Notice of Information Practices
(Detailed Disclosure of Health Information)
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.
Understanding Your Health Record/Information
When you arrive at the Practice, a record of your care and treatment is initiated. Upon
thorough examination and assessment, this record will typically contain your symptoms,
examination and test results, diagnoses, treatment, and a plan for future care or treatment.
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 the many health professionals who contribute to your care
- 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 health professionals
- a source of data for medical research
- a source of data for facility planning and marketing
- a tool with which we can assess and continually work to improve the care we render and the outcomes we achieve
Understanding what is 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, and make more informed decisions when authorizing disclosure to others.
The Practice 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 health 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.
We will not use or disclose your health information without your authorization, except as described in this notice.
How We May Use or Disclose Your Health Information
- Treatment. We will use your health information for treatment. For example, information obtained by a nurse, physician, or other member of your healthcare team will be recorded in your record and used to determine the course of treatment that should work best for you. Your physician will document in your record his or her expectations of the members of your healthcare team. Members of your healthcare team will then record the actions they took and their observations. In that way, the physician will know how you are responding to treatment. We will also provide your physician or a subsequent healthcare provider with copies of various reports that should assist him or her in treating you once you're discharged from our facility.
- Reimbursement. We pledge our best efforts to provide you with the necessary forms and supportive information in a timely manner so as to optimize reimbursement to you. Any reimbursement from your insurance company should go directly to you. In this process, we will use your health information. For example, a bill may be sent to 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. As a reminder, since nearly all of our services are considered alternative or non-standard, the only items we provide superbills for, typically, are, with appropriate diagnosis codes, Dr. Herskowitz's consultations, and Vitamin C drips; we do not provide superbills for other services. If you have questions about this, please see the Office Manager prior to receiving any care.
- Health care operations. We will use your health information for regular health operations. For example, members of the medical staff, the interdisciplinary team, or consultants may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the health care and service we provide.
- Business associates. There are some services provided in our organization through contacts with business associates. Examples include our accountants, consultants and attorneys. When these services are contracted, we may disclose your health information to our business associates so that they can perform the job we've asked them to do. To protect your health information, however, we require the business associates to appropriately safeguard your information.
- Notification. We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, of your location, and general condition. If we are unable to reach your family member or personal representative, then we may leave a message for them at the phone number that they have provided us. e.g., on an answering machine.
- Communication with family. Health professionals, using their best judgment, 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 payment related to your care.
- Food and Drug Administration (FDA). We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.
- 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. We reserve the right to charge for forms as requested or records copied and supplied.
- Law enforcement. We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.
- Reports. 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 work force 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.
Your Health Information Rights
Although your health record is the physical property of the Practice, the information in your health record belongs to you. You have the following rights:
- You may request that we not use or disclose your health information for a particular reason related to treatment, payment, the Practice's general health care operations, and/or to a particular family member, other relative or close personal friend. We ask that such requests be made in writing on a form provided by our facility. Although we will consider your request, please be aware that we are under no obligation to accept it or to abide by it. For more information about this right, see 45 Code of Federal Regulations (C.F.R.) 164.524.
- If you believe that any health information in your record is incorrect or if you believe that important information is missing, you may request that we correct the existing information or add the missing information. Such requests must be made in writing, and must provide a reason to support the amendment. We ask that you use the form provided by our facility to make such requests. For a request form, please contact our Practice Administrator. For more information about this right, see 45 C.F.R.164.526.
- You may request that we provide you with a written accounting of all disclosures made by us during the time period for which you request (not to exceed 6 years). We ask that such requests be made in writing on a form provided by the Practice. Please note that an accounting will not apply to any of the following types of disclosures: disclosures made for reasons of treatment, payment or health care operations; disclosures made to your or your legal representative, or any other individual involved with your care; disclosures to correctional institutions or law enforcement officials; and disclosures for national security purposes.
- You have the right to obtain a paper copy of our Notice of Information Practices upon request.
- You may revoke an authorization to use or disclose health information, except to the extent that action has already been taken. Such a request must be made in writing.
For More Information or to Report a Problem
If you have questions and would like additional information, please contact the Practice's Administrator. If you believe that your privacy rights have been violated, you may file a complaint with us. These complaints must be filed in writing on a form provided by the Practice. The complaint form may be obtained from the Practice Administrator, and when completed should be returned to the Administrator. You may also file a complaint with the secretary of the Federal Department of Health and Human Services. There will be no retaliation for filing a complaint.
Our Fees as Related to Consultations
We schedule consultations as requested, and those are scheduled with our practitioners with the following format: 1 hour consultation is 45 minutes of face-to-face time, and 15 minutes for treatment planning or changes. And consultations fees are charged according to the amount of time spent by the practitioner