NOTICE OF PRIVACY PRACTICES
COASTAL ANESTHESIOLOGY MEDICAL ASSOCIATES (CAMA)
NOTICE OF PRIVACY PRACTICES
CAMA UNDERSTANDS THE IMPORTANCE OF PRIVACY AND IS COMMITTED TO MAINTAINING THE CONFIDENTIALITY OF YOUR MEDICAL INFORMATION. THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. IF YOU HAVE QUESTIONS ABOUT THIS NOTICE PLEASE CALL CAMA’S PRIVACY CONTACT NUMBER AT 805-542-0345.
Please note that CAMA does not keep your official medical record of the anesthesia treatment you received during surgery. That type of medical record—your “anesthesia record”— is maintained by the hospital, surgery center or doctor’s office where you had your surgery performed. CAMA maintains records pertaining to insurance, billing and payment of anesthesia medical care services, which are also considered protected health information.
Uses and Disclosures of Your Protected Health Information
The following paragraphs describe how your health information may be used or disclosed by CAMA. 1. CAMA is legally permitted to make the following types of uses and disclosures for each of the following purposes without separate written authorization: treatment, payment and health care operations (TPO). This means that CAMA may use your medical information for example:
Treatment: to provide anesthesia to you during surgery, refer you for other treatment or share information with another physician or medical staff person also treating you.
Payment: to determine eligibility or coverage benefits for insurance billing purposes, bill you or your insurance company for payment for services, or send your account for collections if necessary.
Healthcare Operations: to support operational activities of CAMA. These activities include but are not limited to quality assessment, employee review activities, training of employees, interns or volunteers (who are trained as workforce employees), and financial reporting activities. These activities may be carried out indirectly by a third party “Business Associate” with whom CAMA has a contract requiring them to also protect your health information.
CAMA may also share medical information about you with all the other health care providers, health care clearinghouses and health plans who participate in “organized health care arrangements” for any health care treatment, payment and operations activities, such as at all the hospitals and surgery centers where licensed CAMA staff provide anesthesia services.
These short examples are not meant to be the whole list; on the contrary, they are provided as simple educational information that illustrate the various types of disclosures that may be made by CAMA. CAMA is not required to account for (track) such disclosures made for treatment, payment or medical practice business operations.
2. CAMA is also legally permitted or sometimes legally required to use or disclose protected health information without your written authorization for the purposes which follow. CAMA may be required to provide an accounting of these disclosures upon your request, depending on the type of use or disclosure.
a) Uses and disclosures for public health activities, such as mandatory disease reports;
b) Mandatory reporting about victims of abuse, neglect or domestic violence;
c) Disclosures for health oversight activities;
d) Disclosures for judicial and administrative proceedings;
e) Disclosures for law enforcement purposes;
f) Uses and disclosures about decedents;
g) Uses and disclosures for cadaveric organ, eye or tissue donation purposes;
h) Disclosures to prevent a serious threat to health or safety; and
i) Uses and disclosures for specialized government functions where required by law, such as for military or national security purposes or to correctional institutions or law enforcement officers that have you in their lawful custody.
3. Other uses and disclosures may be made with your consent, authorization or opportunity to object. If you are not present or able to agree or disagree to the use or disclosure of your health information, or if you have not objected in writing, then a CAMA 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. We may use and disclose your protected health information in the following instances:
a) to others involved in your healthcare, such as a relative or close friend or any other person you identify, for instance, if they call to discuss your insurance coverage when you are unable to do so for yourself.
b) in an emergency treatment situation.
c) if there are communication barriers and it is determined that you intend to authorize the use or disclosure under the specific circumstances involved.
d) for worker’s compensation or similar programs.
4. Other uses and disclosures will be made only with your written authorization and you may revoke such authorization, in writing, at any time, except to the extent that CAMA has taken an action in reliance on the permission given in the original authorization.
Your Health Information Rights
The following paragraphs describe your rights with respect to your medical information. Please note that CAMA does not keep your official medical treatment (anesthesia) record. That record is maintained by the hospital, surgery center or doctor’s office where you had your surgery performed. CAMA maintains records pertaining to insurance, billing and payment of anesthesia medical care services, which are also protected health information. Regarding any protected health information CAMA does maintain, you have these rights:
1. The right to inspect and copy your protected health information. We will charge a reasonable fee for copying and mailing as allowed by California and federal law.
2. The right to receive confidential communications from CAMA. For example, you may ask that we not leave messages on your answering machine.
3. The right to request restrictions on certain uses and disclosures. However, CAMA is not required to agree to a requested restriction. If it does agree, it must not violate that agreement.
4. The right to request an amendment of your protected health information. CAMA is not required to amend such information although it is required to state in writing why it will not do so.
5. The right to receive an accounting of disclosures of protected health information. CAMA is not required to account for disclosures made which are either authorized by you, incidental (if the minimum necessary safeguard standards are met), or for treatment, payment or medical practice operations, or those disclosures made directly to you. Your request must be in writing and you must state a time period which may not be longer than six years and may not include dates before April 14, 2003.
6. The right to obtain a paper copy of the Notice of Privacy Practices from CAMA upon request, even if you have also agreed to receive the Notice electronically.
7. You may exercise these rights by contacting CAMA’s Privacy Contact office at P.O. Box 1185 San Luis Obispo, CA 93406-1185 Telephone: 805-348-4990 and making your request. If you need further detailed information about exercising any of the rights listed above, it will be provided to you in the form of CAMA’s more detailed policies and guidelines. If you request a copy of your health information, CAMA will charge a fee for the cost of copying, mailing or summarizing your information.
Note: CAMA does not keep your official medical treatment (anesthesia) record. Your official medical record is kept at the hospital, surgery center or doctor’s office where you had your medical procedure. CAMA keeps health information connected with billing and claims only, such as information about your insurance company, your payment records or the codes used for billing, which are also considered protected health information.
Medical Practice’s Duties
1. CAMA is required by law to maintain the privacy of confidential information and to provide you with Notice of its legal duties and privacy practices with respect to such information (this Notice of Privacy Practices or one supplied by a organized health care arrangement, such as a hospital or surgery center);
2. CAMA is required to abide by the terms of the Notice of Privacy Practices currently in effect;
3. CAMA reserves the right to amend this Notice of Privacy Practices at any time. After an amendment is made, the revised Notice will apply to all protected health information that CAMA maintains, regardless of when it was created or received. CAMA will keep a copy of our current Notice posted at our Privacy Contact Office.
You may complain to CAMA or to the Secretary of the Department of Health & Human Services if you believe your privacy rights have been violated by CAMA. You may file a complaint with CAMA by contacting CAMA’s Privacy Contact office in writing at HIPAA Privacy Office, P.O. Box 1185
San Luis Obispo, CA 93406-1185 Telephone: 805-348-4990 and asking for a copy of CAMA’s Complaint and Guidelines Form. CAMA will not retaliate against you for filing a complaint.
The date on which this Notice is first in effect is April 14, 2003.
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