HIPPA Notice of Patient Privacy Practices

Genesis ENT & Plastic Surgery, PLLC

Genesis Anti-Aging & Cosmetic Surgery

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

PLEASE REVIEW CAREFULLY

We understand that the privacy of your personal information is important to you and we want you to understand our commitment to protecting that information.  This Notice describes our privacy policies and procedures and how we may use your protected health information (PHI) to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law.  “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health condition and related health care services.

Legal Duties:  

We are required by law to maintain the privacy of your health information and to give you this Notice describing our legal duties and privacy practices.  We are required to follow the terms of the Notice as described.

Use & Disclosure of Health Information: 

We will not use or disclose your health information without your authorization except in the following situations:

Treatment: 

We primarily use and disclose your health information for treatment purposes, in coordinating or managing of your healthcare and to other healthcare providers (such as your primary care or referring physician) to assist them in treating you.

Payment: 

We use your health information to obtain compensation or provide reimbursement for providing your health care.  We may send a bill to you or your health plan which may include information that identifies you, your diagnosis, procedures and supplies used.  We may also disclose information so that your health plan can determine eligibility for benefit payments.

Health Care Operations:

We use your health information in conducting the administrative components of your health care.  We may conduct an internal review of your record to evaluate the quality of care we provide.

Business Associates:

We may disclose your health information to some contracted business associates so that they can do the jobs we’ve asked them to do, such as auditing and accounting. 
We require them to take precautions to protect your health information.

Communication With Family: 

We may use or disclose information to relay or assist in relaying your location and general condition to a family member or other person responsible for your care.  We may disclose to a family member, other relative, close friend or any other person you identify, health information relevant to that person’s involvement in your care.

Food and Drug Administration:

We may disclose to the FDA health information relative to adverse events, product defects, or post-marketing surveillance information to enable product recalls, repairs or replacements.

Public Health: 

As required by law, we may disclose information to public health or legal authorities charged with preventing or controlling disease, disability, or injury, including child abuse and neglect.  We may disclose your information to appropriate governmental agencies if we reasonably believe you are a victim of abuse, neglect or domestic violence.  We may disclose or use health information when it is our good faith belief, consistent with legal and ethical standards, that it is necessary to prevent or lessen a serious or imminent threat to public health or safety, or is necessary to identify or apprehend an individual who so threatens.

Health Oversight:

We may disclose your health information to oversight activities authorized by law, such as audits, and civil administrative or criminal investigations in order to oversee health care systems, government benefits programs, entities subject to governmental regulations and civil rights laws for which health information is necessary to determine compliance.

Workers Compensation: 

We may disclose health information when authorized and necessary to comply with workers compensation laws or other similar programs.

Other Circumstances Consistent With Applicable Law: 

We may disclose information to appropriate research projects which ensure the privacy of your health information; to funeral directors, coroners, and medical examiners to help them carry out their duties; to entities related to organ procurement, banking or transplantation of organs for the purpose of tissue donation and transplant.

Law Enforcement and Legal Proceedings:

Under specific circumstances we may disclose information to law enforcement or court officials, including reporting required by law, pursuant to certain subpoenas or court orders, reporting limited information concerning identification and location at the request of a law enforcement officer, reporting regarding suspected victims of crimes at the request of a law enforcement officer, reporting death, crimes on our premises, and crimes in emergencies.  If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release health information about you to the correctional facility or law enforcement official so that the facility can provide you with health care, to protect your health and safety or that of others, or for the health and safety of the correctional facility.

Specialized Government Functions: 

As required, we may disclose or use health information for national security and intelligence activities, protective services for the President and others, medical suitability determinations for the State Department, for correctional institutions and other law enforcement custodial circumstances, and for public benefit government programs.

Other Uses of Health Information: 

We may contact you as an appointment reminder and leave a message on your voice mail or with an individual who answers the telephone.  We may contact you by letter, electronic mail or telephone to notify you of products and services, treatment alternatives or other health benefits that may be of interest to you.

Prohibitions On Other Use Or Disclosures: 

In all other situations, Genesis ENT & Plastic Surgery, PLLC must obtain your written authorization prior to the use or disclosure of your personal health information.  You may revoke that written authorization by writing to the privacy officer listed at the end of this Notice; however, we are unable to take back any disclosure we have already made with your permission.  We will not use any photograph, video or other likeness of you without your written permission.

You have rights concerning the confidentiality of your health information. All requests must be IN WRITING to the Privacy officer listed below.  You have the right to receive confidential communications about you at a certain location in a specific manner.  You have the right to review or obtain a copy of your health information.  In certain circumstances we may deny this request.  If you are denied access to your health information, you may request that the denial be reviewed.  The person conducting the review will not be the person who denied the request and we will comply with the outcome of the review.  You have the right to request that we amend your health information if you feel it is inaccurate or incomplete; you must supply a reason to support this request for this to be considered. We may deny this request if the health information was not originally created by us, is not part of the information kept by us, or is information you would not be permitted to inspect or copy.  You have the right to request restrictions on the use and disclosure of your health information for treatment, payment and health care operations except when required by law or in an emergency.  We are not required to agree to this request but will review and consider each case on its merits.  You have the right to an accounting of disclosures of your health information for reasons other than treatment, payment, related administrative purposes or on your authorization; it also excludes disclosures we have made to you or to those involved in your care.  You have a right to receive a copy of this Notice.

Changes To This Notice:

We reserve the right to change our privacy practices and apply the revised practices to all information maintained about you.  Any revision to our privacy practices will be described in a revised Notice that will be displayed in our facility.

PRIVACY OFFICER

Please contact our Privacy Officer for concerns, complaints, written requests or other information regarding the privacy of your health information.  He may be reached in writing at:  Henry Ford, Privacy Officer Genesis ENT & Plastic Surgery, PLLC, 14835 John J. Delaney Drive, Suite 210, Charlotte, North Carolina,

28277-2738 or you may call (704) 544-1300.