may complain to the Privacy Officer/Contact Person whose name, address, and phone number are noted above. You may also complain to the DHSS Secretary through the Office of Civil Rights at 1-866-627-7748. We cannot require that you waive this right as a condition for providing treatment, payment, or other services, and cannot retaliate against you for lodging a complaint with the Secretary. Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Revoke Your Authorization to Use or Disclose Health Information. You have the right to revoke your authorization to use or disclose your health information except to the extent that action has already been taken. I. Changes to This Notice. We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in our office in the reception room. The notice will contain on the first page, in the top right-hand corner, the effective date. In addition, each time you come into our office for office visit, we will offer you a copy of the current notice in effect. J. Complaints. If you have questions and would like additional information or if you believe your privacy rights have been violated, you may file a written complaint by registered mail with the Privacy Officer/Contact Person whose name, address, and phone number are noted above. All complaints must be submitted in writing. You may also file a complaint with the Secretary of the Department of Health and Human Services. There will be no retaliation for filing a complaint. You will not be penalized for filing a complaint. K. Other Uses of Medical Information. Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission at any time, in writing and submitted by registered mail to the Privacy Officer/Contact Person whose name, address, and phone number are noted above. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you. L. Incidental Uses and Disclosures of Medical Information. Uses and disclosures of your protected health information that are incidental to the health care that we provide to you in this office may include, but are not limited to: (a) calling your name when you are in the office to take you from the reception area to the laboratory or to an exam room; (b) maintaining a > sign-in= sheet when you come into the office for your appointment; (c) placing copies of your chart on the door of your exam room for the doctor to carry-in when he/she enters the exam room to see you.