NOTICE OF PRIVACY PRACTICES OF NEVADA MEDICAL CLINIC

Notice of Privacy Practices For Nevada Medical Clinic

The Administrator is responsible for developing the Notice of Privacy Practices.

Uses and Disclosures

Treatment: Your health information may be used by staff members or disclosed to other health care professionals for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. For example, results of laboratory tests and procedures will be available in your medical record to all health professionals who may provide treatment or who may be consulted by staff members.

Payment: Your health information may be used to seek payment from your health plan, from other sources of coverage such as an automobile insurer, or from credit card companies that you may use to pay for services. For example, your health plan may request and receive information on dates of service, the services provided, and the medical condition being treated. You have the right to restrict certain disclosures of PHI to a health plan/ PBM/insurance when payment Is made in full and out of pocket by the individual or the responsible party. This means if you choose not to file insurance on a specific visit and PAY IN FULL at the time of service, we cannot bill your insurance or will be in violation.

Health care operations: Your health information may be used as necessary to suppport the day to day activities and management of Nevada Medical Clinic. For example, information on the services you received may be used to support budgeting and financial reporting and activities to evaluate and promote quality.

Law Enforcement: Your health information may be disclosed to law enforcement agencies to suppport government audits and inspections to facilitate law enforcement investigations, and to comply with government mandated reporting.

Public Health Reporting: Your health information may be disclosed to public health agencies as required by law. For example, we are required to report certain communicable diseases to the state’s public health department. Other uses and disclosures require your authorization. If you change your mind after authorizing a use or disclosure of your information, you may submit a written revocation of the disclosure of information that occurred before you notified us of your decision to revoke your authorization.

Additional Uses of Information: Appointment Reminders: Your health information can be used by our staff to send you appointment reminders. Information about treatments: Your health information may be used to send you information that you may find interesting on the treatment and management of your medical condition. We may also send you information describing other health-related products and services that we believe may interest you. Fund Raising : We will not use your name or/and information for any marketing or sales, no PHI will be used unless you have agreed by signing an authorization form used for marketing purposes and sales; this must all be disclosed in the form.

Note:

An additional use or disclosure that the privacy rule requires concerns disclosure of information to plan sponsors. This infor­mation is, however, relevant only to disclosures by a health insurance issuer (including an HMO) to a group health plan. If, however, a prac­tice is preparing a notice for use by a health plan that it sponsors, this use or disclosure should be listed.

Individual rights

You have certain rights under the federal privacy standard. These include:

•   The right to request restrictions on the use and disclosure of your protected health information.

•   The right to receive confidential communications concerning your medical condition and treatment.

•  The right to inspect and copy protected health information.

•   The right to amend or submit corrections to your protected health Information in the event an error by the medical provider or staff was created.

•   The right to receive an accounting of how and to whom your protected health information has been disclosured.

• The right to restrict certain disclosures of PHI to a health plan/PBM/insurance when payment is made in full and out of pocket by the individual (or any person other than the health plan.)
• The right to be notified following a breach of their unsecured PHI.
• Uses and disclosures not described in the Privacy Notice will be made only with the authorization from the individual.

•   The right to receive a printed copy of the Notice of Privacy Practices itself.

Nevada Medical Clinic Duties

We are required by law to maintain the privacy of your protected health information and to provide you with this Notice of Privacy Practices. We are also required to abide by the privacy policies and practices that are outlined in this notice.

Right to Revise Privacy Practices

As permitted by law, we reserve the right to amend or modify our privacy policies and practices. These changes in our policies and practices may be required due to change in federal and state laws and regulations. Upon request, we will provide you with the most recently revised notice on any office visit. The revised policies and practices will be applied to all protected health information we maintain.

Request to Inspect Protected Health Information

You may generally inspect your protected health information that we maintain. As permitted by federal regulation, we require that request to inspect or copy protected health information be submitted in writing. You may obtain a form to request access to your records by contacting the Front Office Clerk-In person or the Privacy Officer. Your request will be reviewed and will generally be approved unless there are legal or medical reasons to deny the request.

Complaints

If you want to submit a comment or complaint about our privacy practices, you can do so by sending a letter outlining your concerns or if you believe your privacy rights have been violated, you should call the matter to our attention by sending a letter describing the cause of your concern to:

Contact Person

David Harms, Privacy Officer

Nevada Medical Clinic

900 S Adams

Nevada, MO 64772

417-667-6015

Effective Date: This Notice is effective on or after September 23, 2013

Regulation