Effective April 14, 2003
This notice describes how medical information about you may be used and disclosed and how you can obtain access to this information. Please review it carefully. If you have any questions about this notice, please contact us.
Our Pledge Regarding Medical Information
We are required by law to:
make sure your health information is kept private;
give you this notice of our legal duties and privacy practices; and
follow the terms of this notice.
We understand that your health information is personal.
We create a record of the care and services you receive. We need this record to provide you with
quality care and to comply with certain legal requirements.
We are committed to protecting this information.
This Notice Will Tell You About:
the ways in which we may use and disclose your health information;
your rights; and your obligations regarding the use and disclosure of health information.
How We May Use And Disclose Your Health Information
We may use or share your health information in certain ways. We will explain how and when we may use or share your health information. We are not able to list each specific way in which we may use or share your health information, but each situation will fall into one of the basic types of situations outlined below:
FOR TREATMENT: In order to effectively treat you, it is important that we be able to use or share your information. We may share your information with doctors, nurses, medical students, or other personnel who are involved in your care.
For your treatment purposes, we may share your information with healthcare providers outside of Ohio Reproductive Medicine. For example, we may need to include records when updating your referring physician on your progress.
Also, we may need to share your information with an outside medical professional in order to schedule you for a surgery or procedure.
FOR PAYMENT: We may use or share your health information to ensure we are paid for the cost of your care. We may share your information with another provider so he or she may be paid for services as well. We may bill and share information with other providers, an insurance company, you, or a third party. For example, we may need to give your health plan provider information about your diagnosis and treatment so they will pay us or reimburse you for the care we provided. We may also inform your health plan provider about a treatment you are going to receive so as to obtain prior approval or to determine whether your plan will cover such treatment. We may also share your health information with another provider who has participated in your care in order to facilitate payment.
FOR HEALTHCARE EVALUATION: We may use and share your health information for healthcare evaluation purposes. These uses and disclosures are necessary to run our facility and ensure that all our patients receive quality care.
For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine medical information about many of our patients to decide what additional services we should offer, what services are not needed, and whether certain new treatments are effective.
We may also disclose information to doctors, nurses, technicians, student trainees, and other healthcare facility personnel for review and learning purposes. We may combine the medical information we have with medical information from other facilities to compare how we are doing and to see where we can make improvements in the care and services we offer. When we share medical information with other facilities for this type of comparison, we remove all information that identifies you so others may use it to study health care and healthcare delivery without knowing who you are.
APPOINTMENT REMINDERS: We may use and disclose medical information to contact you as a reminder that you have an appointment. If you do not wish to receive appointment reminders, or you wish to be contacted at a certain telephone number, be sure to tell us.
HEALTH-RELATED BENEFITS AND SERVICES: We may use and disclose medical Information to inform you of treatment options, health-related benefits, or services that may be of interest to you.
INDIVIDUALS INVOLVED IN YOUR CARE OR PAYMENT FOR YOUR CARE: We may release medical information about you to a family member or other designated person who is involved in your medical care. We may also give information to someone who helps pay for your care. For example, we may need to tell the person who comes to pick you up after your appointment what he or she needs to do to help you once you get home. In the event of an emergency, we may need to use or share information about you in order to inform your family or persons responsible for your care where you are and what your condition is.
SPECIAL SITUATIONS: Additional uses and disclosures for which authorization or opportunity to agree or object is not required by the Health Insurance Portability and Accountability Act (HIPAA).
RESEARCH: You may have the opportunity to be a part of Ohio Reproductive Medicine’s research efforts. Under certain circumstances, we may use and disclose medical information about you for research purposes, or we may contact you about research projects for which you may qualify.
All research projects are subject to a special approval process before we use or disclose medical Information. We also may disclose medical information about you to people who are preparing to conduct a research project. They may be looking for patients with specific needs or for certain information. In either case, the medical information they review will be kept confidential.
AS REQUIRED BY LAW: We will disclose medical information about you when required to do so by federal, state, or local law.
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 to the health and safety of the public or another person.
VICTIMS OF ABUSE, NEGLECT, OR DOMESTIC VIOLENCE: We may disclose certain health information to government agencies that are authorized by law to receive reports of abuse, neglect, or domestic violence if we believe you have been a victim of such events.
HEALTH OVERSIGHT ACTIVITIES: We may disclose medical information to a health oversight agency for activities that are authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure.
JUDICIAL AND ADMINISTRATIVE PROCEEDINGS: We may disclose your health information in the course of an administrative or judicial proceeding, such as in response to a court order.
LAW ENFORCEMENT: We may release medical information about you to law enforcement officials if required to do so by law.
Uses Of Medical Information That Require Authorization
In all other situations (situations that are not treatment-related, payment-related, healthcare evaluation-related, or special situations, as mentioned above), we may only share information with your specific written authorization.
You may revoke that authorization, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization, except to the extent that we already have used or disclosed such information.
Your Rights Regarding Medical Information About You
Although the physical form of your medical information or designated record set is our business record and is the property of Ohio Reproductive Medicine, the information contained therein is your information, and you have certain rights regarding that information.
You have the following rights regarding medical information we maintain about you:
Right To Review And Copy: You have the right to inspect and obtain a copy of medical information that may be used to make decisions about your care.
Usually, this information includes medical and billing records, but does not include records forwarded to us from another facility or physician or certain lab test results subject to the Clinical Laboratories Improvement Act of 1988. You must submit your request for your medical information in writing. If you request a copy of this information, we may charge a fee for the costs of copying, mailing, or other supplies associated with your request.
Right To Appeal A Denial Of Access To Medical Information: You have a right to access your medical information. There are, however, some limitations on that right. If for clear treatment reasons your physician has determined that access to your health information is likely to have an adverse effect on you, the physician shall provide the record to a practitioner who has been designated by you to assist you in your review of the information.
Right To Amend: If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend that information. You have the right to request an amendment for as long as the information is maintained. We may deny your request if you ask us to amend information that:
is not part of the information you would be permitted to inspect and copy; or
we believe is accurate or complete.
Submit your request for amendment to your physician. Your request must be made in writing and include a reason that supports your request.
Right To Accounting Of Disclosures: You have the right to request an accounting of disclosures. This is a list of health/medical information disclosures about you that we have made to others in certain “special situations” as listed above.
These disclosures are not related to treatment, payment, or healthcare evaluation and occur when we are not required to obtain your authorization before we share your information with others.
You must submit your request for accounting disclosure in writing. Your request must tell us the calendar dates you want to see. The time period cannot include more than six years of information and cannot begin prior to April 14, 2003. There will be no charge for the first list you request within a 12-month period. We may, however, charge you for the costs of providing any additional lists. In that event, we will notify you of the cost involved. 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 health information we use or disclose about you for treatment, payment, or healthcare evaluation purposes. We are not, however, required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment. You must make your request for restriction in writing. In your request, you must tell us what information you want to limit and whether you want to limit our use, disclosure, or both.
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 home. You must make your request for confidential communication made known to us. We will not ask you the reason for your request and we will accommodate all reasonable requests.
Right to a paper copy of this notice: You have the right to a paper copy of this notice. You may ask for a copy of this notice at any time. Click here to print a copy of this entire notice.
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 for any information we receive in the future. Current copies of this notice will be available in our office at the front desk. The current notice will also be posted at our website: www.ohiorepromed.com. The effective date of the notice will be posted on the first page.
Ohio Reproductive Medicine is dedicated to ensuring your privacy rights, consistent with the Health Insurance Portability and Accountability Act (HIPAA).
If you believe your privacy rights have been violated, you may file a complaint with our office. All complaints must be made in writing and be mailed to us. You will not be penalized for filing a complaint.