NOTICE OF PRIVACY PRACTICES FOR COMPLETE FAMILY MEDICINE
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
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, or from other sources of coverage such as an automobile insurer or workers compensation that you may use to pay for services.
- we do guarantor billing and we discuss billing issues with you at the front desk and over the telephone
- we utilize a collection agency for delinquent accounts and returned checks
- we work with laboratories, pharmacies, payors, and other supporting health vendors
- we call your home, work and any other phone numbers provided and may leave messages on voice messaging or answering machines, to discuss claims/payment
- we utilize a mailing company to send out statements
- we utilize an electronic claims clearing house to transmit your claims electronically and the postal service for all paper claims
- we utilize a vendor for our practice management system and computer systems
- we utilize a credit card company to process credit card payments
- we may contact an emergency contact if deemed needed
Health care operations: Your health information may be used as necessary to support the day-to-day activities and management of Complete Family Medicine.
- we use health information to make budget/financial reports
- we utilize a sign in sheet at the front desk and ask for patients by name
- we dictate your health information within the office space
- we work with pharmacies, laboratories, suppliers, health agencies, biohazardous waste companies and supporting health vendors
- we call your home, work and any other phone numbers provided to report test results, get information, schedule tests and other reasons to manage your health care and may leave messages on voice messaging or answering machines
- we will contact an emergency contact if deemed needed
- we mail out reminders for preventative appointments and tests
- we mail out letters to report test results
- we utilize vendors for our computer systems, phone systems, and business machinery
- we utilize the buildings management company,maintenance company and cleaning companies
- we utilize medical management companies and diagnostic management companies to obtain referrals
Law enforcement: Your health information may be disclosed to law enforcement agencies, without your permission, to support government audits and inspections, to facilitate law-enforcement investigations, to assist in disaster relief efforts, report abuse or neglect, and to comply with government mandated reporting.
Communication with Family: Using our best judgement, we may disclose to a family member, other relative, close personal friend, or any other person you identify, health information relevant to that person’s involvement in your care or in payment for such care, if you do not object or in an emergency.
Business Associates: We work with other businesses to help Complete Family Medicine operate successfully. We may disclose your health information to these business associates so they they can perform the tasks we hired them to do. Our business associates must guarantee us that they will respect the confidentiality of your personal health information.
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. To avert a serious threat to health or safety, we may disclose your information consistent with law to prevent or lessen a serious, imminent threat to the health or safety of a person or the public.
Coroners, Medical Examiners and Funeral Directors: We may release health information as necessary for them to carry out their duties.
Workers Compensation or Third Party Administrators: We may release health information about you to workers compensation/third party or your employer/adjuster, if we provide health care services to you for those reasons
Other uses and disclosures require your authorization: Disclosure of your health information or its use for any purpose other than those listed above requires your specific written authorization. If you change your mind after authorizing a use or disclosure of your information you may submit a written revocation of the authorization. However, your decision to revoke the authorization will not affect or undo any use or disclosure of information that occurred before you notified us of your decision.
Additional Uses of Information
Information about treatments: Your health information may be used to send/give you information on the treatment and management of your medical condition that you may find to be of interest. We may also send/give you information describing other health-related goods and service that we believe may interest you.
Individual Rights
You have certain rights under the federal privacy standards. These include:
- the right to request restrictions on the use and disclosure of your protected health information although Complete Family Medicine is not required to agree to the restriction that you requested
- the right to receive confidential communications concerning your medical condition and treatment
- the right to inspect and obtain a copy your protected health information for a reasonable fee
- the right to request an amendment or submit corrections to your protected health information although Complete Family Medicine is not required to change your health information
- the right to receive an accounting of how and to whom your protected health information has been disclosed except for the disclosures described in treatment, payment, health care operations and government functions
- the right to receive a printed copy of this notice
Complete Family Medicine 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 also are 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 by changes in federal and state laws and regulations. Whatever the reason for these revisions , we will provide you with a revised notice. The revised policies and practices will be applied to all protected health information that we maintain.
Requests to Inspect Protected Health Information
As permitted by federal regulation, we require that requests to inspect or get a copy of protected health information be submitted in writing. You may obtain a form to request access to your records by contacting a receptionist. Original records may not be taken off the Complete Family Medicine premise and there may be a reasonable fee.
Complaints
If you would like to submit a comment or complaint about our privacy practices, you can do so by sending a letter outlining your concerns to:
Privacy Officer
Complete Family Medicine
8758 Wolff Ct., Suite 200
Westminster, Colorado 80031
If you believe that 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 the above. You will not be penalized or otherwise retaliated against for filing a complaint. If you are not satisfied with the manner in which Complete Family Medicine handles this matter, you may submit a formal written complaint to the Department of Health and Human Services, Office for Civil Rights.
Contact Person
The name and address of the person you can contact for further information concerning our privacy practices is: Privacy Officer
Complete Family Medicine
8758 Wolff Ct., Suite 200
Westminster, Colorado 80031
(303)427-7767
Effective Date
This notice is effective on or after April 14, 2003.