ENT Specialists of Metairie
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.
Information about you is considered protected health information and we will take reasonable efforts and make reasonable safeguards to ensure that your information is protected from unauthorized use and disclosure. We will use and disclose your protected health information in accordance with the requirements of federal and state laws and regulations.
Your Privacy Rights
You have the right to:
- Receive a copy of our Notice of Privacy Policies
- Request access to your protected health information and/or a copy of your information.
- Request that we amend your protected health information.
- Request a restriction on our use and disclosure of your protected health information. We do not have to agree to the restriction.
- Request an accounting of the uses and disclosures of your protected health information. You can ask for an accounting for a period up to six years.
- Request accommodations regarding our communications to you. We will accommodate your request if we can reasonably do so.
- Opt out of a facility directory and restrict information about you that we may disclose to family, friends, caregivers and others.
- Revoke an authorization for specific use and disclosure.
Our Obligations for Privacy
- We will provide you with a Notification of our Privacy Practices and get your written acknowledgement that you receive it.
- We will use and disclose your protected health information only for treatment, payment and health care operations (with the exceptions listed below) without getting your written authorization allowing a specific use and disclosure.
- Exceptions to the requirement for an authorization are:
- Disclosures required by law, for public health or Food and Drug Administration (FDA) purposes, and for law enforcement purposes.
- Certain other disclosures may be made for health oversight activities, for deceased persons, for workers’ compensation purposes, and to the Secretary of the Department of Health and Human Services.
- We have a process where you can tell us your concerns and we can help resolve them.
If you have any questions about this notice, please contact (504) 889-5335 and ask for the Privacy Coordinator.
This Notice of Privacy Practices describes: Your rights to access and control your protected health information; and 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.
Protected health information 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 conditions and related health care services.
We are required to abide by the terms of this Notice of Privacy Practices. We reserve the right to 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. You can request a copy by any of the following methods:
- Calling (504) 889-5335 and asking for the Privacy Coordinator and requesting a copy be sent to you; or
- Asking for a copy at your next scheduled appointment or visit
Inspect and copy your records. You have a right to inspect your protected health information and obtain a copy. To review your protected health information, contact the Privacy Coordinator at (504) 889-5335. We will make arrangements for you to meet with the Privacy Coordinator and inspect and/or copy your information.
Request a restriction on your protected health information. You may ask that we not use or disclose any part of your protected health information for the purposes of treatment, payment or health care operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in our Notice of Privacy Practices. Your request must state what information is to be restricted and to whom you want the restriction to apply.
We are not required to agree to a restriction that you may request. If we do agree to the restriction, we will not use or disclose your protected health information in violation of that restriction unless it is needed to provide emergency treatment. Please discuss any restriction you wish to request with your health care provider. After discussing the restriction with your health care provider, you must request the restriction in writing. Send this request to the Privacy Coordinator at 4315 Houma Blvd., Suite 401, Metairie, LA 70006.
Receive confidential communications from us by alternate means or at an alternate location. We will accommodate reasonable requests to send communications to you by alternate means or at an alternate location. We may condition this accommodation by asking you for information as to how payment will be handled or for an alternate address or other means of contact. We will not ask you why you wanted this accommodation. Please request this accommodation in writing to our Privacy Coordinator at 4315 Houma Blvd., Suite 401, Metairie, LA 70006.
Amend your protected health information. You may request that we amend your protected health information in your medical record. In certain cases, we may deny your request for an amendment. If so, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of this rebuttal. Please contact our Privacy Coordinator to determine if you have any questions about amending your record. Any requested amendment that we agree to accept will be attached as an addendum to your medical record or linked to your medical record.
Receive an accounting of certain disclosure. You have the right to receive an accounting of disclosures of your protected health information for purposes other than treatment, payment or health care operations. This accounting excludes disclosures made to you, for a facility directory, to family members or friends involved in your care, or for notification purposes and for exceptions listed in this Notice. You have the right to receive specific information regarding these disclosures that occurred after April 14, 2003. You may request information about disclosures made up to six years. The right to receive this information is subject to certain expectations, restrictions and limitations. In any twelve-month period, the accounting report will be provided free of charge, but any additional reports during that period will be subject to a fee of $25.00.
Right to obtain a paper copy of this Notice. Upon admission to our care, you will be given a copy of this Notice. You have the right to receive an additional copy or revised copy. You can obtain a paper copy of this notice, even if you have agreed to receive this Notice electronically.
Uses and Disclosures of Protected Health Information
You will be asked to sign an acknowledgement of receipt of our Notice of Privacy Practices. You will be asked if you have received this Notice and you understand its contents. We may use your protected health information for the purposes of treatment, payment and health care operation. Following are examples of how we may use and disclose your protected health information for the purposes of treatment, payment and health care operations. These examples are not meant to be exhaustive, but to provide examples.
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 provided you with their Notice of Privacy Practices. For example, we would disclose your protected health information, as necessary, to a physician who is overseeing your care and to other physicians to whom you have been referred. Also, your protected health information may be provided to another 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 and reviewing coverage prior to providing services. We may report on those services to your payer, upon request.
Health care Operation: We may use or disclose, as needed, your protected health information to support the business activities of our office. These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical staff, licensing, marketing and fundraising activities, and conducting or arranging for other business activities.
For example, we may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment. Also, we may use a sign-in sheet or an assignment sheet. If we see you in an office setting, we may call you by name to tell you that we are ready to see you.
We will share your protected health care information with third party “business associates” that perform various activities (e.g., accreditation and financial services) for us. Whenever an arrangement between us and a business associate involves the use or disclosure of your protected health information, we will have a written contract that contains terms that will protect the privacy of your protected health information.
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 company and the services we offer, or to send you information about products or services that we believe may be beneficial to you. We may also send you a survey form asking you to comment about our services. Such surveys will be kept confidential, unless you tell us that you want us to share the information.
You may contact our Privacy Coordinator to request that any of these materials not be sent to you.
Release of Information
- I understand that as part of my healthcare, ENT Specialists of Metairie personnel and my physician create and maintain a record of the care and services provided. I also understand that such information may be used and/or disclosed in the management and delivery of care and services provided by ENT Specialists of Metairie to me, as described in the Notice of Privacy Practices.
- I understand and acknowledge that ENT Specialists of Metairie participates in an electronic medical record exchange program with other healthcare facilities and providers (“Exchange Participants”). I understand that when I seek treatment from ENT Specialists of Metairie or Exchange Participants, my health information may be shared electronically between ENT Specialists of Metairie and Exchange Participants in order to provide care and services to me, and I do hereby authorize ENT Specialists of Metairie to share my health information in this manner with Exchange Participants. I also understand that my health information may include certain sensitive Information such as genetic information and diagnoses or treatments for substance abuse, mental illness (excluding psychological notes) or communicable diseases (including HIV or AIDS), and some sensitive information cannot be disclosed through the medical exchange program without a separate authorization by me.
- I understand and acknowledge that as part of receiving my healthcare at ENT Specialists of Metairie, my physician and other personnel engaged in my care may electronically request my prescription medication history from participating pharmacies, pharmacy benefit managers, or payers, and that such prescription medication history may become part of my medical records.
Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law. You may revoke this authorization at any time, in writing, except to the extent that we have taken an action in reliance on the use and disclosure indicated in the authorization.
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 to or object to the use of disclosure of the protected health information, then our office, using professional judgment, will determine whether the disclosure is in your best interest; however, only the protected health information relevant to your health care will be disclosed.
Others involved in your health care: 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 we are required to treat you before receiving an acknowledgment of our Notice of Privacy Practices, we will try to obtain your acknowledgement as soon as reasonably practicable after the delivery of treatment.
Fundraising: We may use or disclose your demographic information and the dates that you received treatment, in order to contact you about fundraising activities supported by our office. If you do not want to receive these materials, contact our Privacy Coordinator and request that these materials not be sent to you.
Other Required and Permitted Uses and Disclosures
We may use and disclose your protected health information in the following circumstances without your authorization.
- Required by law. These situations include but are not limited to release of information requested under subpoena, court order or other legally required release. You will be notified, as required by law, of any such disclosure.
- 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.
- 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. Also, 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 (FDA). We may disclose your protected health information to a person or company required by the FDA to report adverse events, product defects or problems, biologic product
deviations, track products, to enable product recalls to make repairs or 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 and otherwise 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 at your workplace, and (6) a medical emergency where it is likely that a crime has occurred.
- Coroners, Funeral Directors and Organ Donations. 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 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 cadaver organ, eye or tissue donation purposes.
- Research. We may disclose your protected health information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure privacy.
- 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 authorities if you are a member of that foreign military service. We may also disclose your protected health information to authorized federal officials for conducting national security and intelligence activities, including for the provision of protected services for the President or others legally authorized.
- Workers’ Compensation. Our office may disclose your protected health information to comply with workers’ compensation laws and other 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.
- Required uses and disclosures. Under the law, we must make disclosures to you 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.
You may tell us or the Secretary of Health and Human Services if you believe your privacy rights have been violated. You may tell us your concerns by notifying our Privacy Coordinator or by writing to the Privacy Coordinator, 4315 Houma Blvd., Suite 401, Metairie, LA 70006.
You may contact our Privacy Coordinator at (504) 889-5335 for further information about this process and how we may assist you with your concerns. Effective date is April 14, 2003.