MASEL Urology Center:

Privacy Practices

NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Each time you visit a hospital, physician, or other healthcare provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care. This information, often referred to as your health or medical record, serves as a:

basis for planning your care and treatment
means of communication among your health providers
legal document describing the care you received
means by which you or a third party payer can verify that services billed were actually provided
a tool in educating heath professionals
a source of information for public health officials
a tool with which we can assess and continually work to improve the care we render and the outcomes we achieve

Understanding what is in your record and how your health information is used helps you to:

ensure its accuracy
better understand who, what, when, where and why others may access your health information
make more informed decisions when authorizing disclosure to others

Although your health record is the physical property of our office, the information belongs to you. You have the right to:

request a restriction on certain uses and disclosures of your information as provided by 45 CFR 164.522
obtain a paper copy of the notice of privacy practices upon request
inspect and copy your health record as provided for in 45 CFR 164.524
amend your health record as provided in 45 CFR 164.528
obtain an accounting of disclosures of your health information as provided in 45 CFR 164.528
request communications of your health information by alternative means or at alternative locations
revoke your authorization to use or disclose health information except to the extent that action has already been taken

This medical office is required to:

maintain the privacy of your health information
provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about you
abide by the terms of this notice
notify you if we are unable to agree to a requested restriction
accommodate reasonable requests you may have to communicate information by alternative means or at alternative locations

We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our privacy practices change, we will make a revised notice available at our office and on our website.

We will not use or disclose your health information without your authorization, except as described in this notice.

For More Information or to Report a Problem

If have questions and would like additional information, you may contact your doctor at this office. If you believe your privacy rights have been violated, you can file a complaint with your doctor or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.

We will use your health information for treatment. For example: Information obtained by your doctor or an assistant will be recorded in your record and used to determine your course of treatment. We will also provide this information to your referring physician, or other physicians actively involved in your medical care.

We will use your health information for payment. For example: A bill may be sent to you or a third party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures and supplies used.

We will use your health information for regular health operations. For example: Your doctor and the assistants may use information in your health record to assess the outcome of your care in an effort to continually improve the quality of the healthcare and service we provide.

Business Associates: We provide some services through contracts with business associates. Examples include radiology services, certain laboratory tests, billing services, and clerical services. When these services are contracted we may disclose your health information, however, we require the business associate to appropriately safeguard your information.

Notification: We may disclose information to your family member or personal representative if we obtain your verbal consent to do so or if we give you an opportunity to object to such a disclosure and you do not raise an objection.

Research: We may disclose 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 the privacy of your health information.

Marketing: We may contact you to provide appointment reminders or information about treatment alternatives or other health related benefits and services that may be of interest to you.

Food and Drug Administration (FDA): We may disclose to the FDA health information relative to product recalls, repairs or replacement.

Workers Compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.

Public Health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury or disability.

Law Enforcement: We may disclose health information for law enforcement purposes as required by law, or in response to a valid subpoena or legal requirement.

Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a workforce member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public.

Acknowledgement of Reciept

I have been given the above copy of the Notice of Privacy Practices that describes how my health information is used and shared by Masel Urology Center I understand this Notice may change at any time and that I may obtain a current copy by contacting the doctors' office or by visiting the website at www.drmasel.com

Your Health Information Rights

Our Responsibilities

Examples of Disclosures for Treatment, Payment and Health Operations

Other Uses or Disclosures