PULMONARY & CRITICAL CARE SPECIALISTS, INC.
Notice of Privacy Practices
THIS NOTICE, WHICH IS EFFECTIVE AS OF APRIL 13, 2003, DESCRIBES
HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW
The doctors and staff here at Pulmonary
& Critical Care Specialists believe your medical information
should remain confidential. The law requires us to establish
office policies that are designed to safeguard your health
information. The information contained in this notice constitutes
our promise to you that we acknowledge our legal obligation
to protect your health information, and it describes your
rights concerning our use of your health information.
We will use and disclose your health information for purposes
of treatment, payment and/or health care operations.
1. Treatment means the provision, coordination, or management
of health care and related services by one of more health
care providers, including the coordination or management
of health care by a health care provider with a third party;
consultation between health care providers relating to a
patient; or the referral of a patient for health care from
one health care provider to another. For example, a consultation
follow up letter from a specialist to your primary care
physician would be medical information maintained for treatment
2. Payment means activities undertaken by a covered health
care provider or health plan to obtain or provide reimbursement
for the provision of health care. For example, the medical
information furnished to your insurance company so that
we may be paid for our services is considered information
maintained for payment purposes.
3. Health Care Operations includes certain activities of
the practice, as well as activities of an organized health
care arrangement in which we participate, including: quality
assessment and improvement activities, reviews of the competence
or qualifications of health care professionals, activities
related to underwriting or premium rating of insurance contracts,
activities related to legal or accounting services provided
to the practice, and business management and planning. For
example, from time to time hospitals and insurance companies
will review physicians' clinical skills in order to assure
that quality care is being provided. When such reviews are
conducted, it is often necessary for the reviewer to randomly
select and examine patients' medical records.
We are permitted or required to disclose
limited health information about you, without your authorization,
in the following circumstances:
1. As required by law so long as it is limited to the relevant
requirements of such law.
2. For public health activities, including the prevention
and control of disease, vital statistics, and public health
3. For purposes of making required reports about victims
of abuse, neglect or domestic violence.
4. Health oversight activities, including audits, civil,
criminal or administrative investigations, proceedings or
actions; inspections; licensure or disciplinary actions.
5. Judicial and administrative proceedings, in response
to court orders.
6. Law enforcement purposes (i.e., reports of gunshot wounds;
grand jury subpoenas; and information regarding victims
7. To coroners, medical examiners and funeral directors
for purposes of identifying deceased persons or determining
cause of death.
8. For organ and tissue donation, consistent with applicable
9. Research, provided the federal regulations governing
research activities that insure the privacy of your health
information are met.
10. To avert serious threats to health or safety.
11. Specialized government functions regarding military
personnel and military veterans, certain national security
purposes, and inmates.
12. Workers' compensation to the extent necessary to comply
with applicable laws.
13. Marketing, for purposes of appointment reminders, treatment
alternatives, or other related benefits and services that
may be of interest to you.
Any uses or disclosures other than those
noted above require us to obtain your written authorization,
which you may revoke at any time. Any such revocation must
be in writing.
You have the following rights with respect
to your health information:
1. The right to request restrictions on certain uses of
your health information, however we are not required to
agree to your request.
2. The right to request, in writing, the manner or method
by which we contact you to furnish confidential communications
about your health information (i.e., fax, e-mail, voicemail,
etc.). You are obligated to notify us, in writing, of any
changes to your request.
3. The right to inspect your health information (you are
entitled to receive a copy of your health information, except
for psychotherapy notes and information compiled in anticipation
of or for use in, a civil, criminal, or administrative action
4. In limited circumstances, the right to ask us to amend
your health information, however we reserve the right to
deny your request. If your request to amend is denied, we
will provide you with information about the basis of our
denial and your right to submit a written statement disagreeing
with our denial.
5. The right to receive an accounting of disclosures of
your health information, except those disclosures related
to treatment, payment or health operations, disclosures
that are made to you, disclosures made for national security
purposes or to correctional institutions or law enforcement
officials, or disclosures that were made prior to the compliance
6. The right to receive a copy of this Notice in writing.
We have the following obligations:
1. We are required by law to maintain the privacy of your
health information, and we are required to provide you with
a notice of our legal duties and privacy practices.
2. We are required to abide by the terms of the notice.
3. We are required to advise you of any changes we make
in the terms of our notice of privacy practices. If any
changes are made to notice of privacy practices, we will
post the revised notice and make a copy of it available
If you believe we have violated your privacy rights, you
may file a written complaint to our Privacy Officer and/or
to the Secretary of Health and Human Services. There will
be no retaliation for filing a complaint.
If you want more information or you believe your rights
have been violated, you can contact Our Privacy Officer
at the following address:
Pulmonary & Critical Care Specialists,
Attention Privacy Officer
1661 Holland Rd.
Maumee, Ohio 43537
Alternatively, you may wish to contact the federal agency
in charge of enforcing patients' privacy rights. That address
is: Office for Civil Rights, U.S. Department of Health and
Human Services, 200 Independence Ave., S.W., Room 509F,
HHS Building, Washington, D.D. 20201.