NOTICE OF PRIVACY PRACTICES

Integrated Pain Specialists of Southern California, Inc.

Kevin S. Smith M.D. / Nicole Wright, PA-C

7910 Frost Street, Suite 280,  San Diego, CA 92123

5525 Grossmont Center Drive,  Suite 609,  La Mesa, CA 91942

Phone: (619) 398-2988  –  Fax: (619) 398-2987  –  Alt Fax: (858) 300-1156

 

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Integrated Pain Specialist respects your privacy. We understand that your personal health information is very sensitive. We will not disclose your information to others unless you tell us to do so, or unless the law authorizes or requires us to do so.

The law protects the privacy of the health information we create and obtain in providing our care and services to you. For example, you protected health information includes your symptoms, test results, diagnoses, treatment, health information from other providers, and billing and payment information, relating to these services. Federal and State law allows us to use and disclose your protected health information for purposes of treatment and health care operations.

EXAMPLES AND USE OF DISCLOSURE OF PROTECTED HEALTH INFORMATION FOR TREATMENT, PAYMENT AND HEALTH OPERATIONS 

 

FOR TREATMENT:

  • Information obtained by a nurse, physician, or other member of our health care team will be recorded in your medical record and used to determine what care may be right for you.
  • We may also provide information to others providing your care, to keep them informed about your care.

FOR PAYMENT:

  • We request payment from your health insurance plan. Health Plans need information from us about your medical care. Information provided to health plans may include your diagnosis; procedure performed, or recommended care.

FOR HEALTHCARE OPERATIONS:

  • We use your medical records to assess quality and improve services.
  • We may use and disclose medical records to review the qualifications and performance of our health care providers and to train our staff.
  • We may contact you to remind you about appointments and give you information about treatment alternatives or other health related benefits and services.
  • We may use and disclose your information to conduct or arrange for services, including:
  • Medical quality review by your health plan
  • Accounting, legal, risk management, and insurance services
  • Audit functions, including fraud and abuse detection and compliance programs

You may receive the most recent copy of this notice by calling and asking for it or by visiting our office to pick one up.

TO ASK FOR HELP OR TO COMPLAIN:

If you have questions, want more information, or want to report a problem about the handling of your protected health information, you may contact:

Office Manager for Integrated Pain Specialist

7910 Frost St Ste 280

San Diego, CA 92123

If you believe your privacy rights have been violated, you may discuss your concerns with any staff member. You may also deliver a written complaint to the Office Manager of Integrated Pain Specialist. You may also file a complaint with the U.S. Secretary of Health and Human Services.

We respect your right to file a complaint with us or with the U.S. Secretary of Health and Human Services. If you complain we will not retaliate against you.

OTHER DISCLOSURE AND USES OF PROTECTED HEALTH INFORMATION

NOTIFICATION OF FAMILY MEMBERS AND OTHERS

  • Unless you object, we may release health information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. We may tell your family or friends your condition and that you are in a hospital. In addition, we may disclose health information about you to assist in disaster relief efforts.

You have the right to object to this use or disclosure or your information. If you object, we will not use of disclose it.

WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION WITHOUT YOUR AUTHORIZATION AS FOLLOWS:

  • With Medical Researchers– if the research has been approved and has policies to protect the privacy of your health information. We may also share information with medical researchers preparing to conduct a research project.
  • To Funeral Directors/Coroners– consistent with applicable law to allow them to carry out their duties.
  • To the Drug Enforcement Agency (DEA)- relating to problems with narcotics
  • To the Food and Drug Administration (FDA) – relating to problems with food supplements, and products.
  • To comply with Workers’ Compensation Laws- if you make a workers compensation claim
  • For Public Health and Safety Purposes as allowed or required by law:
  • To prevent or reduce a serious, immediate threat to the health or safety of a  person, or to the public.
  • To Public Health or Legal authorities

 

YOUR HEALTH INFORMATION RIGHTS

The health and billing records we create and store are the property of Integrated Pain Specialist. The protected health information in it, however, generally belongs to you. You have a right to:

  • Receive, read, and ask questions about this Notice
  • Ask us to restrict certain uses and disclosures. You must deliver this request in writing to us. We are not required to grant the request, but we will comply with any request granted
  • Request and receive from us a paper copy of the most current Notice of Privacy Practices for Protected Health Information
  • Request that you be allowed to see and get a copy of your protected health information. You may make this request in writing. We have a form available for this type of request. We will let you know of the cost involved.
  • Have us review a denial of access to your health information – except in certain circumstances
  • Ask us to change your health information. You may give us this request in writing. You may write a statement of disagreement if your request is denied. It will be stored in your medical record, and included with any release of your records.
  • When you request, we will give you a disclosures of your health information. The list will not include disclosures to third-party payors. You may receive this information without charge once every 12 months. We will notify you of the cost involved if you request this information more than once in 12 months.
  • Cancel prior authorizations to use of disclose health information by giving us a written revocation. Your revocation does not affect information that has already been released. It also does not affect any action taken before we have it. Sometimes, you cannot cancel an authorization if its purpose was to obtain insurance.

FOR HELP WITH THESE RIGHTS DURING NORMAL BUSINESS HOURS, PLEASE CONTACT:

Office Manager for Integrated Pain Specialist

7910 Frost Street, Suite 280, San Diego, CA 92123

OUR RESPONSIBILITIES

We are required to:

  • Keep your protected health information private
  • Give you this notice
  • Follow the terms of this Notice

We have the right to change our practices regarding the protected health information we maintain. If we make changes, we will update this Notice.

  • To protect public health or safety
  • To prevent or control disease, injury or disability
  • To report vital statistics such as birth or deaths
  • To report suspected abuse or neglect to public authorities
  • To correctional institutions, if you are in jail or prison, as necessary, for your health and the health and safety of others
  • For Law enforcement purposes, such as when we receive a subpoena, court order, or other legal process, or if you are the victim of a crime
  • For health and safety oversight activities. For example we may share health information with the Department of Health
  • For work related conditions that could affect employees health. For example, an employer may ask us to assist health risks on a job site.
  • To the military authorities of U.S. and Foreign Military Personnel. For example, the law might require us to provide information necessary to a military mission.
  • In the course of Judicial/Administrative Proceeding. For example, we may share information for national security purposes.

OTHER USES AND DISCLOSURE OF PROTECTED HEALTH INFORMATION

  • Uses and disclosures not in this Notice will be made only as allowed or required by law or with your written authorization.

Effective date: September 18, 2007