POTOMAC PHYSICIANS, P.A.


NOTICE OF PRIVACY PRACTICES


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

Potomac Physicians, P.A. (PPPA) is required by law to maintain the privacy of protected health information and provide you with notice of our legal commitment and privacy practices with respect to this information. This Notice describes our privacy practices, which include how we might use, disclose (share or give out), collect, handle, maintain and protect our patients' health information. This notice is effective April 14, 2003. We must abide by the privacy practices described in the current notice.

PPPA reserves the right to change its privacy practices and the terms of this notice. In the event that material changes are made to the notice, we will post a revised notice in a clear and prominent location on site and make the new notice available upon request. The new notice provisions will be effective for all protected health information that we maintain.

Uses and Disclosures of Protected Health Information


Primary Uses and Disclosures

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 or treatment. We use this information, often referred to as your medical record or health information, to plan your care and treatment; to obtain payment for services rendered to you and/or your dependent and for other health care operations. Your personal and health information is called Protected Health Information, or PHI.

Treatment: Information obtained by your health practitioner in this office will be recorded in your medical record and used to determine the course of treatment that should work best for you. We may share your health information with other professionals such as primary care and specialty physicians, other providers and ancillary care professionals such as lab technicians.

             Payment: A bill may be sent to you or a third party payer (your health plan or insurance company or your guarantor) with accompanying documentation that identifies you, your diagnosis, procedures performed and supplies used. We may also use your information to verify your eligibility for benefits.

Health Care Operations: Your information may be reviewed for risk management, quality improvement, or to develop clinical guidelines in our efforts to continually improve the quality and effectiveness of the care and services we provide to you. We may also use your information to ensure that our providers are practicing effective medicine (peer review) and to provide you with access to helpful disease management activities.

             Business Associates: Sometimes we contract with other organizations to perform various services and functions on our behalf, such as billing and transcription (typing medical records). These organizations are called Business Associates. They may receive, maintain, use or disclose your information, but only after the Business Associate has agreed in writing to specific conditions designed to appropriately safeguard your information.

Other Covered Entities: We might use or disclose your PHI to assist other covered entities (other providers or health plans) in connection with their treatment or payment activities, or certain of their health care operations. For example, we might send your information to another health care provider who will render services to you, or to a health plan to ensure payment of a claim.

Other Possible Uses and Disclosures of Protected Health Information

To you, or With Your Authorization: We must disclose your PHI to you, as described in the Individual Rights section of this notice. You may give us written authorization to use or disclose your PHI to anyone else for any reason not listed in this notice. If you have given us an authorization to release information, you may revoke it in writing at any time. However, your revocation will not affect any prior use or disclosure that we made as permitted by your authorization while it was in effect. Other uses and disclosures of your PHI that are not described below, and are not part of treatment, payment or health care operations, will only be made with your authorization or to your personal representative.

Disclosures to the Secretary of the U.S. Department of Health and Human Services (DHHS): We are required to disclose your PHI to the Secretary of DHHS when the Secretary is investigating or determining our compliance with the HIPAA Privacy Regulations.

To Family and Friends: If you agree, or if you are unavailable to agree, such as in a medical emergency, we might disclose your information to a family member, personal friend or other person to the extent necessary to help you with your health care or payment for care.

To you, for Appointment Reminders: We may contact you by phone or mail to remind you of appointments. If we are unable to reach you directly, we will only leave your doctor's name, date and time of your appointment on your answering machine.

To you, for Health Information: We may contact you to provide information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Research: We are permitted to disclose your PHI to researchers when an institutional review board or privacy board has: (1) reviewed the research proposal and established protocols to ensure the privacy of the information; and (2) approved the research. Your information can be an important part of clinical studies or clinical trials, which help determine the effectiveness of a particular treatment or medicine. We may use or disclose your information to assess the feasibility of conducting such a study prior to the approval of an institutional review board or privacy board.

Health Oversight Activities: We might disclose your PHI to a health oversight agency for activities authorized by law, such as: audits; investigations; inspections; licensure or disciplinary actions; or civil, administrative, or criminal proceedings or actions. For example, if there is a review of our physician's credentials for a peer review, we might submit your information to the appropriate State Board of Physicians Quality Review as part of the evaluation. Other oversight agencies that seek information about our patients and the services we render include government agencies that oversee: (i) the health care system; (ii) government benefit programs; (iii) other government regulatory programs; and (iv) compliance with civil rights laws.

Abuse or Neglect: We might disclose your PHI to appropriate authorities if we have reason to believe that you might be a possible victim of abuse, neglect, domestic violence or other crimes.

Coroners, Medical Examiners, Funeral Directors, and Organ Donation or Transplant Services: Your health information may be disclosed consistent with laws governing mortician services, and laws governing entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation or transplant. For example, we might disclose PHI to a coroner or medical examiner to determine the cause of death, if necessary.

Public Health and Safety: We may disclose health information to public health and/or legal authorities that are charged with tracking reports of birth and morbidity. We may report instances of communicable disease, injury, or disability; as required by law or, if we believe disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.

Legal Process, Proceedings, Required by Law, Workers' Compensation, and Law Enforcement: We might disclose your PHI in response to a court or administrative order, subpoena, discovery request, or other lawful process, under certain circumstances. We might also disclose your PHI to comply with workers' compensation laws and other similar programs that provide benefits for work related injuries or illness. Under limited circumstances, such as a court order, warrant, or grand jury subpoena, we might disclose your PHI to law enforcement officials; and we may disclose limited PHI to a law enforcement agency about a suspect, fugitive, material witness, crime victim, or missing person. We might also disclose PHI where necessary to assist law enforcement officials to capture an individual who has admitted to participation in a crime or has escaped from lawful custody.

Military and National Security: We might disclose the PHI of Armed Forces personnel to military authorities under certain circumstances. We are also permitted to disclose PHI to federal officials when it is required for lawful intelligence, counterintelligence, and other national security activities.

Understanding Your Individual Rights

Your medical record is the physical property of the health care practitioner or facility that created it, but the content is about you, and therefore you have certain rights to the information. These rights are explained below. In all cases except emergencies, your requests for each of the individual rights described must be in writing.

(1) Access/Inspection: You have the right to look at or get copies of the PHI contained in most of the records we keep about you and your care. These are called a designated record set. You may request that we provide copies in a format other than photocopies. We will use the format you request unless we cannot reasonably do so. If you request copies, we might charge you a reasonable fee for each page, and postage if you want the copies mailed to you. If you request an alternative format, we might charge a cost-based fee for that format. If you prefer, we will prepare a summary or an explanation of your protected health information, but we might charge a fee to do so.

We might deny your request to inspect or copy your information in certain limited circumstances. In some cases, our denial will not be reviewable and we will inform you of this in writing. If you are denied access to your information and the denial is subject to review, you may request that the denial be reviewed. A licensed health care professional chosen by us will review your request and the denial. The person performing this review will not be the same person who denied your initial request.

(2) Accounting of Disclosures: You have the right to receive a list of instances in which we or our business associates disclosed your PHI for purposes other than treatment, payment, health care operations and certain other activities, after April 14, 2003. We will provide you with the date on which we made the disclosure, the name of the person or entity to which we disclosed your PHI, a description of the PHI we disclosed, and the reason for the disclosure. If you request this list more than once in a 12-month period, we might charge you a reasonable, cost-based fee for responding to these additional requests. Your request may be for disclosures made up to 6 years before the date of your request, but in no event, for disclosures made before April 14, 2003.

(3) Restriction Requests: You have the right to request that we place certain restrictions on our use or disclosure of your PHI, for Treatment, Payment or Health Care Operations. Your request should include: (1) the information you want to restrict from use or disclosure; and (2) how you want to limit the use and/or disclosure of the information. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in an emergency). Any agreement that we might make to a request for additional restrictions must be in writing and signed by a person authorized to make such an agreement on our behalf. We will not be liable for uses and disclosures made outside of the requested restriction unless our agreement is in writing. We are permitted to end our agreement to the requested restriction by notifying you in writing.

(4)Confidential Communication: You have the right to request that we communicate with you in confidence. This means that you may request that we send you information by alternative means or to an alternate location (address). We will accommodate your request if it is reasonable, specifies the alternative means or alternate location, and specifies how payment issues (premiums and claims) will be handled.

(5) Amendment:You have the right to request that we modify the PHI in your record. Your request must explain why the information should be amended. We may deny your request if we did not create the information you want amended or for certain other reasons. If we deny your request, we will provide you with a written explanation. You may respond with a statement of disagreement to be appended to the information you wanted amended. If we accept your request to amend the information, we will make reasonable efforts to inform others of the amendment, including people you name and to include the changes in any future disclosures of that information.

Electronic Notice: Even if you agree to receive this notice on our web site, or by electronic mail (e-mail), you are entitled to receive a paper copy as well.

To Receive Additional Information or Report a Problem

For further explanation of this notice you may contact the Privacy Officer at 410-528-7800. You may send written requests or comments to:

Filing a Complaint: If you are concerned that we might have violated your privacy rights, or you disagree with a decision we made about your individual rights, you may use the contact information listed above to complain to us. You also may submit a written complaint to the U.S. Department of Health and Human Services (DHHS). We will provide you with the contact information for DHHS upon request. We support your right to protect the privacy of your protected health and financial information. We will not retaliate in any way if you choose to file a complaint with us or with DHHS.

Internet Privacy

Potomac Physicians, P.A. does not currently collect any personal information through our website.