Notice of Health Information Practices

Introduction:

PolyClinics.Net, PLLC is committed to treating and using protected health information about you responsibly. This Notice of Health Information Practices describes the personal information we collect, and how and when we use or disclose that information. It also describes your rights as they relate to your protected health information. This notice is effective Aug 18th 2005 and applies to all protected health information as defined by federal regulations.

Understanding Your Health Record/ Information:

Each time you visit PolyClinics.Net, PLLC a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnosis, treatment, and plan of care. This information, often referred 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 can contribute to your care;
• Legal documentation describing the type of care you received;
• Means by which you can verify that services billed were actually provided;
• A tool in educating health professionals;
• A source of information for public health officials charged with improving the health of the state and the nation;
• A source of data for our planning and marketing student health;
• A tool with which we can assess and continually work to improve the care 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; and make informed decisions when authorizing disclosure to others.

Your Health Information Rights

Although your health record is the physical property of PolyClinics.Net, PLLC, the information belongs to you. You have the right to:

• Request restrictions on the use and disclosure of your protected health information, however, PolyClinics.Net, PLLC is not required by law to agree to such restrictions;
• Receive confidential communications concerning your medical condition and treatment;
• Inspect and obtain a copy of your protected health information;
• Receive an accounting of how and to whom your protected health information has been disclosed;
• Receive a printed copy of this notice;
• All such requests for copies, restrictions, and amendments must be in Your health

Our Responsibilities

PolyClinics.Net, PLLC is required to:

• Maintain the privacy of your health information;
• Provide you with this 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 amendment, correction, or restriction, and;
• 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. Should our information practices change, we will provide you with a revised notice on your next office visit. The revised polices and practices will be applied to all protected health information that we maintain. We will not disclose your health information without your authorization, except as described in this notice. We will also discontinue to use or disclose your health information after we have received a written revocation of the authorization according to the procedures included in this authorization.

How We May Use and/ or Disclose Your Health Information:

1. We will use your health information for treatment. Your health information may be used by staff members or disclosed to other health professionals for the purpose of evaluating your health diagnosing medical conditions, and providing treatment. For example, results of lab 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.
2. We will use your information for payment. Your protected health information will be used, as needed, to obtain payment for your health care services. If you do not pay at the time services are rendered, you may receive a bill in the mail which may contain information about diagnosis, tests performed, and medication.
3. We will use your information for regular health operations. Your health information may be used as necessary to support the day-to-day operations and management of PolyClinics.Net, PLLC. For example, we may use a sign-in sheet at the registration desk where you will be asked to sign in your name. We may also call you by name in the waiting room when the Healthcare Provider are ready.
4. Communication with family. Due to the nature of our field, we will use our best judgment when disclosing health information to a family member, other relatives, or any other person that is involved in your care or that you have authorized to receive this information. Please inform health services when you do not wish a family member or other individual to have authorization to receive your information.
5. Research / Teaching / Training. We may use your information for the purpose of research, teaching, and training.
6. Healthcare Oversight. Federal law requires us to release your information to an appropriate health authority or attorney, or other federal or state appointee if there are circumstances that require us to do so.
7. Public Health Reporting. Your health information may be disclosed to public health agencies as required by law
8. Law Enforcement. Your health information may be disclosed to law enforcement agencies, without your permission, to support, governmental audits and inspections, and to comply with government mandating reporting.
9. Appointment Reminders and Test Results. PolyClinics.Net, PLLC may use your information to remind you about upcoming appointments or to ask you to call back to get information about test results. For example, a brief nonspecific message may be left on your answering machine. If you do not approve of this method, please inform us.
10. Other uses and disclosures. Disclosure of your health information or its use for any other 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.
11. Business Associates. In some instances, we have contracted separate entities to provide services for us. These associates require your health information in order to accomplish the tasks that we ask them to provide. For example, x-rays or tests performed at other facilities. To protect your health information, we require the business associate to protect your health information.

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.

For More Information or to Report a Problem:

If you have questions and would like additional information, you may contact the PolyClinics.Net, PLLC Privacy Officer, David M. Jenkinson DO, at 423-775-7150.

If you believe your privacy rights have been violated, you can file a compliant with the Privacy Officer or with the Office for Civil Rights (OCR), U.S. Department of Health and Human Services. There will be no retaliation for filing a complaint with either the Privacy Officer or the Office for Civil Rights. The address for OCR is:

Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509 HHH Building
Washington D.C.

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