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Privacy PolicyNOTICE OF PRIVACY PRACTICESJOSEPH J. MORAVEC, M.D., INC. & THE FACIAL SURGERY CENTERPLEASE READ THIS NOTICE OF PRIVACY PRACTICES. THIS PRIVACY NOTICE DESCRIBES HOW MEDICAL AND OTHER HEALTH INFORMATION ABOUT YOU MAY BE USED AND/OR DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. THIS NOTICE PERTAINS TO INDIVIDUALS RECEIVING MEDICAL AND OTHER HEALTH CARE SERVICES FROM JOSEPH J. MORAVEC, M.D. AND THE FACIAL SURGERY CENTER. (COLLECTIVELY REFERRED TO IN THIS PRIVACY NOTICE AS "THE FACIAL SURGERY CENTER"). PLEASE REVIEW THIS INFORMATION CAREFULLY. At the Facial Surgery Center, we specialize in otolaryngology (ear, nose, throat) and facial cosmetic and reconstructive surgery. We bring this specialized expertise to bear on the most thorough, personally focused treatment plan possible. Specially trained personnel and a lead-edge facility offer you consistent top-quality care from start to finish. We devote time and attention to listening, providing information, and establishing shared realistic expectations. If you are looking for a cosmetic change, we want one that will make a difference in your quality of life. Important—indeed essential—to our efforts is the respect, integrity and dignity we pay to patient privacy, confidentiality and rights relating to their medical and health care records and information. As an individual who receives medical and health care services, we understand that you may be concerned about how information about you may be used, disclosed, created, maintained or otherwise handled. That is why The Facial Surgery Center, as a health care provider, is committed to help ensure the privacy and confidentially of your individually identifiable health information. So, too, we are committed as a practice to be and stay compliant with new federal patient privacy regulations, known as the HIPAA Privacy Rules, effective April 14, 2003. The Facial Surgery Center has developed this Joint Notice of Privacy Practices, made it available to you, and put into practice specific policies, procedure and protocols to abide by its terms as currently in effect under the terms and provision of the HIPAA Privacy Rules. This Joint Privacy Notice is intended to cover both entities (Joseph J. Moravec, M.D., Inc, and the ambulatory surgery center, The Facial Surgery Center). In addition, as permitted under the HIPAA Privacy Rules, these same entities shall conduct their HIPAA Privacy Rules Compliance Program and efforts in coordination with one another. Still, however, to the extent that these entities and/or persons are separate entities and persons under the law, this Joint Privacy Notice is not intended, nor should it be construed, to mean that they are liable for the other entity’s or person’s acts and/or omissions in violation of the HIPAA Privacy Rules. Any questions or concerns relating to the matters and issues addressed in this Notice should be addressed to our specially designated HIPAA Privacy Rules Compliance Officer, Linda Moravec. Contact information is listed on the last page of this notice. Please note: The Facial Surgery Center reserves the right to revise and/or modify this Joint Privacy Notice, and apply its provisions to individually identifiably health information that is created, received or maintained prior to the date that the Joint Privacy Notice is revised and/or modified. The Facial Surgery Center will make good faith efforts to timely provide the revised Joint Privacy Notice to its patients in accordance with the requirements of the HIPAA Privacy Rules. For purposes of the Joint Privacy Notice individually identifiable health information is referred to as “Protected Health Information”.
The HIPAA Privacy Rules are this nation’s first set of comprehensive standards to ensure health care consumer privacy and confidentiality. Certain activities and functions of The Facial Surgery Center are directly covered by the HIPAA Privacy Rules. The Facial Surgery Center takes patient privacy and confidentiality seriously and is committed as an organization to the underlying purpose and philosophy of the HIPAA Privacy Rules—the safeguard of Protected Health Information. To the extent that State patient privacy law may be stricter than the HIPAA Privacy Rules, the Facial Surgery Center is committed to comply with those stricter requirements. 1. Uses/Disclosures Related To Treatment, Payment Or Health Care Operations The HIPAA Privacy Rules permit The Facial Surgery Center to use and/or disclose patient Protected Health Information for treatment/care, payment and/or health care operations. In most cases the HIPAA Privacy Rules allow us to use and/or disclose Protected Health Information without first obtaining a written or oral Consent from the patient. Being able to use, disclose, receive, create or otherwise handle your Protected health Information is essential to our ability to provide quality patient care to or patients, and to do so in a way that affords patient privacy and confidentiality, in accordance with the HIPAA regulations. We shall make good faith attempts to ensure that patients have obtained a copy of this Notice, and have acknowledged their receipt of it. The following examples illustrate what we mean by “treatment” and “payment” and “health care operations”” Treatment: An example of when The Facial Surgery Center might use or disclose your Protected Health Information for treatment/care purposes is when your medical/health information is needed by us to properly diagnose, better understand or make proper referrals in relation to your medical or other health condition. The Facial Surgery Center may use or disclose your Protected Health Information by sharing it with another health care provider or pharmacy to meet your health, prescription (fill and refill) needs. Payment: An example of when The Facial Surgery Center might use or disclose your Protected Health Information for payment purposes is when The Facial Surgery Center does so to obtain reimbursement and coverage for medical care, such as obtaining payment or reimbursement from Medicare, Medicaid or private third party payors. When The Facial Surgery Center uses or discloses your Protected health Information for payment purposes, The Facial Surgery Center only shall strive to disclose that Protected health Information that is minimally necessary to ensure proper and timely payment of claims. Health Care Operations: “Health Care Operations” means those other functions and activities that allow The Facial Surgery Center to properly carry out its functions and activities that allow The Facial Surgery Center to properly carry out its medical and other health care-related business functions. Examples include The Facial Surgery Center’s using or disclosing your Protected Health Information for quality assessment and improvement activities; in relation to accounts receivable analysis or assessment; to address regulatory compliance or legal issues; or to carry out general administrative and practice management activities. These activities include but are not limited to the development and use of photos, training of medical residents, and training by medical equipment representatives. Other examples include the use of a sign-in sheet at the registration desk where you will be asked to sign your name. We may also call you by name in the waiting room when Dr. Moravec is ready to see you or talk with you in the hallway. We may use or disclose your Protected Health Information, as necessary, to contact you in order to remind you of your appointment. 2. Uses/Disclosures Requiring An Authorization In certain instances, The Facial Surgery Center will request an Authorization from you that satisfies the requirements of the HIPAA Privacy Rules. Some examples of when you might be asked to execute a HIPAA-compliance authorization prior to the time The Facial Surgery Center uses or discloses your Protected health Information include; when a patient’s employer asks The Facial Surgery Center to disclose Protected Health Information about a patient in connection with an employment-related determination; when the media or the general public contact The Facial Surgery Center requesting that certain of our Protected Health Information be disclosed to them; when a family member requests to see your medical charts and files; in certain circumstances involving the use or disclosure of patient psychotherapy notes, etc. Should you be asked to execute an Authorization it is important for you to know the following information: 1. In most cases The Facial Surgery Center and other entities that are directly subject to the HIPAA Privacy Rules (“Covered Entities”) may not condition treatment, payment, enrollment or eligibility on your providing them with an Authorization. 2. Still, there are some cases in which The Facial Surgery Center and other Covered Entities may condition their services and/or other efforts based upon their securing a HIPAA-compliant Authorization from you. a. In some circumstances the Facial Surgery Center and other Covered Entities may condition treatment or other health care services to you when such treatment or other health care services are solely for the purpose of creating Protected Health Information in order to provide it to a third party for whose benefit the Authorization is intended (e.g. an employer sending a patient for a physical; to undergo certain safety and health-related diagnostic tests; for fitness for duty/return to work purposes; relating to family medical leave issues; etc.) b. To the extent The Facial Surgery Center or other covered Entities may provide treatment or other health care services in connection with carrying out clinical research involving human subjects, your research-related treatment may be conditioned upon an Authorization when your Authorization is requested and required to use or disclose Protected health Information in connection with research-related purposes. 3. Regardless of whether you execute an Authorization, you always have the right to request that it be revoked. When revoking your prior Authorization, you must do so in writing. Also, please note that any time you revoke an Authorization, the revocation does not apply to the extent that and in those circumstances in which action in reliance on your Authorization already has been taken. 4. Consistent with the HIPAA Privacy Rules, The Facial Surgery Center is not required to account for disclosures of your Protected health Information that are made in accordance with the Authorization that you execute.
3. Use/Disclosures (Other Than Treatment, Payment Or Health Care Operations) Not Requiring An Authorization The Facial Surgery Center may use or disclose your Protected health Information in the following situations without your authorization: a. To avert the spread of communicable diseases. b. Public Health initiatives to control or prevent disease, injury, or disability. c. To report child abuse, neglect or domestic violence in accordance with applicable State law. d. In relation to United States Food and Drug Administration (“FDA”) regulated products, in accordance with applicable FDA requirements. e. To carry out occupational safety and health efforts in accordance with federal and State occupational safety and health statutes and regulations. f. For health oversight purposes, such as in relation to authorized governmental civil audits, criminal investigations, inspections, licenses, disciplinary actions. g. In the course of judicial or administrative proceedings. h. To facilitate the efforts of law enforcement (including in relation to crimes on the premises; homicides; pursuant to legal process; emergency circumstances; etc.) i. In connection with certain disclosures relating to decedents (to coroner/funeral directors; organ/eye/tissue donation matters). j. Clinical research related purposes that have 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. k. To avert serious threat to health and safety or a person or the public. l. To address special governmental purposes (including national security; military and veterans activities; correctional institution/custodial situations; etc.) m. To address workplace, injury or workers’ compensation issues. n. To make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of the HIPAA Privacy Rules. 4. Uses Or Disclosures For Which Opportunity to Agree Or Object Is Required There are also those instances in which, although The Facial Surgery Center is not required to obtain a written Authorization, it still is required to provide you with the opportunity to agree or object to the use or disclosure before such time it is made. Such instances may include those involving family members and close loved ones of your condition or location. They may include those in connection with disaster relief efforts. 5. Uses/Disclosures For Fundraising, Marketing And Other Purposes In accordance with the HIPAA Privacy Rules we may use and/or disclose your Protected Health Information for marketing, fundraising, and/or treatment alternative purposes that may be of interest to you. If we do so, we are committed to meeting the requirements of the HIPAA Privacy Rules to best ensure privacy and confidentiality. In addition, we may use and/or disclose your Protected Health Information for patient scheduling purposes, and we may also use or disclose your Protected Health Information to send you a newsletter about our practice and the services we offer. We may also send you information about products or services that we believe may be beneficial to you. In some instances, you have the right under the HIPAA Privacy rules to opt out of such communications. 6. Your Rights a. You have the right to inspect and copy your Protected Health Information. This means you may inspect and obtain a copy of Protected Health Information about you that is contained in a designated record set for as long as we maintain the Protected Health Information. A “designated record set” contains medical and billing records and any other records that your physician and the practice uses for making decisions about you. b. You have the right to request a restriction of your Protected Health Information. This means you may ask us not to use or disclose any part of your Protected Health Information for the purposes of treatment, payment or healthcare operations. You may also request that any part of your Protected Health Information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in the Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply. Although we shall act in good faith with respect to any such requests, however, we are not legally obligated under the HIPAA Privacy Rules to agree to such requested restriction of confidential communications. c. You have the right to request to receive confidential communications from us by alternative means or at an alternative location. We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification for an alternative address or other method of contact. We will not request an explanation from you as to the basis for the request. Please make this request in writing to our Privacy Officer, Linda Moravec. d. You may have the right to have your physician amend your Protected Health Information. This means you may request an amendment of Protected Health Information about you in a designated record set for as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny you request for amendment, you have the right to the statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact our Privacy Officer to determine if you have questions about amending your medical record. e. You have the right to receive an accounting of certain disclosures we have made, if any, of your Protected Health Information. This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice of Privacy Practices. It excludes disclosures we may have made to you, for a facility directory, to family members or friends involved in your care, or for notification purposes. You have the right to receive specific information regarding these disclosures that occurred after April 14, 2003. You may request a shorter timeframe. The right to receive this information is subject to certain exception, restrictions and limitations. f. You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice electronically. 7. Complaints You may complain to us or to the secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our privacy officer of your complaint. We will not retaliate against you for filing a complaint. Contact Information:
email:facialsurgerycetner@moravecfsc.com In addition, should you ever find that The Facial Surgery Center has not been attentive or responsive to your patient privacy, confidentiality or other rights under the HIPAA Privacy Rules, you may contact HHS OCR at the following address, telephone, and website: Medical Privacy, Complain Division, Office of Civil Rights, Untied States Department of Health and Human Services, 200 Independence Avenue, S.W. , Room 509F, HHH Building, Washing, D.C. 20201; Voice Hotline Number: (800) 368-1019; Internet Address: http://www.hhs.gov/ocr; email address: ocrmail@hh.gov.
This notice becomes effective on April 14, 2003.
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