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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.

YOUR PROTECTED HEALTH INFORMATION
Integrated Medical Group PC is required by the federal privacy rule to maintain the privacy of your health information that is protected by the rule, and to provide you with notice of our legal duties and privacy practices with respect to your protected health care information. We are required to abide by the terms of the notice currently in effect.

Generally speaking, your protected health information is any information that relates to your past, present or future physical or mental health or condition, the provision of health care to you, or payment for health care provided to you that individually identifies you or reasonably can be used to identify you. When we retain your protected health information in our computer system, it is called "electronic protected health information" ("ePHI"). This Notice applies to all PHI and ePHI related to your care that we have created or received. Your medical and billing records at our practice are examples of information that usually will be regarded as your protected health information.

USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION
We will attempt in good faith to obtain your signed Acknowledgement that you have received this Notice to use and disclose your PHI and ePHI for the following purposes.

A. Treatment, payment, and health care operations This section describes how we may use and disclose your protected health information for treatment, payment, and health care operations purposes. The descriptions include examples. Not every possible use or disclosure for treatment, payment, and health care operations purposes will be listed.

  1. Treatment
    We may use and disclose your protected health information to help us with your treatment. We may also release your protected health information to help other health care providers treat you. Treatment includes the provision, coordination, or management of health care services to you by one or more health care providers. Some examples of treatment uses and disclosures include:
    • During an office visit, practice physicians and other staff involved your care may review your medical record and share and discuss your medical information with each other.
    • We may share and discuss your medical information with an outside physician to whom we have referred you for care.
    • We may share and discuss your medical information with an outside physician with whom we are consulting regarding you.
    • We may share and discuss your medical information with an outside laboratory, radiology center, or other health care facility where we have referred you for testing.
    • We may share and discuss your medical information with an outside home health agency, durable medical equipment agency, or other health care provider to whom we have referred you for health care services and products.
    • We may share and discuss your medical information with a hospital or other health care facility where we are admitting or treating you.
    • We may share and discuss your medical information with another health care provider who seeks this information for the purpose of treating you.
    • We may use a patient sign-in sheet in the waiting area that is accessible to all patients.
    • We may page patients in the waiting room when it is time for them to go to an examining room.
    • We may contact you to provide appointment reminders.
  2. Payment
    We may use and disclose your protected health information for our payment reimbursement for care. Some examples of payment uses and disclosures include:
    • Sharing information with your health insurer to determine whether you are eligible for coverage or whether proposed treatment is a covered service.
    • Submission of a claim to your health insurer.
    • Providing supplemental information to your health insurer so that your health insurer can obtain reimbursement from another health plan under a coordination of benefits clause in your subscriber agreement.
    • Sharing your demographic information (for example, your address) with other health care providers who seek this information to obtain payment for health care services provided to you.
    • Mailing you bills in envelopes with our practice name and return address.
    • Provision of a bill to a family member or other person designated as responsible for payment for services rendered to you.
    • Providing medical records and other documentation to your health insurer to support the medical necessity of a health service.
    • Allowing your health insurer access to your medical record for a medical necessity or quality review audit.
    • Providing consumer reporting agencies with credit information (your name and address, date of birth, Social Security number, payment history, account number, and our name and address).
    • Providing information to a collection agency or our attorney for purposes of securing payment of a delinquent account.
    • Disclosing information in a legal action for purposes of securing payment of a delinquent account.
  3. Health care operations
    We may use and disclose your protected health information for our health care operation purposes as well as certain health care operation purposes of other health care providers and health plans. Some examples of health care operation purposes include:
    • Quality assessment and improvement activities.
    • Population based activities relating to improving health or reducing health care costs.
    • Reviewing the competence, qualifications, or performance of health care professionals.
    • Conducting training programs for medical and other students.
    • Accreditation, certification, licensing, and credentialing activities.
    • Health care fraud and abuse detection and compliance programs.
    • Conducting other medical review, legal services, and auditing functions.
    • Business planning and development activities, such as conducting cost management and planning related analyses.
    • Sharing information regarding patients with entities that are interested in purchasing our practice and turning over patient records to entities that have purchased our practice.
    • Other business management and general administrative activities, such as compliance with the federal privacy rule and resolution of patient grievances.

B. Uses and disclosures for other purposes
We may use and disclose your protected health information for other purposes. This section generally describes those purposes by category. Each category includes one or more examples. Not every use or disclosure in a category will be listed. Some examples fall into more than one category - not just the category under which they are listed.

  1. Individuals involved in care or payment for care.
    We may disclose your protected health information to someone involved in your care or payment for your care, such as a spouse, a family member, or close friend. For example, if you have surgery, we may discuss your physical limitations with a family member assisting in your post-operative care.
  2. Notification purposes
    We may use and disclose your protected health information to notify, or to assist in the notification of, a family member, a personal representative, or another person responsible for your care regarding your location, general condition, or death. For example, if you are hospitalized, we may notify a family member of the name and address of the hospital and your general condition. In addition, we may disclose your protected health information to a disaster relief entity, such as the American Red Cross, so that it can notify a family member, a personal representative, or another person involved in your care regarding your location, general condition, or death.
  3. Required by law
    We may use and disclose protected health information when required by federal, state, or local law. For example, we may disclose protected health information to comply with mandatory reporting requirements involving births and deaths, child abuse, disease prevention and control, vaccine-related injuries, medical device-related deaths and serious injuries, gunshot and other injuries by a deadly weapon or criminal act, driving impairments, and blood alcohol testing.
  4. Other public health activities
    We may use and disclose protected health information for public health activities, including:
    • Public health reporting, for example, communicable disease reports.
    • Child abuse and neglect reports.
    • FDA-related reports and disclosures, for example, adverse event reports.
    • Public health warnings to third parties at risk of a communicable disease or condition.
    • OSHA requirements for workplace surveillance and injury reports.
  5. Victims of abuse, neglect, or domestic violence
    We may use and disclose protected health information for purposes of reporting of abuse, neglect, or domestic violence in addition to child abuse, for example, reports of elder abuse to the Department of Aging or abuse of a nursing home patient to the Department of Public Welfare.
  6. Health oversight activities
    We may use and disclose protected health information for purposes of health oversight activities authorized by law. These activities could include audits, inspections, investigations, licensure actions, and legal proceedings. For example, we may comply with a Drug Enforcement Agency inspection of patient records.
  7. Judicial and administrative proceedings
    We may use and disclose protected health information disclosures in judicial and administrative proceedings in response to a court order or subpoena, discovery request or other lawful process. For example, we may comply with a court order to testify in a case at which your medical condition is at issue.
  8. Law enforcement purposes
    We may use and disclose protected health information for certain law enforcement purposes including to:
    • Comply with a legal process, for example, a search warrant.
    • Comply with a legal requirement, for example, mandatory reporting of gun-shot wounds.
    • Respond to a request for information for identification/location purposes.
    • Respond to a request for information about a crime victim.
    • Report a death suspected to have resulted from criminal activity.
    • Provide information regarding a crime on the premises.
    • Report a crime in an emergency.
  9. Coroners and medical examiners
    We may use and disclose protected health information for purposes of providing information to a coroner or medical examiner for the purpose of identifying a deceased patient, determining a cause of death, or facilitating their performance of other duties required by law.
  10. Funeral directors
    We may use and disclose protected health information for purposes of providing information to funeral directors as necessary to carry out their duties.
  11. Organ and tissue donation
    For purposes of facilitating organ, eye, and tissue donation and transplantation, we may use and disclose protected health information to entities engaged in the procurement, banking, or transplantation of cadaveric organs, eyes, or tissue.
  12. Threat to public safety
    We may use and disclose protected health information for purposes involving a threat to public safety, including protection of a third party from harm and identification and apprehension of a criminal. For example, in certain circumstances, we are required by law to disclose information to protect someone from imminent serious harm.
  13. Specialized government functions
    We may use and disclose protected health information for purposes involving specialized government functions including:
    • Military and veterans activities.
    • National security and intelligence.
    • Protective services for the President and others.
    • Correctional institutions and other law enforcement custodial situations.
  14. Workers' compensation and similar programs
    We may use and disclose protected health information as authorized by and to the extent necessary to comply with laws relating to workers' compensation or similar programs, established by law that provide benefits for work-related injuries or illness without regard to fault. For example, this would include submitting a claim for payment to your employer's workers' compensation carrier if we treat you for a work injury.
  15. Business associates
    Certain functions of the practice are performed by a business associate such as a billing company, an accountant firm, or a law firm. We may disclose protected health information to our business associates and allow them to create and receive protected health information on our behalf. For example, we may share with our billing company information regarding your care and payment for your care so that the company can file health insurance claims and bill you or another responsible party.
  16. Creation of de-identified information
    We may use protected health information about you in the process of de-identifying the information. For example, we may use your protected health information in the process of removing those aspects which could identify you so that the information can be disclosed to a researcher without your authorization.
  17. Incidental disclosures
    We may disclose protected health information as by-product of an otherwise permitted use or disclosure. For example, other patients may overhear your name being paged in the waiting room.

C. Uses and disclosures with authorization
For all other purposes that do not fall under a category listed under sections A and B, we will obtain your written authorization to use or disclose your protected health information. Your authorization can be revoked at any time except to the extent that we have relied on the authorization.

PATIENT PRIVACY RIGHTS
You have certain rights with respect to your medical record information, as follows:

  1. You may request that we restrict the uses and disclosures of your medical records information for treatment, payment and operations, or restrictions involving your care or payment related to that care. We are not required to agree to the restriction; however, if we agree, we will comply with it, except with respect to emergencies, disclosures of the information to you or if we are otherwise required by law to make a full disclosure without restriction.
  2. You may also request a restriction on disclosure of protected health information to a health plan for purpose of payment of health care operations if you paid for the services out of your own pocket, in full. This does not apply to services that are covered by insurance. You are required to pay cash, in full, for the services before the restriction applies.
  3. With respect to ePHI, we agree to give you your ePHI in the form and format requested by you, if it is readily producible in that form or format. If it is not readily producible in the form or format requested, we will give you a readable hard copy form. Any directive given to use by you to transmit ePHI must be done in writing by you, signed and clearly identify the designated person and location to send the ePHI. We will provide you access to you PHI or ePHI within thirty (30) days from the date of request.
  4. You have the right to request receipt of confidential communications of your medical information by an alternative means or at an alternative location. If you require such an accommodation, you will be charged a fee for the accommodation and will be required to specify the alternative address or method of contact and how payment will be handled.
  5. You have the right to inspect, copy and request amendment to your medical records. Access to your medical records will not include psychotherapy notes contained in them, or information compiled in anticipation of or for use in a civil, criminal or administrative action or proceeding or for which your access is otherwise restricted by law. We will charge a reasonable fee for providing a copy of your medical records, or a summary of those records, at your request, which includes the cost of copying, postage, or preparation of an explanation or summary of the information.
  6. We may deny any request for amendment of you PHI or ePHI if the information was not created by us (unless the originator of the information is no longer available to act on your request); is not part of the designated record set maintained by us; is not part of the information to which you have a right of access; or is already accurate and complete, as determined by us. If we deny your request for an amendment, we will give you a written statement disagreeing with the denial.
  7. All requests for inspection, copying and/or amending information in you medical records must be made in writing and be addressed to "Privacy Officer" at our address. We will respond to our request in a timely fashion.
  8. You have a limited right to receive an accounting of all disclosures we make to other persons or entities of your medical records information except for disclosures required for treatment, payment and health care operations, disclosures that require and Authorization, disclosures incidental to another permissible use or disclosure, and otherwise as allowed by law. We will not charge you for the first accounting in any 12-month period; however, we will charge you a reasonable fee for each subsequent request for an accounting within the same 12-month period.
  9. You have the right to obtain a paper copy of this notice if the notice was initially provided to you electronically, and to take one home with you if you wish.
  10. All requests related to you rights herein must be made in writing and addressed to "Privacy Officer" at the address noted below.
  11. You have the right to receive notification from us if any breach of your unsecured protected health information occurs.

OUR DUTIES
We have the following duties with respect to the maintenance, use and disclosure of your medical records:

  1. We are required by law to maintain the privacy of the protected health information in your medical records and to provide you with this Notice of its legal duties and privacy practices with respect to that information.
  2. We are required to abide by the terms of the Notice currently in effect.
  3. We reserve the right to change the terms of this Notice at any time, making the new provisions effective for all health information and medical records we have and continue to maintain. All changes in this Notice will be prominently displayed and available at our office.

CHANGES TO THIS NOTICE
We reserve the right to change this notice at any time. We further reserve the right to make any change effective for all protected health information that we maintain at the time of the change - including information that we created or received prior to the effective date of the change. We will post a copy of our current notice in the waiting room for the practice. At any time, patients may review the current notice by contacting our privacy officer. Patients also may access the current notice at our web site at www.imgpc.com.

COMPLAINTS
If you believe that we have violated your privacy rights, you may submit a complaint to our privacy officer who may be contacted at:

Address:
Integrated Medical Group PC
Attention: Privacy Officer
48 Tunnel Road, Suite 203
Pottsville, PA 17901

Telephone: 570-622-5455
Fax: 570-622-5493
eMail: hr@imgpc.com
You may also submit a complaint to the Office of Civil Rights at:
Office of Civil Rights
US Department of Health and Human Services
150 S. Independence Mall West, Suite 372
Public Ledger Building
Philadelphia, PA 19106-9111
Main Line: (800) 368-1019
Fax: (215) 861-4431
TDD: (800) 537-7697

LEGAL EFFECT OF THIS NOTICE
This Notice of Privacy Practices shall not be construed as a contract or legally binding agreement. Any non-compliance with any provision of this Notice shall not be construed as a breach of contract, breach of confidentiality, invasion of privacy, misappropriation of name or likeness, violation of any consumer protection law, negligence or violation of any state law. By signing the Acknowledgement of Receipt of this Notice, you agree that the sole legal recourse for our non-compliance with this Notice is to file a written complaint to the Secretary of the U.S. Department of Health and Human Services, and that no complaint or cause of action may be filed in any federal or state court for breach of contract, breach of confidentiality, invasion of privacy, misappropriation of name or likeness, violation of any consumer protection law, negligence or violation of any state law, or under any tort theory.

EFFECTIVE DATE
This Notice is effective April 14th, 2003 and applies to all protected health information in your medical records maintained by us.

IMG Greenhills Family Medical Associates

1903 Morgantown Rd.
Reading, PA 19607

Tel. (610) 777-4040

Email: info@IMGGreenhills.com