Our Privacy Policy
North Arkansas Center for Surgical Weight Control, P.A.
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!
Our office is permitted by federal privacy laws to make uses and disclosures
of your health information for purposes of treatment, payment, and health care
operations. Protected health information is the information we create
and obtain in providing our services to you. Such information may include
documenting your symptoms, examination and test results, diagnoses, treatment,
and applying for future care or treatment. It also includes billing documents
for those services.
Examples of uses of your health information for treatment purposes are:
- A nurse obtains treatment information about you and records it in
a health record.
- During the course of your treatment, the physician determines he/she
will need to consult with another specialist in the area. He/she will
share the information with such specialist and obtain his/her input.
Example of use of your health information for payment purposes:
- We submit requests for payment to your health insurance company. The
health insurance company or business associate helping us obtain payment requests
information from us regarding your medical care given. We will provide
information to them about you and the care given.
Example of Use of Your Information for Health Care Operations:
- We may obtain services from business associates such as quality assessment,
quality improvement, outcome evaluation, protocol and clinical guidelines
development, training programs, credentialing, medical review, legal services,
and insurance. We will share information about you with such business
associates as necessary to obtain these services.
Your Health Information Rights
The health and billing records we maintain are the physical property of the
doctor's office. You have the following rights with respect to your Protected
Health Information.
- Request a restriction on certain uses and disclosures of your health information
by delivering the request in writing to our office—we are not required
to grant the request but we will comply with any request granted;
- Obtain a paper copy of the Notice of Privacy Practices for Protected Health
Information ("Notice") by making a request at our office;
- Right to inspect and copy your health record and billing record—you
may exercise this right by delivering the request in writing to our office
using the form we provide to you upon request; appeal a denial of access to
your protected health information except in certain circumstances;
- Right to request that your health care record be amended to correct incomplete
or incorrect information by delivering a written request to our office using
the form we provide to you upon request. (The physician or other health care
provider is not required to make such amendments); you may file a statement
of disagreement if your amendment is denied, and require that the request
for amendment and any denial be attached in all future disclosures of your
protected health information;
- Right to receive an accounting of disclosures of your health information
as required to be maintained by law by delivering a written request to our
office using the form we provide to you upon request. An accounting will not
include internal uses of information for treatment, payment, or operations,
disclosures made to you or made at your request, or disclosures made to family
members or friends in the course of providing care;
- Right to confidential communication by requesting that communication of
your health information be made by alternative means or at an alternative
location by delivering the request in writing to our office using the form
we give you upon request; and,
If you want to exercise any of the above rights, please contact:
Tammy Coles
1215 Sidney Street, Suite 200
Batesville, AR 72501
(870) 793-4445
in person or in writing, during normal hours. She will provide you with
assistance on the steps to take to exercise your rights.
Our Responsibilities
The office is required to:
- Maintain the privacy of your health information as required by law;
- Provide you with a notice as to our duties and privacy practices as to
the information we collect and maintain about you;
- Abide by the terms of this Notice;
- Notify you if we cannot accommodate a requested restriction or request;
and
- Accommodate your reasonable requests regarding methods to communicate health
information with you.
- Accommodate your request for an accounting of disclosures.
We reserve the right to amend, change, or eliminate provisions in our privacy
practices and access practices and to enact new provisions regarding the protected
health information we maintain. If our information practices change, we
will amend our Notice. You are entitled to receive a revised copy of the
Notice by calling and requesting a copy of our “Notice” or by visiting
our office and picking up a copy.
To Request Information or File a Complaint
If you have questions, would like additional information, or want to report
a problem regarding the handling of your information, you may contact: Tammy
Coles, Privacy officer, (870) 793-4445.
Additionally, if you believe your privacy rights have been violated, you may
file a written complaint at our office by delivering the written complaint to
[Tammy Coles]. You may also file a complaint by mailing it or e-mailing it to
the Secretary of Health and Human Services whose street address and e-mail address
is [1215 Sidney Street, Suite200, Batesville, AR 72501 or info@lapobesity.com.
We cannot, and will not, require you to waive the right to file a complaint
with the Secretary of Health and Human Services (HHS) as a condition of
receiving treatment from the office.
We cannot, and will not, retaliate against you for filing a complaint with
the Secretary of Health and Human Services.
Following is a List of Other Uses and Disclosures Allowed by the Privacy
Rule
Patient Contact
We may contact you to provide you with appointment reminders, with information
about treatment alternatives, or with information about other health-related
benefits and services that may be of interest to you. We may contact you as
part of a fund raising effort.
Notification – Opportunity to Agree or Object
Unless you object we may use or disclose your protected health information to
notify, or assist in notifying, a family member, personal representative, or
other person responsible for your care, about your location, and about your
general condition, or your death.
Communication with Family - Using our best judgment, we may disclose to a family
member, other relative, close personal friend, or any other person you identify,
health information relevant to that person's involvement in your care or in
payment for such care if you do not object or in an emergency.
We may use and disclose your protected health information to assist in disaster
relief efforts.
Opportunity to Agree or Object Not Required
Public Health Activities
Controlling Disease
As required by law, we may disclose your protected health information to public
health or legal authorities charged with preventing or controlling disease,
injury, or disability.
Child Abuse & Neglect
We may disclose protected health information to public authorities as allowed
by law to report child abuse or neglect.
Food and Drug Administration (FDA)
We may disclose to the FDA your protected health information relating to
adverse events with respect to food, supplements, products and product defects,
or post-marketing surveillance information to enable product recalls, repairs,
or replacements.
Victims of Abuse, Neglect, or Domestic Violence
We can disclose protected health information to governmental authorities
to the extent the disclosure is authorized by statute or regulation and in the
exercise of professional judgment the doctor believes the disclosure is necessary
to prevent serious harm to the individual or other potential victim.
Oversight Agencies
Federal law allows us to release your protected health information to appropriate
health oversight agencies or for health oversight activities to include audits,
civil, administrative or criminal investigations: inspections; licensure's or
disciplinary actions, and for similar reasons related to the administration
of healthcare.
Judicial / Administrative Proceedings
We may disclose your protected health information in the course of any judicial
or administrative proceeding as allowed or required by law, or as directed by
a proper court order or administrative tribunal, provided that only the protected
health information released is expressly authorized by such order, or in response
to a subpoena, discovery request or other lawful process.
Law Enforcement
We may disclose your protected health information for law enforcement purposes
as required by law, such as when required by court order, including laws that
require reporting of certain types of wounds or other physical injury.
Coroners, Medical Examiners And Funeral Directors
We may disclose your protected health information to funeral directors or coroners
consistent with applicable law to allow them to carry out their duties.
Organ Procurement Organizations
Consistent with applicable law, we may disclose your protected health information
to organ procurement organizations or other entities engaged in the procurement,
banking, or transplantation of organs, eyes, or tissue for the purpose of donation
and transplant.
Research
We may disclose information to researchers when their research has been approved
by an institutional review board that has reviewed the research proposal and
established protocols to ensure the privacy of your protected health information.
Threat To Health And Safety
To avert a serious threat to health or safety, we may disclose your protected
health information consistent with applicable law to prevent or lessen a serious,
imminent threat to the health or safety of a person or the public.
For Specialized Governmental Functions
We may disclose your protected health information for specialized government
functions as authorized by law such as to Armed Forces personnel, for national
security purposes, or to public assistance program personnel.
Correctional Institutions
If you are an inmate of a correctional institution, we may disclose to the
institution or it's agents the protected health information necessary
for your health and the health and safety of other individuals.
Workers Compensation
If you are seeking compensation through Workers Compensation, we may disclose
your protected health information to the extent necessary to comply with laws
relating to Workers Compensation.
Other Uses and Disclosures
Other uses and disclosures besides those identified in this Notice will be
made only as otherwise authorized by law or with your written authorization
which you may revoke except to the extent information or action has already
been taken.
Website
If we maintain a website that provides information about our entity, this Notice
will be on the website.
Effective Date: March 20, 2003
