Patient Privacy-Medicine Clinic of Morgan City

NOTICE OF PRIVACY PRACTICES

This notice is meant to explain how your protected health information may be used and disclosed. It will also instruct you how to access your individual health information.

A. OUR COMMITMENT TO YOUR PRIVACY

Our practice is dedicated to maintaining the privacy of your health information. We are required by law to provide you with this notice of the privacy practices that we maintain at the Medicine Clinic of Morgan City concerning your health information. The following is an outline of important information regarding your privacy:

• How we may use and disclose your health information
• Your rights in regard to your health information
• Our obligations concerning the use and disclosure of your health information

B. IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT:

Privacy Officer / Office Manager at the Medicine Clinic of Morgan City,
1126 Marguerite Street, Morgan City, LA, 70380 (985) 702-8500

C. WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION IN THE FOLLOW WAYS:

1. Treatment. The Medicine Clinic of Morgan City providers may utilize your health information in order to treat you more effectively. Your health information may be used to order laboratory testing, to fill prescriptions, to consult other treating physicians, or other entities necessary to assist with the proper care of you health.
2. Payment. The Medicine Clinic of Morgan City may access your health information in order to bill and collect payment for the services rendered by our providers following an office visit or hospitalization. We often contact your health insurer to verify your eligibility for benefits and we may provide your insurer with information regarding your treatment to determine if your insurer will cover, or pay for, your treatment. Finally, we might use your health information to bill you directly for services and items.
3. Appointment Reminders. Our staff will access your health information as a means to contact you and remind you of an appointment. No sensitive material is disclosed if a message is left on your voicemail.
4. Disclosure Required by Law. If mandated by federal, state, or local law, the Medicine Clinic is obliged to use and disclose your health information.

D. SPECIAL CIRCUMSTANCES

1. Public Health Risks. the Medicine Clinic of Morgan City staff must disclose your personal health information in the following instances:

• Maintenance of vital records (births and deaths)
• To report child abuse or neglect
• To prevent or control infectious disease, injury or disability
• To report drug reactions or problems with medical devices, including recall data

2. Health Oversight Activities. The Medicine Clinic of Morgan City reserves the right to disclose your health information for the following purposes: investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative, and criminal procedures or actions, or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.

3. Lawsuits and Similar Proceedings. Our practice may use and disclose your health information in response to a court or administrative order, if you are involved on a lawsuit or similar proceeding. We also may disclose your health information in response to discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.

4. Law Enforcement. Our staff will release your health information to law enforcement official when it involves the following situations:

• Victims of crime, violence, or death, if we are unable to obtain authorization
• Any criminal conduct reported at our facility
• In response to a warrant, summons, court order, or subpoena

5. Deceased Patients. The Medicine Clinic of Morgan City may release medical infomation to a medical examiner or coroner as a means to identify a deceased individual or to indentify the cause of death

6. Serious Threats to Health and Safety. Our staff will disclose your heath information only when necessary to prevent or reduce a serious threat to your health or the health of another individual.

7. Military. The Medicine Clinic of Morgan City will disclose your health information if you are a member of the military, and if required by the appropriate authorities.

8. National Services. Our practice may disclose your PHI to federal officials for intelligence and national security activities authorized by law. We may also disclose your health information to federal officials in order to protect the President, or other officials or foreign heads of state, or to conduct investigations

E. YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION

1. Confidential Communications. You have the right to request that our practice communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home, rather than work. In order to request a type of confidential communication, you must make a written request to Privacy Officer specifying the need to give a reason for your request.

2. Requesting Restrictions. Just as you have the right to authorize confidential communication, you also have the right to restrict our disclosure of your health information to certain individuals or the payment for your care. As we would like to honor every request, we cannot restrict certain health information when it is summoned by law, in emergencies, or when the information is necessary to treat you. Please notify a member of our staff if you choose to restrict your health information and provide the following:

• The information you would like restricted
• To whom you want the limits to apply.

3. Medical record copies. You have the right to obtain copies of the health information used to make decisions regarding your health, including patient medical records and billing records.

4. Amendment. If you believe your health information has been documented incorrectly or incompletely, please request an amendment from the Privacy Officer/Office Manager. Please provide the reason to supports your request for amendment. We will make every effort to make modifications that are appropriate based on the recommendation of your health care provider.

5. Right to File a Complaint. If you believe your privacy rights have been violated you may file a complaint directly to our staff or with the Secretary of the Department of Health and Human Services. To file a complaint with our practice, contact the Privacy Officer/Office Manager at 985-702-8500.

6. Right to Provide an Authorization for Other Disclosures. Our practice will obtain your written authorization for disclosures that have been omitted in this notice. Any authorization you provide us may be revoked at any time in writing.