What is Protected Health Information (PHI)?

Our practice values your privacy and is committed to protecting medical information about you. Protected Health Information, or PHI, is ANY HEALTH INFORMATION that can be used to identify you, which we maintain or transmit in written, oral, or electronic form. It may relate to your past, present, or future medical health or services.

This Notice of Privacy Practices tells you how we may use and disclose your PHI that deals with your Treatment, Payment or Health Care Operations (TPO), or for other lawful purposes.

It also describes your rights under the Health Insurance Portability and Accountability Act (HIPAA) of 1996 (Public Law 104-191).

This notice is EFFECTIVE 04-14-2003.

Summary

This document describes how we safeguard your Protected Health Information (PHI) to make sure only the minimum amount of information is used and disclosed only to individuals with a legal right to access or view your PHI.

Use is the sharing, utilization, or examination of information by individuals within our practice.
Disclosure is the release, transfer, or divulging of information by us to individuals, outside our practice.
Consent is your granting us permission to disclose your PHI in order to provide you treatment, provide for payment of your health services, or manage our health care operations.
Authorization is when you give us written permission to release your information to you, another person, or an organization.

1. With Your Written Consent

These areas cover your Treatment, Payment and Health Care Operations.

2. With Your Written Authorization

This covers times when you wish to have your information used or disclosed to another person or organization.

3. With Your Authorization or Opportunity To Object

This document describes those times when you may agree or object to the use of certain PHI.

4. Without Your Consent, Authorization or Opportunity To Object

This document lists times when we are permitted or required to use or disclose your PHI without your consent or authorization.

5. Your Rights

Your rights regarding your PHI and procedures for appealing a decision regarding the use or disclosure of your PHI are listed in this document.

6. Complaints

Your rights to complain and the method for making the complaint are also listed in this document.

Please read this document and sign the attached acknowledgment that you have received a copy of our Notice of Privacy Practices for review. If you have any questions you may contact our privacy officer at the below address. We appreciate serving you.

Privacy Officer Contact Information:

Fort Smith Store: Kimberly Sullivan, 7700 HWY 271 South, Fort Smith, AR 72908. 479-649-7875.Barling Store: Tina Johnson, 1610 Fort Street, Barling, AR 72923. 479-452-1237.Greenwood Store: Denise Gulley, 1530 West Center, Greenwood, AR 72936. 479-996-9898.Equipment Store: Angie Beakley, 1210 Cavanaugh Road, Fort Smith, AR 72908. 479-649-9500.

1. Uses and Disclosures of PHI With Your Written Consent

After you review this information, you will be asked to sign a consent form regarding the use and disclosure of your protected health information (PHI). This consent will allow us to use your Protected Health Information (PHI) for providing you with prescriptions, treatment, making payment arrangements regarding your treatment, or for health care operations.

Your PHI may be used or disclosed by those within our office with a necessary reason to have access to the information, or we may use or disclose your PHI to those outside our office who have a need to know that information in order to provide you with health care services related to your treatment, payment, or health care operations.

We will always make reasonable efforts to limit the use and disclosure of your PHI to the minimum necessary. Listed below are examples of the use and disclosure we may make of your PHI once we have received your signed consent form. We may also use and disclose your PHI for routine or recurring requests. We will always review on an individual basis non-routine request for use or disclosure of your PHI.

__Treatment - We may use and disclose your PHI for use by staff, physicians, or other health care professionals involved in providing you with health care services in our office that have a need to know in order to provide you with evaluation, diagnostic, and health care services. Examples may include but are not limited to: other physicians who are treating you; home health care services, pharmacies, laboratories, radiologists, specialists, or diagnostic facilities necessary for your treatment.

__Payment - We will use your PHI as necessary to assist you in providing us with payment for your health care services, or for obtaining other medical services on your behalf. This may include but is not limited to: providing health care plans or insurance companies with information about the dates of service, services provided, and the medical condition you are being treated for in order for them to make a decision regarding eligibility, coverage or payment for those services.

__Health Care Operations - We may use and disclose your PHI in order to conduct the normal, ordinary, and reasonable business operations of our office on a day-to-day to basis. These activities may include but are not limited to: the planning, organizing, controlling, and budgeting activities of our office, and the directing and managing of our staff in performing their duties. From time to time we may use or disclose your PHI in order to train medical students, physician assistants, pharmacists, pharmacy technicians, nurses, or nursing assistants. We may also use or disclose your PHI in order to evaluate the actions or performance of our staff members. As needed, your PHI may be used or disclosed to state regulatory agencies (as required by law), accrediting agencies, or licensing review boards.

We may use your PHI to keep ordinary and necessary business records including asking you to sign-in when you visit our office, contacting you to remind you of an appointment, and calling your name or identifying number in the waiting room. We may email or use a facsimile (fax) to contact you if you give us permission.

Marketing: We may use or disclose your PHI in order to provide you with information about health care benefits, services, or products that may be of interest to you. Additionally, we may use your name for a newsletter, or email notification about other services, products, or for general health information. If you do not wish to receive any of these you may opt out by completing the Information Form attached to this document.

Business Associates: If we contract with any Business Associates, such as diagnostic services, medical records copying services, transcription services, billing services, or any other associate involved with your PHI, we signify to you that we will have a legal contract with them allowing them to perform such services and by that contract they will be bound to terms that will protect your PHI.

2. Uses & Disclosures With Your Written Authorization

Any other uses and disclosures of your PHI will only be made after we have received your written authorization, unless we are allowed, permitted or required by law to do so. Revocation: You may revoke any authorization you have made at any time, providing that your request for revocation be in writing and states which authorization you wish to revoke. However, if we have already relied upon your authorization to use or disclose your PHI, or if the authorization was obtained as a condition of obtaining insurance coverage you may not revoke your authorization regarding releases prior to the date of your revocation.

3. Uses & Disclosures With Your Consent, Authorization, or Opportunity To Object

There are other instances in which may use and disclose your PHI. There is an optional form at the end of this document, which you may agree or object to the use or disclosure of all or part of your PHI. If you are unable to agree or object we will use our professional judgment in making a decision about which portions of your PHI should be used or disclosed. When you are able to give us your opinion about our decision regarding the use of your PHI you may modify our decision.

Family Members, Friends, Guardians and Caregivers: We may disclose a portion of your PHI that relates to the listed persons’ need to know to provide you with healthcare. In making this decision we will determine what we believe your best interest to be. This may include notifying one of the parties of your location and general condition. We may also disclose a portion of your PHI to assist authorized persons in disaster or emergency relief efforts. This would include patient profiles and records for insurance and tax purposes provided to your spouse, children, guardian or caregiver.

Other Disclosures: We may use or disclose your PHI to provide you with emergency treatment, until such a time that you are able to consent, or if we attempt to obtain your consent but cannot because of a substantial communication barrier and in our professional judgment, we believe you intend to consent to the requested use or disclosure.

4. Uses and Disclosures of your PHI Without your Consent, Authorization or Opportunity to Object

__As Required By Law - If any county, state, or federal law requires that we use or disclose your PHI we will do so to the degree required by such law, or such disclosure will be made in response to an order of any court of proper jurisdiction. If the law requires us we will notify you of such disclosure.

__Law Enforcement - If we are presented with a proper court order or other legal presentations or lawful demand from a law enforcement agency or officer we will disclose your PHI to the extent that such order, presentation or demand requires. These requests may include court orders, subpoenas, warrants issued by a court of proper jurisdiction, or government audits and inspections. We will also disclose PHI if necessary for law enforcement authorities to identify, arrest, or apprehend a suspect or other individual; or if we believe that by reporting such information the disclosure will help protect the health or safety of a person. We may disclose to authorized agencies child abuse or neglect, instances of neglect or violence, or other injuries which we are required to report by law.

__Public Health - As required by law we may report your PHI to any county, state, or federal health agency whom we are required to report to for specific purposes. These purposes may include the controlling of disease, injury or disability, investigation, oversight, and audit.

__Food and Drug Administration - As required by law, we may disclose your PHI to the FDA or their lawful representative in order to control adverse effects with respect to food, drugs, or products. This may involve product improvements or product recalls.

__Personal Notification - We may use or disclose your PHI to assist in notifying a family member, guardian, caregiver, or personal representative of your general condition and location.

__Normal Course of Business - Our business dictates the pharmacist be readily available and visible, therefore any interaction with a pharmacist will also be visible. This would include, but not be limited to phone conversations with you, your doctors office, or your insurance company discussing your medication and or medical condition. The pharmacist or pharmacy staff may call your name aloud to let you know your medication is ready, and counsel you on the condition it is prescribed for and its proper use. We will allow others who satisfactorily identify themselves as family or friends to pick up medication and or prescription profiles for you. In the event you choose to have something delivered, if you are not personally available to accept the package we may leave it with someone for you, or someplace where you will find it.

__Research - We may disclose your PHI to researchers when an institutional review board has approved the research and ensured the privacy of your PHI.

__National & Homeland Security - We may disclose your PHI to any authorized county, state, or federal official who is authorized by state or federal law, or who has an order from a court of competent jurisdiction to receive such information for homeland or national security reasons.

__Organ Donation - We may use or disclose your PHI to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of cadaveric organs, eyes, or tissue for donation and transplantation.

__Other - We may use or disclose your PHI to the institution or its agents if you are an inmate of a correctional facility. We may use or disclose your PHI as required by Worker’s Compensation Laws. We may disclose your PHI to your insurance carrier. If you are injured on the job we may disclose your PHI to your employer or their workers compensation carrier. We may use or disclose your PHI as required by law, and under appropriate conditions to the appropriate military authorities if you are a member of the Armed Forces. We may use and disclose your PHI to Coroners, Medical Examiners, and Funeral Directors as necessary in order for them to perform their duties as required by law.

In Accordance with Public Law 104-191 (HIPAA-1996) - We must make disclosures regarding your PHI to the Department of Health & Human Services, as necessary and required, in order for them to determine our compliance with HIPAA standards.

If a use or disclosure for any of the above purposes is prohibited or materially limited by any applicable law, we will use and disclose your PHI to reflect the more stringent law.

5. Your Rights

Your rights to your Protected Health Information (PHI) and how you may exercise these rights are listed below.

__You have the right to request that we not use or disclose any, or part of, your PHI in order to carry out your treatment, payment, or health care operations or other disclosures as listed in this notice. This right to request restriction does not extend to uses or disclosures required by law. This includes your right to request that your PHI not be disclosed to family members, guardians, caregivers, or others who may be involved in your care as described in this Notice of Privacy Practices.

We are not required, by law, to agree to your request for restriction, but if we do agree to your request for restriction we will not use or disclose your PHI as specified in your request unless the use or disclosure of the restricted PHI is necessary to provide you with necessary or emergency treatment by us or another health care provider.

If we disclose the restricted PHI to another health care provider for emergency treatment we will request of them, that they not further use or disclose the restricted information. Any request for such restrictions must state the specific restrictions you are requesting, and to whom the restrictions apply. You should make such requests to your attending physician or else submit a written request to our office. We will document the request in your records and discuss this request with you at your next visit.

If we grant you a restriction to your PHI we may terminate our agreement to the restriction if: (a) you agree to the termination or request the termination in writing; (b) you orally agree to such termination and we document your oral agreement; or (c) we notify you in writing that we are terminating our agreement to a restriction. If we do terminate such an agreement the termination will only cover the PHI that was created or received after we notified you of the termination.

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You have no responsibility to tell us why you are requesting such information. You may make the request to our Privacy Officer listed at the bottom of this notice

__You have the right of access to inspect and obtain a copy of your Protected Health Information in a designated record set, for as long as we maintain the PHI in that designated record set. A “designated record set” contains medical and billing records and other PHI records that we use in making decisions about you or your medical care.

You may not receive Psychotherapy notes, PHI compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding, PHI that is subject to the Clinical Laboratory Improvements Amendments of 1988, or PHI that is restricted by any other state of federal law.

Unreviewable Grounds for Denial: We may deny you access to your PHI without providing you an opportunity for review if law restricts the PHI, if requesting psychotherapy notes, or if you are an inmate of a jail or correctional institution.

We may also suspend access to your PHI if we obtained the PHI during the course of research that included treatment provided that you have agreed to the denial of access when you consented to participate in the research that included the treatment. Your right of access will be reinstated upon completion of the research.

Your right of access to your PHI that is contained in records that are subject to the Privacy Act, 5 U.S.C. Section 552a, may be denied, if our denial of access under the Privacy Act meets the requirements of that law.

We may deny you access to your PHI if your PHI was obtained from someone other than us, under the promise of confidentiality and the access you request would be reasonably likely to reveal the source of the information.

Reviewable Grounds for Denial: If we deny you access to your PHI for one of the following three reasons you have the right to have our decision of denial reviewed by a licensed health care professional who we have designated to act as our reviewing official and who did not participate in the original decision to deny. Our decision to provide access will be based upon the reviewing official’s decision.

(1) A licensed health care professional has determined, in the exercise of their professional judgment, that the access you have requested is reasonably likely to endanger the life or physical safety of you or another person.
(2) The PHI you have requested makes reference to another person that is not a health care provider and a licensed health care professional has determined, in the exercise of their professional judgment, that the access you have requested is reasonably likely to cause substantial harm to the person referenced.
(3) The request for the PHI is being made by your personal representative and a licensed health care professional has determined, in the exercise of their professional judgment, that the provision of access to such personal representative is reasonably likely to cause substantial harm to you or another person.

If we select to have your request reviewed by another licensed health care professional we will promptly refer that request and we will ask for a determination, whether or not to deny the access requested, within a reasonable period of time. We will promptly provide you with written notice of the determination of the designated reviewing official and we will take any action necessary to carry out the designated reviewing official’s determination.

Making A Request: Your request must be made to the Privacy Officer listed below. We will act upon your request and notify you in writing no later than 30 days after receipt of your request. If your request for access is for PHI that we do not maintain or is not accessible at our office we will act on the request no later than 60 days from the receipt of your request.
Delays: If we are unable to respond to your request within the 30 or 60-day period as required, we may extend the time for our response for no more than 30 days. If we need an extension we will provide you with a written statement of the reasons for the delay in granting your request and the date by which we will complete our action on your request. We are not allowed by law to have more than one extension of time for action on your request.

If we allow you the access you have requested we will arrange with you a convenient time and place to inspect or to obtain a copy of the requested PHI, or if you have requested, we will mail you a copy of your requested PHI.

If we deny your request for your Protected Health Information in whole or part, to the extent possible we will give you access to other PHI you have requested after excluding the PHI which we have grounds to deny. If we deny your request we will do so in writing within 30 days from the date of your request. Our denial will tell you on what basis we have made the denial, your rights, if any, to have our denial reviewed, and how you may complain to us or to the Secretary of Health & Human Services.

If we do not maintain the PHI that you have requested, and we know where the requested PHI is maintained, we will inform you of where to direct your request for access. If we grant you access, in whole or in part, to your PHI we will provide you the access requested, including inspection, copies, or both, of the PHI in the designated records sets. If we maintain the PHI that you have requested in more than one designated record set or at more than one location, we will only produce the PHI once in direct response to your request.

We will provide you access to the PHI you have requested in the form or format that you have requested, if we maintain it in such form or format. If we do not, we will provide it in a readable hard copy form or other form or format agreed upon.

We will provide you with a summary or explanation of the requested PHI, in lieu of providing access to the PHI if you agree that such summary or explanation is sufficient and also agree to any reasonable fees we may charge you in granting the summary or explanation.

__You have the right to amend your Protected Health Information: You have the right to request that we amend your PHI or a record about you in a designated record set as long as we maintain the information.

We may deny your request for amendment if we determine that the PHI or record that you have requested be amended:

(1) Was not created by us, unless you can provide us with a reasonable basis to believe that the originator of the PHI is no longer available to act on the requested amendment,
(2) Is not part of the designated record set,
(3) Is not required to be accessed to you by law (for example psychotherapy notes, or records compiled in reasonable anticipation of, or for use in a judicial action), or
(4) Is accurate and complete.

Your request for amendment must be in writing and provide a reason to support your requested amendment. We will act on your request for an amendment no later than 60 days after the receipt of your request

If we accept the requested amendment, in whole or part, we will make the appropriate amendment to your PHI or record that is the subject of your request by identifying the records in the designated record set that are affected by the amendment and by appending or otherwise providing a link to the location of the amendment.

We will inform you that we have accepted your amendment and obtain your identification of and agreement to have us notify the person or persons with which the amendment needs to be shared.

We will make all reasonable efforts to inform and provide the amendment within a reasonable time to persons you have identified as having received PHI about you and needing the amendment, and persons, including our business associates, that we identify as having the PHI that is the subject of the amendment and that may have been relied upon, or could foreseeably be relied on to the detriment of you.

If we deny your request for amendment, in whole or part we will provide you, with a timely, written denial within 60 days of the denial stating the reason for the denial. We will also inform you of your right to submit a written statement disagreeing with the denial and give you information on filing such a statement.

You may make your request for amendments to the Privacy Officer listed below.

You have the right to receive an accounting of any disclosures of your PHI, which we have made in the six years prior to the date on which the accounting is requested, except for disclosures...

(1) We have made to carry out treatment, payment, and health care operations as listed in this Notice,
(2) Made to you,
(3) Required and protected by law,
(4) Made in compliance with a valid authorization,
(5) Made for a facility directory,
(6) To family members, guardians or friends involved in your care,
(7) For national security or intelligence proposes or to correctional institutions of law enforcement officials as required by law, or
(8) That occurred prior to the original date of or Notice of Privacy Practices.

Your right to receive an accounting of disclosures to a health oversight agency or law enforcement official will be temporarily suspended if such person or agency provides us with a written statement that such an accounting to the individual would be reasonably likely to impede the agency’s activities and specifies the time for which such a suspension is required.

__You may request to receive a full printed copy of our Notice of Privacy Practices, even if you have requested this document in electronic form.

6. How To Make A Complaint

__You have the right to complain to us if you believe your privacy rights have been violated by us. Any complaints should be in writing and state the nature of the complaint and how to contact you. You will not be retaliated against for filing a complaint and your complaint will not affect your diagnosis or any treatment we are providing you. You may contact our Privacy Officer or the Secretary of Health and Human Services, whose contact information is listed below.

Who To Contact

Privacy Officer Contact Information:

Secretary of Health & Human Services
The U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
(202) 619-0257, Toll Free: 1-877-696-6775

Fort Smith Store: Kimberly Sullivan, 7700 HWY 271 South, Fort Smith, AR 72908. 479-649-7875.
Barling Store: Tina Johnson, 1610 Fort Street, Barling, AR 72923. 479-452-1237.
Greenwood Store: Denise Gulley, 1530 West Center, Greenwood, AR 72936. 479-996-9898.
Equipment Store: Angie Beakley, 1210 Cavanaugh Road, Fort Smith, AR 72908. 479-649-9500.