Contact: Cathy Golas
Updated:
May 12, 2008
© Phillips Academy |
NOTICE OF PRIVACY PRACTICES
This notice describes how medical information about your child may
be used and disclosed and how you can get access to this information.
Please review it carefully.
This Notice of Privacy Practices is mandated by the Health Insurance
Portability and Accountability Act of 1996 ("HIPAA"). It
describes how we may use and disclose your child’s 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
child’s protected health information. "Protected health
information" is information about your child, including demographic
information, that may identify him or her and that relates to his
or her past, present or 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. Any such new notice will be effective
for all protected health information that we maintain at that time. Upon your
request, you may obtain any revised Notice of Privacy Practices by calling us
and requesting that a revised copy be sent to you in the mail or asking for one
at the time of your next visit.
1. Uses and Disclosures of Protected Health Information
Uses and Disclosures of Protected Health Information Based Upon Your Written
Consent
You will be asked to sign a consent form regarding use and disclosure of your
child’s protected health information for treatment, payment and health
care operations. With your consent, Isham Health Center will use or disclose
your child’s protected health information as described below.
Your child’s protected health information may be used and disclosed by
Isham Health Center, his or her treating physician at Isham Health Center, our
staff and others outside Isham Health Center that are involved in your child’s
care and treatment for the purpose of providing health care services to him or
her. Your child’s protected health information may also be used and disclosed
to pay health care bills and to support the operation of Isham Health Center.
Set forth below are examples of the types of uses and disclosures of your child’s
protected health care information that Isham Health Center is permitted to make.
These examples are not meant to be exhaustive, but rather to describe for you
the types of uses and disclosures that may be made by Isham Health Center.
Treatment: We may use and disclose your child’s protected health information
to provide, coordinate, or manage your child’s health care and any related
services. For example, we may disclose your child’s protected health information
to a physician or health care provider (e.g., a specialist or a laboratory) who,
at the request of your child’s physician or Isham Health Center, becomes
involved in your child’s care.
Payment: Your child’s protected health information may be used, as needed,
to obtain payment for your child’s health care services. For example, obtaining
approval for a hospital stay may require that your child’s relevant protected
health information be disclosed to a health plan to obtain approval for the hospital
admission.
Healthcare Operations: We may use or disclose, as needed, your child’s
protected health information in order to support the normal business activities
of Isham Health Center. Examples of these activities include, but are not limited
to, quality assessment activities, employee review activities, training, licensing,
and conducting or arranging for other business activities.
We also may need to share your child’s protected health information with
certain of its “business associates,” third parties that perform
various activities (e.g., billing, transcribing medical records) for Isham Health
Center. Whenever an arrangement between Isham Health Center and a business associate
involves the use or disclosure of your child’s protected health information,
we will have in place the legally required safeguards to protect the privacy
of your child’s health information.
Uses and Disclosures of Protected Health Information Based upon Your Written
Authorization
Other uses and disclosures of your child’s protected health information
will be made only with your written authorization, unless otherwise permitted
or required by law as described below. You may revoke your authorization, at
any time, in writing, except to the extent that Isham Health Center has taken
an action in
reliance on the use or disclosure indicated in the authorization.
Other Uses and Disclosures That May Be Made and to Which You May Agree or Object
In the circumstances listed below, you may agree or object to the use or disclosure
of the protected health information in the manner described. In the absence of
agreement or objection, Isham Health Center may, using professional judgment,
determine whether the disclosure of health information is in your child’s
best interest. If such a determination is made, only the protected health information
that is relevant to your child’s health care will be disclosed.
Others Involved in Your Child’s 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 child’s protected health information that directly relates
to that person’s involvement in your child’s 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 child’s best interests,
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 child’s care of your child’s
location, general condition or death. Finally, we may use or disclose your child’s
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 child’s health care.
Emergencies: In an emergency treatment situation, we may have to use or disclose
your child’s protected health information in a context in which consent
for the release of information has not already been given. If this happens, Isham
Health Center will try to obtain your consent to the release of information as
soon as reasonably practicable after the delivery of the treatment. If Isham
Health Center is required by law to treat your child and has attempted to obtain
your consent but is unable to obtain your consent, it may still use or disclose
your child’s protected health information to treat him or her.
Other Permitted and Required Uses and Disclosures That May Be Made Without
Your Consent, Authorization or Opportunity to Object
There are other circumstances in which we may have to use or disclose your child’s
protected health information, even without your consent or authorization. These
situations include:
Communication Barriers: If Isham Health Center attempts to obtain consent from
you but is unable to do so due to substantial communication barriers and Isham
Health Center determines, using professional judgment, that you would consent
to the use or disclosure under the circumstances, we may use and disclose your
child’s protected health information.
Disclosure Required By Law: We may use or disclose your child’s protected
health information to the extent that the use or disclosure is required by law.
The use or disclosure will be made in compliance with the law and will be limited
to the relevant requirements of the law. You will be notified, as required by
law, of any such uses or disclosures.
Public Health: We may disclose your child’s 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 child’s protected health information, if directed by the
public health authority, to a government agency that is collaborating with the
public health authority.
Communicable Diseases: We may disclose your child’s 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 or condition.
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 child’s protected health information
to a government authority that is authorized by law to receive reports of child
abuse or neglect. In addition, we may disclose
your child’s protected health information if we believe that your child
has 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: We
may disclose your child’s protected health
information to a person or company required by the Food and Drug Administration
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 or Administrative Proceedings or Investigations: We may disclose protected
health information in the course of any judicial or administrative proceeding
or investigation, 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 or request.
Law Enforcement: We may disclose protected health information, so long as applicable
legal requirements are met, for law enforcement purposes. These law enforcement
purposes include requests: (1) pursuant to legal processes or as otherwise required
by law; (2) for limited information for identification and location purposes;
(3) pertaining to potential victims of a crime; (4) relating to suspicion that
a death has occurred as a result of criminal conduct; (5) in the event that a
crime occurs at Isham Health Center; or (6) relating to a medical emergency (not
at Isham Health Center) and it is necessary to alert law enforcement regarding
a potential crime.
Coroners, Funeral Directors, and Organ Donation: 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 may also disclose protected health information to a funeral
director, as authorized by law, in order to permit the funeral director to carry
out his/her duties. We may disclose such information in reasonable anticipation
of death. Protected health information may be used and disclosed for cadaveric
organ, eye or tissue donation purposes.
Threat to Public Safety: Consistent with applicable federal and state laws, we
may disclose your child’s 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.
2. Your Rights
Set forth below is a statement of your rights with respect to your child’s
protected health information and a brief description of how you may exercise
these rights.
You have the right to inspect and copy your child’s protected health information.
This means you may inspect and obtain a copy of protected health information
about your child 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 Isham Health Center uses
for making decisions about your child.
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. In some circumstances, you may have a right to review a decision
that denies you access to information. Please contact our Privacy Contact if
you have questions about access to your child’s health information.
You have the right to request a restriction on the use or disclosure of your
child’s protected health information. This means you may ask us not to
use or disclose any part of your child’s protected health information for
the purposes of treatment, payment or healthcare operations. You may also request
that any part of your child’s protected health information not be disclosed
to family members or friends who may be involved in your child’s 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. However, Isham Health Center is not required to agree to
a restriction that you request. If Isham Health Center believes it is in your
child’s best interest to permit use and disclosure of your child’s
protected health information, your child’s protected health information
will not be restricted. If Isham Health Center does agree to a requested restriction,
we may not use or disclose your child’s protected health information in
violation of that restriction unless it is needed to provide emergency treatment
for your child. With this in mind, please discuss any restriction you wish to
request in advance with the Privacy Contact listed below.
You have the right to request to receive confidential communications of your
child’s protected health information from Isham Health Center by alternative
means or at an alternative location. We will accommodate reasonable requests.
We also may condition this accommodation by asking you for 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 such requests in writing to our Privacy Contact.
You may have the right to have Isham Health Center amend your child’s protected
health information. This means you may request an amendment of protected health
information about your child 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 a 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 child’s medical record.
After new HIPAA privacy regulations go into effect on April 14, 2003, you have
the right to receive an accounting of certain disclosures we have made, if any,
of your child’s protected health information. This right does not apply
to all disclosures; in particular, it does not apply to disclosures for purposes
necessary to carry out treatment, payment or healthcare operations as described
in this Notice of Privacy Practices. It excludes disclosures we may have made
to you, your child, to family members or friends involved in your child’s
care, or for notification purposes. The right to receive this information is
subject to additional exceptions, restrictions and limitations.
3. Complaints
You may complain to us or to the Secretary of Health and Human Services if you
believe your child’s 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 or your child for the filing of such a complaint. |
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You
may reach us via 'snail' mail:
Isham Health Center
180 Main Street, Andover MA 01810-4161
978-749-4455
for
further information about this notice and the policies and procedures
set forth herein.
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