Privacy Policy
Our Practice
Turkle & Associates Cosmetic Surgeons in Indianapolis,
Indiana
HIPAA Privacy Policy
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 Contact, Jeanine Turpin.
This notice of Privacy Practices describes 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. It also describes your rights to access and
control your protected health information. “Protected
health information” is information about you,
including demographic information, that may identify
you and that relates to your past, present and future
physical or mental health or condition and related
health care services.
We are required to abide by the terms of this Notice
of Privacy Practices. We may change the terms of our
notice at any time. The new notice will be effective
for all protected health information that we maintain
both before and after the change. Upon your request,
we will provide you with any revised Notice of Privacy
Practices by calling the office and requesting that
a revised copy be sent to you in the mail or asking
for one at the time of your next appointment.
1. Uses and Disclosures of Protected Health Information
You will be asked by your physician to sign this Notice
of Privacy Practices. We will make a good faith effort
to obtain a written acknowledgement that you received
this Notice of Privacy Practices for Protected Health
Information the first time we provide the services
to you after April 14, 2003 or as soon as reasonably
practicable under the circumstances. Your protected
health information may be used and disclosed by your
physician, our office staff and others outside of our
office that are involved in your care and treatment
for the purpose of providing health care services to
you. Your protected health information may also be
used and disclosed to obtain payment for your health
care bills and to support the operation of the physician’s
practice.
Following are examples of the types of uses and disclosures
of your protected health care information that the
physician’s office is permitted to make. These
examples are not meant to be exhaustive, but to describe
the types of uses and disclosures that may be made
by our office.
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 may need access to your protected
health information. For example, we would disclose
your protected health information, as necessary, to
a home or health agency that provides care to you.
We will also disclose protected health information
to other physicians who may be treating you. For example,
your protected health information may be provided to
a physician to whom you have been referred to ensure
that the physician has the necessary information to
diagnose or treat you.
In addition, we may disclose your protected health
information from time-to-time to another physician
or 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 diagnoses 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, reviewing
services provided to you for medical necessity and
undertaking utilization review activities. For example,
obtaining approval for a hospital stay may require
that your relevant protected health information be
disclosed to the health plan to obtain approval for
the hospital admission.
Healthcare operations. We may use or disclose, as
needed, your protected health information in order
to support the business activities of your physician’s
practice. These activities include, but are not limited
to, quality assessment activities, employee review
activities, training of medical students, licensing,
and conducting or arranging for other business activities.
For example, we may disclose your protected health
information to medical school students that see patients
at our office. In addition, we may use a sign-in sheet
at the registration desk where you will be asked to
sign your name and indicate your physician. We may
also call you by name in the waiting room when your
physician is ready to see you. We may use or disclose
your protected health information, as necessary, to
contact you to remind you of your appointment.
We will share your protected health information with
a third party “business associate” that
perform various activities (e.g., billing, transcription
services) for the practice. Whenever an arrangement
between our office and a business associate involves
the use or disclosure or 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 practice and the services we offer. We may also
send you information about products or services that
we believe may be beneficial to you. You may contact
our Privacy Contact to request that these materials
not be sent to you.
We may use or disclose your demographic information
and the dates that you received treatment from your
physician, as necessary, in order to contact you for
fundraising activities supported by our office. If
you do not want to receive these materials, please
contact our Privacy Contact and request that these
fundraising materials not be sent to you.
Uses and Disclosures of Protected Health Information
Bases Upon Your Written Authorization
Other uses and disclosures of your protected health
information will be made only with your written authorization,
unless otherwise permitted or required by law as described
below. You may revoke this authorization, at any time,
in writing, except to the extent that your physician
or the physician’s practice has taken an action
in reliance on the use or disclosure indicated in the
authorization.
Other Permitted and Required Uses and Disclosures
that may be made without Your Authorization or 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 or object to the use
or disclosure of the protected health information,
then your physician may, using professional judgment,
determine whether the disclosure is in your best interest.
In this case, only the protected health information
that is relevant to your health care will be disclosed.
Facility Directories. Unless you object, we will use
and disclose in our facility directory your name, the
location at which you are receiving care, your condition
(in general terms), and your religious affiliation.
All of this information, except religious affiliation,
will be disclosed to people that ask for you by name.
Members of the clergy will be told your religious affiliation.
Others Involved In Your Healthcare. 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 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 this happens, your physician shall try to obtain
your acknowledgment of our Privacy Practices as soon
as reasonably practicable after the delivery of treatment.
If your physician or another physician in the practice
is required by law to treat you and the physician has
attempted to attain your acknowledgment, but is unable,
he or she may still use or disclose your protected
health information for treatment, payment, and health
care operations.
Communication Barriers. We may use and disclose your
protected health information if your physician or another
physician in the practice attempts to obtain an acknowledgment
of our Private Practices from you, but is unable to
do so due to substantial communication barriers.
Other Permitted and Required Uses and Disclosures
that may be made without Your Consent, Authorization
or Opportunity to Object
We may use or disclose your protected health information
in the following situations without your acknowledgement
or authorization. These situations include:
Required by Law
Public Health
Communicable Diseases
Health Oversight
Abuse or Neglect
Food and Drug Administration
Legal Proceedings
Law Enforcement
Coroners, Funeral Directors and Organ Donation
Research
Criminal Activity
Military Activity and National Security
Workers’ Compensation
Inmates
Required Uses and Disclosures
2. Your Rights
Following is a statement of your rights with respect
to your protected health information and a brief description
of how you may exercise these rights.
You have the right to inspect and copy your protected
health information. This means you may inspect and
obtain a copy of protected health information about
you that is contained in a designated record set for
as long as we maintain the protected health information.
A “designated record set” contains medical
and billing records and any other records that your
physician and the practice uses for making decisions
about you.
Under federal law, however; you may not inspect or
copy the following records: psychotherapy notes; information
compiled in reasonable anticipation of, or use in,
a civil, criminal, or administrative action or proceeding;
and protected health information that is subject to
law that prohibits access to protected health information.
Depending on the circumstances, a decision to deny
access may be reviewable. In some circumstances, you
may have the right to have this decision reviewed.
Please contact our Private Contact if you have questions
about access to your medical record.
You have the right to request a restriction of your
protected health information. This means you may ask
us not to use or disclose any part of your protected
health information for the purpose 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 this Notice of Privacy Practices. Your request must
state the specific restriction requested and to whom
you want the restriction to apply.
Your physician is not required to agree to a restriction
that you may request. If a physician believes it is
in your best interest to permit use and disclose of
your protected health information, your protected health
information will not be restricted. If your physician
does agree to the requested restriction, we may not
use or disclose your protected health information in
violation of that restriction unless it is needed to
provide emergency treatment. With this in mind, please
discuss any restriction you wish to request with your
physician. You may request a restriction by submitting
a written request to our Privacy Contact.
You have the right to request to receive confidential
communications from us by alternative means or at an
alternative location. We will accommodate reasonable
requests. We may also condition this accommodation
by asking you for your information as to how payment
will be handled or specification of an alternative
address or other method of contact. We will not request
an explanation from you as to the basis for the request.
Please make this request in writing to our Privacy
Contact.
You may have the right to have your physician amend
your protected health information. This means you may
request an amendment of protected health information
about you in a designated record set for as long as
we maintain this information. In certain cases, we
may deny your request for an amendment. If we deny
your request for amendment, you have the right to file
a statement of disagreement with us and we may prepare
our rebuttal to your statement and will provide you
with a copy of any such rebuttal. Please contact our
Privacy Contact if you have questions about amending
your medical record.
You have the right to receive an accounting of certain
disclosures we have made, if any, of your protected
health information. This right applies to disclosures
for purposes other than treatment, payment or healthcare
operations and valid authorizations or incidental disclosures
as described in this Notice of Privacy Practices. It
excludes disclosures we may have made to you, for a
facility directory, to family members or friends involved
in your care, or for notification purposes. You have
the right to receive specific information regarding
these disclosures that occurred after April 14, 2003.
You may request a shorter timeframe. The right to receive
this information is subject to certain expectations,
restrictions and limitations.
You have the right to obtain a paper copy of this
notice from us, upon request, even if you have agreed
to accept this notice electronically.
3. Complaints
You may complain to us or to the Secretary of Health
and Human Services if you believe your privacy rights
have been violated by us. You may file a complaint
with us by notifying our Privacy Contact of your complaint.
We will not retaliate against you for filing complaint.
You may contact our Privacy Contact, Jeanine Turpin
at 317-848-0001 for further information about the complaint
process.
This notice was published and becomes effective
on April 14, 2003. |
