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NOTICE OF HEALTH INFORMATION PRIVACY PRACTICES

This represents Saratoga Emergency Physicians LLC, Alliance Emergency Systems. Also Saratoga Hospitalist Practice and Adirondack Urgent Care

 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.

 Understanding Your Health Record/Information

Each time you visit a hospital, physician or other healthcare provider, a record of your visit is made.  Typically, this record contains your symptoms, examination and test results, diagnoses, treatment and a plan for future care or treatment.  It will also include your identity, any personal information including your address and telephone number, your health insurance coverage, and any other health-related information which may identify you.  This information, often referred to as your health or medical record, contains “Protected Health Information” (PHI). 

Understanding what is in your record and how your PHI (Protected Health Information) is used allows you to:
·
ensure its accuracy
·  better understand who, what, when, where and why others may     access your health information.
· 
make more informed decisions when authorizing disclosure to others.

Use of Your PHI Without Your Signed Authorization

Examples of Uses and Disclosures of your PHI which do not require your written authorization including for Treatment, Payment and Health Operations.

 We may use your PHI or share it with others in order to treat your condition, obtain payment for that treatment, and run our normal business operations.  PHI may also be shared with affiliated or related hospitals and health care providers so that they may jointly perform certain payment activities and business operations along with Saratoga Emergency Physicians.   

Treatment:  Information obtained by a nurse, physician or other member of the healthcare team will be recorded in your medical record and used to determine your course of treatment.  Members of your healthcare team will record the actions they took and their observations.  This will allow the physician to know how you are responding to treatment.  We will also provide subsequent healthcare providers with copies of various reports and information that should assist them in diagnosing and treating you.

We may also contact you about appointment reminders, treatment alternatives and other health related benefits and services.

Payment:  A bill may be sent to you or a third-party payer or others so that we can obtain payment for your health care services.    This information on or accompanying the bill may include PHI information that identifies you as well as your diagnosis, procedures and supplies used.  As an example we may share information about you with your health insurance company in order to obtain reimbursement after we have treated you Or we may share information about you with your health insurance company to determine whether it will cover your treatment which might also include preapproval for your treatment such as admitting you to the hospital.  We may also share your PHI with our affiliated or related health care providers for their own payment activities.

Health Operations:  We may use your PHI or share it with others in order to conduct our normal business operations.   

1. Risk Management - Members of the medical staff or the risk or quality improvement staff may use information in your health record to assess the care and outcomes in your case and other like it.  This information will then be used in an effort to continually improve the quality and effectiveness of the healthcare and service we provide.

2. Business Associates - There are some services provided in our organization through contacts with business associates.  Examples include Coding Service, radiology, laboratory, copy services, transcription services, billing services, legal services, auditing, etc.  When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we have asked them to do and bill you or your third-party payer for services rendered.  To protect your health information, however, we require the business associate to appropriately maintain the privacy and confidentiality of your PHI and safeguard your information.  Also, at the request of your other health care providers or health plan, we may disclose PHI to their authorized business associates for purposes of performing certain business functions or health care services on their behalf.  An example would be to disclose PHI to a business associate of Medicare for medical necessity review/audit.

3. Notification – We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, of your location and general condition or death.  . 

4.Communication With Family – Unless you object, Health professionals, using their best judgment, may disclose to a family member, other relative, close personal friend or any other person you identify, health information that is directly relevant to that person’s involvement in your care or payment related to your care. You have the right to object.

If you are unable able to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment.  We may use or disclose PHI to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care, of your location, general condition or death.  

5. Research – In most cases we will ask for your written authorization before using your PHI or sharing it with others in order to conduct research, However, under some circumstances, we may use and disclose your PHI without your authorization if: the research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information and poses minimal risk to your privacy.  Under no circumstances would we allow researchers to use your name or identity publicly.  We may also release our PHI without your authorization to people who are preparing a future research project, so long as any information identifying you does not leave our facility.  In the unfortunate event of your death, we may share your PHI with people who are conducting research using the information of deceased persons, as long as they agree not to remove from our facility any information that identifies you.

6. Funeral Directors, Coroners, and Medical Examiners – We may disclose health information to funeral directors, medical examiners, coroners consistent with applicable law to carry out their duties.  As an example, a coroner may require PHI I in order to determine the cause of death. 

7. Organ Procurement Organizations – Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking or transplantation of organs for the purpose of tissue donation and transplant, if we have no indication on hand about your donation preferences (or a positive indication;. So that these organizations may investigate whether donation or transplantation is possible under applicable laws.

8. Fundraising Communications – We may use:  Certain information  about where you work, the dates you received treatment, the department which treated you, our treating physician, and your medical outcomes, in order to contact you to raise money to help us operate.  We may also share this information with a charitable foundation that will contact you to raise money on our behalf. 

 You have the right to opt-out of receiving fundraising communications.   For any fundraising communication sent to you we will let you know how you can opt-out of receiving similar communications in the future, or you may opt-out of receiving fundraising communications by sending your name and address to:

Compliance Officer
Saratoga Emergency Physicians
454 Maple Avenue,
Saratoga Springs N.Y.  12866

together with a statement that you do not wish to receive fundraising materials or communications from us.       

Your treatment or payment will not be conditioned on your   choice with respect to the receipt of fundraising communications.

9. Emergencies – We may use or disclose your PHI if you   need emergency treatment or if we are required by law to treat you but are unable to obtain your consent.  If this happens, we will try to obtain your consent as soon as we reasonably can after we treat you.   

10. Workers’ Compensation – We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers’ compensation or other similar programs established by law.

11. Communication Barriers – We may use and disclose your PHI if we are unable to obtain your consent because of communication barriers, and we believe you would want us to treat you if we could communicate with you.

             12.  Required by Law - Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public.

                13. Law Enforcement We may disclose protected health information to law enforcement for the following purposes:

·      to comply with court orders or law that we are required to follow.
·     
to assist law enforcement officers with identifying or locating a suspect, fugitive, witness, or missing person.
·     
if you have been the victim of a crime and we determine that: (1) we have been unable to obtain your consent because of an emergency or your incapacity; (2) law enforcement officials need this information immediately to carry out their law enforcement duties; and (3) in our professional judgment disclosure to these officers is in your best interests.
·     
if we suspect that your death resulted from criminal conduct.
·     
if necessary to report a crime that occurred on our property or
if necessary to report a crime discovered during an offsite medical emergency (for example, by emergency medical technicians at the scene of a crime)

               14. Lawsuits and disputes:  We may disclose your PHI if we are ordered to do so by a court adjudicating a lawsuit or other dispute.

15. Public Health Activities – As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury or disability and /or report abuse and neglect.  We may also disclose PHI to a person who may have been exposed to a communicable disease or be at risk for contracting or spreading the disease if a law permits us to do so.

Also, we may release some health information about you to your employer if your employer hires us to provide you with a physical exam and we discover that you have a work-related injury or disease that your employer must know about in order to comply with employment laws.

Abuse, neglect or Domestic Violence Victims – This PHI may be released to a public health authority that is authorized to receive reports of abuse, neglect or domestic violence.  As an example we may report your PHI to the government officials if we reasonably believe that you have been a victim of abuse, neglect or domestic violence.  We will make every effort to obtain your permission before releasing this information, but in some cases we may be required or authorized to act without your permission.

Food and Drug Administration (FDA) – We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects, recalls, repairs or replacement.

Product monitoring and recall:  Disclosure of PI to a person or company that is required by the Food and Drug Administration to report or rack product defects or problems; repair, replace, or recall defective or dangerous products; or monitor the performance of a product after it has been approved for use by the general public.

16. Health Oversight Activities – PHI may be released to government agencies authorized to conduct audits, investigations and inspections of our facilities.  These government agencies monitor the operation of the health care system, government benefit programs such as Medicare and Medicaid, and compliance with government regulatory programs and civil rights laws.

Other Uses and Disclosures that do not require Your Written Authorization:

National Security and Intelligence Activities or Protective Services – We may disclose your PHI to authorized federal officials who are conducting national security and intelligence activities or providing protective services to the President or other important officials.

Military and Veterans – If you are in the Armed Forces, we may disclose your PHI to appropriate military command authorities for activities they deem necessary to carry out their military mission.  We may also release health information about foreign military authority.

Inmates and Correctional Institutions – If  you are an inmate or you are detained by a law enforcement officer; we may disclose your PHI to the prison officers or law enforcement officers if necessary to provide you with healthcare, or to maintain safety, security and good order at the place where you are confined.  This includes sharing information that is necessary to protect the health and safety of other inmates or person involved in supervising or transporting inmates.

Serious Threat to Health or Safety – We may disclose your PHI if necessary to prevent or lessen a serious and/or imminent threat to the health or safety of a person or the public.               

USES AND DISCLOSURES OF YOUR PHI WHICH REQUIRE YOUR WRITTEN AUTHORIZATION

Marketing – Your written authorization is required for us to use or disclose your PHI for marketing purposes, except if we communicate personally to you, face-to-face or if we provide you with prescription refill reminders or otherwise communicate with you about a drug or biologic that you are currently prescribed and we do not in exchange receive any financial remuneration that is unreasonably related to our cost of making such communication to you.

It is not considered marketing and therefore your written authorization is not required, if we communicate with you related to your individual treatment, case management, or care coordination, or if we direct or recommend alternative treatment, therapies, healthcare providers or settings of care, unless we receive financial remuneration from a third-party in exchange for making such communication to you.  If marketing activities are to result in financial remuneration to us from a third party we will state this on the authorization.

Sale of PHI – Your written authorization is required for any use or disclosure which is considered a sale of PHI.  Any authorization for the sale of PI will state that the disclosure will result in remuneration to us.

Psychotherapy Notes – Your written authorization required for any use or disclosure or psychotherapy note, except for use by the originator of the psychotherapy notes for treatment or health oversight programs;   for use or disclosure to defend us in a legal action or other proceeding brought by you;  to the extent required to investigate or determine our compliance with the applicable law;  to the extent that such use or disclosure is required by law and the use or disclosure complies with and is limited to the relevant requirements of such law;  for health oversight activities with respect to the oversight of the originator of the psychotherapy notes; for disclosure to a coroner or medical examiner for the purpose of identifying a deceased person, determining a cause of death, or other duties as authorized by law; or if disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public and is made to a person or persons reasonably able to prevent or lessen the threat, including the target of the threat.

All other Uses and Disclosures – Your written authorization is required for any other use or disclosure not specifically described in this notice.  You may also initiate the transfer of your records to another person by completing an authorization form.  If you provide us with written authorization, you may revoke that authorization at any time, except to the extent that we have already relied upon it.  To revoke an authorization, please write to the Compliance Officer at Saratoga Emergency Physicians, 454 Maple Avenue, Saratoga Springs, NY  12866.

Special Protection for HIV, Alcohol and Substance Abuse, Mental Health and Genetic Information – Special privacy protections apply to HIV-related information, alcohol and substance abuse information, mental health information, and genetic information.  Some parts of this general Notice of Privacy Practices may not apply to these types of information, which require increased privacy protection.

Our Responsibilities:  We are required by law to protect the  privacy of certain health information called “Protected Health Information” (PHI).

This organization is required to:

·         maintain the privacy of your health information.
·        
provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about you.
·        
abide by the terms of this notice.
·        
notify you if we are unable to agree to a requested restriction.
·        
accommodate reasonable requests you  may have to communicate health information by alternative means or at alternative locations.
·        
notify you of a breach of “unsecured” protected health information; that would include if Saratoga Emergency Physicians or a Business Associate discovers a breach involving your protected health information.

Your Rights to Access and Control Your Health Information - Although your health record is the physical property of the healthcare practitioner or facility that compiled it, the information belongs to you.  You have the following rights to access and control your PHI.  These rights will also provide you with the ability to have some control for the way we use your PHI and how it is shared with others, including the way we communicate with you and others regarding your protected health information.

Right to ACCESS - Inspect and Copy Records – you may inspect and obtain a copy of your PHI for as long as we maintain this information in our records.  To inspect or obtain a copy of your PHI, submit your request in writing to the Saratoga Emergency Physicians, 454 Maple Ave., Saratoga Springs, NY  12866.   We may charge a fee for the costs of copying, mailing or other supplies used to fulfill your request.  The allowable fee is $0.75 per page.

Our response to your request for inspection of PHI will be within 10 days.  Our response for copies of PHI is within 10 days if the information is immediately available, or up to 30 days if the PHI is not accessible within the 10 day timeframe.  We will notify you in writing within the above timeframe to explain the reason for the delay and the time you may expect to receive the PHI or a final answer to your request.

You should know that under certain very limited conditions, we may deny your request to inspect or obtain a copy of your PHI.  If we do so, we will provide you with a summary of the PHI instead.  “We will also provide a written notice that explains our reasons for providing only a summary, and a complete description of your rights to have that decision reviewed and how you can exercise those rights.  The notice will also include information on how to file a complaint about these issues with us or with the Secretary of the Department of Health and Human Services.  If we have reason to deny only part of your request, we will provide complete access to the remaining parts after excluding the information we cannot let you inspect or copy.

Right to Amend Records - If you discover that the PHI documented about you is incorrect or incomplete, you may ask to amend the information.  You have the right to request amendment for as long as the information is kept in our records.  To request an amendment, please write to the Compliance Officer, Saratoga Emergency Physicians at 454 Maple Ave.  Saratoga Springs, NY  12866.

This request should include the reasons why this amendment should be made.  We will respond within 10 working days to your request.  If we require additional time to reply, you will be notified in writing within 30 days to explain the reason for the delay and when you m-ay expect to have an answer.

Should we deny your request, you will be provided a written notice that explains our reasons for doing so.  You will have the right to have certain information related to your requested amendment included in your PHI.  As an example, should you disagree with our decision, you will have an opportunity to submit a statement explaining our disagreement which we will include in your records. 
You will also receive information on how to file a complaint with us or with the secretary of the department of Health and Human Services.

Right to an Accounting of Disclosures – You have a right to request an “accounting of disclosures” which is a list with information about how we have shared your PHI with others.  This accounting list will not include:  

1.  Disclosures made to you.
2. 
Disclosures made in order to provide you with treatment, obtain payment for that treatment, or conduct normal business operations.
3. 
Disclosures made in the facility directory.
4. 
Disclosures made to your friends and family involved in your care.
5. 
Disclosures made to federal officials for national security and intelligence activities.
6. 
Disclosures about inmates to correctional institutions or law enforcement officers.
7. 
Disclosures made before April 14, 2003.

To request an accounting of disclosures – Write to: Compliance Officer, Saratoga Emergency Physicians, 454 Maple Ave.  Saratoga Springs, NY  12866

This request must state the time period for the disclosures of information that you would like to receive.  As an example:  A disclosure request might state disclosures from January 1, 2009 to January 1, 2013.  You may request a list every 12 months period for free.  Should you require additional lists we may charge you for the cost of providing additional lists in that same 12 month period.  We will notify you of any cost involved in order that you may choose to withdraw or modify your request before any costs are incurred.

We will respond to your request for the disclosure list within 10 working days.  Should we need additional time to prepare the disclosure list, you will be notified in writing regarding the reason for the delay and the date when you can expect to receive the disclosure list.  In rare cases we may have to delay the disclosure list due to a request by law enforcement or government agency request.

Right to Request Additional Privacy Protections – You may request that we further restrict the way we use and disclose your PHI to treat your condition, collect payment for that treatment, or run or normal business operations.  You may also request that we limit how we disclose information about you to family or friends involved in your care.  As an example:  You may request that we not disclose information about an Urgent Care Visit that you had.  To request restrictions, write to:  Compliance Officer, Saratoga Emergency Physicians, 454 Maple Ave.  Saratoga Springs, NY  12866.  This request should include; the information that should be restricted; if you want to restrict how this information is used and how we share it with others, or both; and to whom you want the limits to apply.

We are required to comply with a request that we not disclose your PHI to a health plan for payment or health care operations purposes, if the PHI pertains to a health care item or service for which we have been involved and you have paid for the item or service in full out-of-pocket.

For all other requests, we will consider your requested restriction but we are not required to agree to your request (and in some cases the restriction you request may not be permitted under law.  Should we agree to the restriction we will be bound by our agreement unless the PHI is needed to provide you with emergency treatment or comply with the law.  Once we have agreed to a restriction, you have the right to revoke the restriction at any time.  Under some circumstances, we will also have the right to revoke the restriction as long as we notify you before doing so.  In other cases we will need your permission before we can revoke the restriction.

 Right to Request Confidential Communication – You have the right to request that we communicate with you about your medical matters in a more confidential way.  As an example:  You may request that we contact you at home and not at work.  To request more confidential communications, write to:  Compliance Officer, Saratoga Emergency Physicians, 454 Maple Ave.  Saratoga Springs, NY  12866.  You will not be asked the reason for your request and we will try to accommodate all reasonable requests.  You must specify in your request how or where you wish to be contacted, how payment for your health care will be handled if we communicate with you through this alternative method or location.

 Right to have Someone Act on Your Behalf – You have the right to name a personal representative who may act on your behalf to control the privacy of your health information.  Parents and guardians will generally have the right to control the privacy of health information about minors unless the minors are permitted by law to act on their own behalf.

 Notification of a Breach of Your PHI - We will notify you in writing if we discover a breach of your unsecured PHI, unless we determine, based on a risk assessment, that notification is not required by applicable law.  You will be notified without unreasonable delay and no later than 60 days after discovery of the breach.  Such notification will include information about what happened and what has been done or can be done to mitigate any harm to you as a result of such breach.

We reserve the right to change our practices and to make the new provisions effective for all protected health information that we maintain.  Should our information practices change, you may get updates or reissue of this notice at your request. 

We will not use or disclose your health information without your written authorization, except as described in this notice in addition to any other permission you provide.  For example, we need written authorization before we would sell your PHI or in most instances, market a third party’s services to you, if we are receiving payment for that marketing.

To Report a Problem
If you have questions and would like additional information, you may contact this office at 518-587-1141.

If you believe your privacy rights have been violated, you can file a complaint with this office or with the secretary of Health and Human Services.  There will be no retaliation for filing a complaint.

When we use or disclose your PHI we are required to follow the terms of this Notice of Privacy Practices or other notice in effect at the time we use or disclose your PHI.  At  Adirondack Urgent Care  a copy of our current notice will be posted in our registration area.  You will also be able to obtain copies by accessing our website at wwwSEPPC.com or www.ADKUC.org or calling our office at 518-587-1141 or Adirondack Urgent Care at 518-223-0155 or asking for one at your next visit.

·         How to obtain a copy of this notice – You have the right to a paper copy of this notice.  You may request a paper copy at any time, even if you have previously agreed to receive this notice electronically.  To do so, please call the Compliance Officer at Saratoga Emergency Physicians at (518)587-1141.

·         
For more information about our privacy practices, please contact: the Compliance Officer at 518-587-1141, Located at 454 Maple Avenue  Saratoga Springs, NY  12866

Effective Date of revised notice::  September 23, 2013

Effective Date of revised notice::  May 30,  2014