Effective Date:  May 1, 2007

    

This Notice of Privacy Practices describes how health information about you (as a patient) may be used and disclosed and how you can get access to this information.  This Notice also describes certain rights that you have regarding your health information.  Please review it carefully.

           

Our Responsibilities

     

We understand that information about you and your health is personal, and we are committed to protecting the privacy of this information.  As a healthcare provider, we are required by law to:

     

§   protect the privacy of your health information,

§   provide this Notice about our health information practices, and

§   follow the information practices that are described in this Notice

     

We will not use or disclose your health information without your authorization, except as described in this Notice, and your health information will never be sold to third parties.

     

How We May Use and Disclose Your Health Information

     

Treatment:  We will use or disclose your protected health information to provide treatment and to coordinate or manage your healthcare and any related services.  For example, we give information to doctors, nurses, lab technicians, students, and other healthcare providers so that they can provide quality healthcare services to you.  We may also provide your information to certain outside parties such as your health plan or other healthcare providers in order to arrange referrals, schedule consultations, or to facilitate care that you may receive outside of our facility.

     

Billing & Payment:  We will use or disclose your health information, as needed, to obtain payment for healthcare services that we provide.  For example, we may contact your insurer to verify your healthcare benefits, to obtain prior authorization, and to provide them with details about your treatment to make sure that they will pay for your care.  We will also use or disclose your medical information to bill and obtain payment from third parties that may be responsible for payment, such as family members.

     

Family Members and Other Close Individuals:  Unless you notify us in writing, we may disclose your health information to close family members such as your spouse, children, or parents.  Similarly, we may disclose information to a personal representative, close friend, or other persons involved in your care or well-being.  If there are certain family members or individuals of this type that you do not want to receive your health information, you must notify us in writing.

     

Telephone / Answering Machine / Voice Mail Messages:  We may contact you via the telephone at your home, place of work, or mobile telephone, and if you are not available, we may leave messages on an answering machine or voice mail system to confirm appointments, to notify you of test results, or to provide you information about your condition or treatment.  If you do not want for us to communicate with you in this manner, you must notify us in writing.

     

Postal & E-mail Correspondence:  We may send letters, correspondence, and other documents to you via e-mail, the postal service, or other courier services to confirm appointments, to notify you of test results, or to provide you information about your condition or treatment.  If you do not want for us to send correspondence of this type, you must notify us in writing.

     

Healthcare Operations:  We will use or disclose your health information, as needed, in order to perform normal healthcare operations.  For example, members of the medical staff, risk managers, or quality improvement case workers may use information in your health record to assess the care and outcomes in your case and in others like it.  This information will then be used in an effort to improve the quality and effectiveness of the healthcare and service we provide.  We may also disclose your health information to our business associates that perform activities on our behalf and for other business activities.

     

Health Oversight Activities:  We may disclose your health information to health oversight agencies that are authorized to oversee and monitor our operations.

     

Public Health:  We may use or disclose your health information for public health activities or to comply with public health agencies when necessary to protect your health or the health and safety of the public or another person.  For example, we may disclose your health information to the Health Department if you have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition.

     

Required By Law:  We may use or disclose your health information to the extent that the use or disclosure is required by law, but only to the extent and under the circumstances provided in such law.  For example, we may disclose your health information to appropriate authorities or agencies to report cases of abuse, neglect, or domestic violence if we believe that you may be a victim or that intervention is necessary.  We may also use and disclose your health information as required by law to assist in law enforcement activities or to prevent or lessen a threat to the health or safety of a person or the public.

     

Legal Proceedings:  We may disclose your health information in response to court or administrative orders, or in response to subpoenas, discovery requests, or other lawful processes.

     

Coroners, Medical Examiners, Funeral Directors:  We may disclose your health information to a coroner or medical examiner for identification purposes, for determining cause of death, or for the coroner or medical examiner to perform other duties authorized by law.  We may also disclose your health information to a funeral director in order to permit them to carry out their duties.

     

Organ Donation:  We may disclose your health information to organizations that handle organ procurement and/or eye or tissue transplantation.

     

Research:  We may disclose your protected health information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure your privacy.

 

Correctional Institutions:  We may disclose your health information to a correctional institution if you are an inmate of that institution.

     

Worker’s Compensation:  We may disclose your health information to comply with worker’s compensation laws and other similar legally established programs.

 

Military Activity:  We may disclose your health information if you are in the armed forces and information is required by command authorities, or for the purposes of determining your eligibility for benefits by the Department of Veteran Affairs.

     

National Security:  We may disclose your health information to authorized federal officials for conducting national security and intelligence activities, including for the provision of protective services to the President.

     

Your Rights Regarding Your Health Information

     

Right to Request a Restriction on Certain Uses and Disclosures:  You have the right to request restrictions on uses and disclosures of your medical information for the purposes of treatment, payment, and healthcare operations.  You also have the right to request that your health information be withheld from family members or individuals close to you.  These requests must be made to us in writing.  We are not required to follow your request; however, we will make every effort to do so.  If we agree to a request that you make, we will comply with the request except to the extent that disclosure has already occurred or in the event that you are in need of emergency treatment and the information is necessary to provide the emergency treatment.

     

Right to Request the Method of Communication of your Health Information: You have the right to request that confidential communications be made by alternate means or at alternate locations, and we will honor your request if it is reasonable.  For example, you can request that we contact you at work and not at home.  These requests must be made to us in writing.

     

Right to Inspect and Request a Copy of Your Health Record:  You have the right to inspect and obtain a copy of your health record.  Your request will not be denied except in very limited circumstances defined by federal regulations.  If you are denied access to your health record, the denial can be reviewed by another licensed healthcare professional.  For more information, please contact our Privacy Officer.  A fee may be charged to make a copy of your health record.

     

Right to Request an Amendment to Your Health Record:  You have the right to request amendments to your health information.  Your request must be made to us in writing, and you must give us the reason for the amendment.  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.  We will provide you with a copy of any such rebuttal.  Please contact our staff if you have any questions about amending your health record.

     

Right to Obtain an Accounting of Disclosures of Your Health Information:  You have a right to obtain an accounting of disclosures of your health information to other parties, with the exception of disclosures made for purposes of treatment, billing and payment, healthcare operations, and communicating with your family and others involved in your care.

     

Right to Obtain a Copy of this Notice of Privacy Practices:  You have the right to obtain a paper copy of our Notice of Privacy Practices upon request.  A copy of the current Notice in effect will be available at our facility during normal operating hours, or you can visit our web site at DRWalkin.com to review the current Notice.

           

Changes to This Notice

     

We reserve the right to revise this Notice, and we reserve the right to make the revised Notice effective for information that we already have about you as well as any information we receive in the future.  A copy of the current Notice of Privacy Practices will be available at our facility during normal operating hours, or you can visit our web site at DRWalkin.com to review the current Notice.

           

For More Information Or To Report A Problem

     

If you have questions or if you would like more information about our privacy practices, you can contact our staff at the address and phone numbers at the beginning of this Notice.  If you would like to report a problem or if you believe your privacy rights have been violated, you can contact our Privacy Officer at  (202) 955-0000 or 1700 Pennsylvania Avenue SW, Suite 550, Washington, DC  20006.  You may also file a complaint with the Secretary of the Department of Health and Human Services.  Filing a complaint will in no way adversely affect the care or treatment that you receive from our facility.