Patient Privacy

Privacy Practices

Eastover Family Care, P.C.

Effective Date - February 5, 2008

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.

Our Obligations

We are required to:

Maintain the privacy of protected health information. We have strict guidelines to insure only authorized employees have access to your medical records. We have 4 procedures in place that dictates to those employees how they must handle your confidential information to insure your privacy. We have security measures in our computer system that prevent unauthorized persons from accessing your medical information.

• Give you this notice of our legal duties and privacy practices regarding health information about you.

• Follow the terms of our notice that is currently in effect.

How we may use and disclose health information Described as follows are the ways we may use and disclose your health information. Except for the following purposes, we would disclose your health in-

formation only with your written permission.

• Treatment - We may use health information about

you to provide medical treatment or services. For example, we may need to disclose information to doctors, nurses, office staff or other personnel who need that information to provide you with medical care.

Payment- We may use health information about you so that we may bill and receive payment from you, an insurance company or a third party for the treatment and services you received. For example, we may need to release health information about you to obtain prior approval or benefit information from your insurance company.

• Appointment Reminders - We may contact you to remind you that you have an appointment for treatment or medical care at the office. If you do not wish to be contacted for appointment reminders, please notify us in writing.

Special Situations

We may use or disclose health information about you for the following purposes:

1. To avert a serious threat to health or safety -We may use and disclose health information when necessary to prevent a serious threat to your health and safety or safety of the public or another person. Disclosures would only be made to someone who may be able to help prevent the threat.

2. Required by law. - We will disclose health information about you when required to do so by Federal, State or Local Law.

3. Organ and Tissue 'Donation - If you are an organ donor, we may release health information to organizations that handle organ procurement or organ, eye and tissue transplantation or to any organ donation bank as necessary to facilitate such donation and transplantation.

4. Military, Veterans, National Security and Intelligence - If you were a member of the armed forces, or part of the national security or intelligence communities, we may be required by military command or other government authorities to release health information about you.

5. Workers Compensation We may release health information about you for workers compensation or similar programs. These programs provide benefits for work-related injuries or illnesses.

6. Public Health Risk - We may disclose health information about you for public health reasons in order to prevent or control disease, injury, disability, report births, deaths, suspected abuse or neglect, non-accidental physical injuries, reactions to medications, or problems with products.

7. Health Oversight Activities - We may disclose health information to a health oversight agency for audits, investigations, inspections, or licensing purposes. These disclosures may be necessary for certain State and Federal agencies to monitor the health care system, government programs and compliance with civil right laws.

8. Lawsuits and Disputes - If you are involved in a lawsuit or a dispute we may disclose health information about you in a response to a court or administrative order. Subject to all applicable legal requirements, we may also disclose health information about you in response to a subpoena.

9. Law Enforcement - We may release health information if asked to do so by a law enforcement officer in response to a court order, subpoena, warrant, summons or similar process, subject to all applicable legal requirements.

10. Coroners, Medical Examiners and Funeral Directors - We may release health information to a coroner or medical examiner. This may be necessary to identify a deceased person or determine the cause of death.

11. Inmates or Individuals in Custody - If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release health information to the correctional institution or law enforcement official. This release would be made if necessary for the institution to provide you with health care, to protect your health and safety or the health and safety of others or for the safety and security of the correctional institution.

12. Family and Friends - We may disclose health information about you to your family members or friends if we obtain your verbal agreement to do so or if we give you an opportunity to object to such a disclosure and you do not object. We may also disclose health information to your family or friends if we can infer from the circumstances, based on our professional judgment, that you would not object. For instance, we may assume you agree to our disclosure of your personal health information to another person when you bring that person with you into the examination room during treatment or while treatment is being discussed.

Your Rights

You have the following rights regarding health information we maintain about you:

1. Right to inspect and obtain a copy - You have the right to inspect and obtain a copy of your health information. To obtain a copy of your medical records please make a written request to our office manager. The fee for a copy of your records is twenty-five cents a page plus a ten-dollar administrative fee. Copies will be provided within 30 days of your request.

2. Right to Amend - If you believe health information we have about you is incorrect or incomplete, you may ask us to amend the information. To request an amendment, complete and submit a Medical Record Amendment/ Correction Form to our office manager. You may obtain this form at our front desk. We may deny your request if you information is already accurate and complete.

3. Right to an Accounting of Disclosures - You have the right to obtain a list of agencies that have received medical information about you other than for purposes of treatment, payment and health care operations or for which you provided written authorization.

4. Right to Request Restrictions - You have the right to request a restriction or limitation on the health information we use or disclose for treatment, payment or health care operations. You also have the right to request a limit on the health information we disclose to someone involved in your care or payment for your care, like a family member or friend. For instance, you could ask that we not share information about a particular diagnosis or treatment with your spouse. Please inform our office in writing if you want to restrict information.

5. Right to Request Confidential Communication 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 contact you only by mail or at work. To request confidential communication, please make your request in writing to our office. Your request must specify how or where you wish to be contacted. We will accommodate reasonable requests.


Changes to this Notice

We reserve the right to change this notice and make the new notice apply to health information we already have as well as any information we receive in the future. We will post a copy of our current notice at our office. The notice will contain the effective date on the first page.

If you believe your privacy rights have violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services. All complaints must be made in writing. You will not be penalized for filing a complaint.