HIPAA NOTICE OF PRIVACY PRACTICES
Virginia Oral & Facial Surgery
Drs. Niamtu, Alexander, Keeney, Harris, Metzger & Dymon, P.C.
Business Office: 11545-A Nuckols Road, Glen Allen, VA 23112; (804) 673-8061
Brandermill: 6031 Harbour Park Drive; Midlothian, VA 23112; Brandermill Office Phone Number804-608-3200
Monument: 5224 Monument Avenue; Richmond, VA 23226; Monument Office Phone Number804-359-4474
Mechanicsville: 7481 Right Flank Road, Suite 120; Mechanicsville, VA 23116; Mechanicsville Office Phone Number804-559-5416
Sandston: 5510 Whiteside Road; Sandston, VA 23150; Sandston Office Phone Number804-737-0992
South Side: 11319 Polo Place; Midlothian, VA 23113; Southside Office Phone Number804-794-0794
West End: 7702 Parham Road, Suite 103; Richmond, VA 23294; West End Office Phone Number804-270-5028
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.
This Notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment or health care operations (TPO) and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. “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 or condition and related health care services.
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
Your protected health information may be used and disclosed by your physician, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you, to pay your health care bills, to support the operation of the physician’s practice, and any other use required by law .
Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party. For example, we would disclose your protected health information, as necessary, to a home health agency that provides care to you. Also, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.
Payment: Your protected health information will be used, as needed, to obtain payment for your health care services. For example, obtaining approval for a hospital stay may require that your relevant protected health information be disclosed to the health plan to obtain approval for the hospital admission.
Healthcare Operations: We may use or disclose, as-needed, your protected health information in order to support the business activities of your physician’s practice. These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, licensing, and conducting or arranging for other business activities. For example, we may disclose your protected health information to medical school students that see patients at our office. We may also call you by name in the waiting room when your physician is ready to see you. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment.
We may use or disclose your protected health information in the following situations without your authorization. These situations include: as Required By Law, Public Health issues as required by law, Communicable Diseases: Health Oversight: Abuse or Neglect: Food and Drug Administration requirements: Legal Proceedings: Law Enforcement: Coroners, Funeral Directors, and Organ Donation: Research: Criminal Activity: Military Activity and National Security: Workers’ Compensation: Inmates: Required Uses and Disclosures: Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500.
Other Permitted and Required Uses and Disclosures Will Be Made Only With Your Consent, Authorization or Opportunity to Object unless required by law.
You may revoke your authorization, at any time, in writing, except to the extent that your physician or the physician’s practice has taken an action in reliance on the use or disclosure indicated in the authorization.
Following is a statement of your rights with respect to your protected health information.
You have the right to obtain a copy of your medical record. We will provide a copy or summary of your health information within 30 days of your request. We will charge a reasonable, cost-based fee.
You may have the right to have your physician amend your protected health information. If we deny your request for amendment, we will give explanation in writing within 60 days. You have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal, within 60 days.
You have the right to request a restriction of your protected health information. This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.
Your physician is not required to agree to a restriction that you may request. If physician believes it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted. You then have the right to use another Healthcare Professional.
You have the right to restrict disclosures to Health plans for payment and health care operations of the health plan, where the patient has paid out of pocket in full for all services.
You have the right to request to receive confidential communications. You may request us to contact you via home, cell, or office phone or to send mail to a different address.
You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information.
You have the right to ask for a copy of this Notice of Privacy and Practices at any time.
You have the right to opt out of all fundraising communications.
We are required by law to maintain the privacy and security of your protected health information.
We will inform you if a breach of your protected health information occurs unless the provider demonstrates that there is a low probability that the protected health information has been compromised.
We will follow the duties and privacy practice described in this notice.
We will not use or share your information other than as described here unless you give us permission in writing.
We reserve the right to change the terms of this notice. The new notices will be available upon request, in our office, and on our website.
You may file a complaint, to our privacy officer, if you feel we have violated your rights. You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by calling 1-877-969-6775 or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. We will not retaliated against you for filling a complaint.
This notice was published and becomes effective on October 1, 2017.
Privacy Officer: Ashley Gulak
Email: [email protected]
Phone Number: 804.673.8061, extension 2004