NOTICE OF PRIVACY PRACTICES

FUTURECARE MEDICAL ASSOCIATES IPA

5000 Airport Plaza Drive, Suite 150, Long Beach, CA 90815

Privacy Officer: Paul J. Pew, 562-766-2000 ext. 240

 

EFFECTIVE DATE: JANUARY 1, 2010
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.
We are an Independent Practitioner Association (IPA) -- an organization of independent health care professionals who jointly contract with health plans to provide medical care. We understand the importance of privacy and are committed to maintaining the confidentiality of your medical information. Our physicians make a record of the medical care provided to you and we receive similar records from others. We use these records to provide or enable other health care providers to provide quality medical care to you, to obtain payment for services provided to you as allowed by your health plan and to enable us to meet our professional and legal obligations to operate properly. This notice describes how we may use and disclose your medical information. It also describes your rights and our legal obligations with respect to your medical information. If you have any questions about this notice, please contact our Privacy Officer listed above

A. HOW WE MAY USE OR DISCLOSE YOUR HEALTH INFORMATION

Protected Health Information (PHI) is individually identifiable information, including demographic information, related to your past, present, or future physical or mental health or condition; the provision of health care to you; and the past, present, or future payment for such health care. The law permits us to use or disclose your health information for the following purposes. The examples sited are illustrative and not a complete list

1. TREATMENT. We are permitted to use and disclose your PHI with regards to providing, coordinating and managing health care, consulting with other health care providers, and processing referrals to other providers. An example of this would be
receiving, reviewing and authorizing a request from your primary care physician to refer you to a specialist physician.

2. PAYMENT. We are permitted to use and disclose your PHI in determining health plan coverage and benefits, obtaining reimbursement for providing health care, determining eligibility, coordinating benefits, adjudicating and managing health care claims, utilization review, obtaining payment for reinsurance and determining medical necessity. An example of this would be verifying by telephone your health plan coverage and benefits prior to paying a claim for medical services

3. HEALTH CARE OPERATIONS. We may use and disclose medical information about you to operate the IPA. We are permitted to use and disclose your PHI with regard to conducting quality assessments or improvement activities, reviewing the competency or qualifications of health care practitioners, training programs, credentialing activities, medical review, auditing functions, including fraud and abuse detection and compliance programs, business planning and development, business management, and general administrative activities. An example of this would be the IPA peer review committee reviewing your medical chart to determine if a member physician rendered appropriate care. We may share medical information about you to all the other health care providers who participate under the IPA’s organized health care arrangement We may also share your medical information with "business associates" such as our management company that performs administrative services for us. We have a written contract with each of these business associates that contains terms requiring them to protect the confidentiality of your medical information. Although federal law does not
protect health information that is disclosed to someone other than another health care provider, health plan or health care clearinghouse, under California law all recipients of health care information are prohibited from re-disclosing it except as specifically required or permitted by law. We may also share your information with other health care providers, health care clearinghouses or health plans that have a relationship with you, when they request this information to help them with their treatment, payment, and health care operations such as: quality assessment and improvement activities, their efforts to improve health or reduce health care costs, their review of competence, qualifications and performance of health care professionals, their training programs, their accreditation, certification or licensing activities, or their health care fraud and abuse detection and compliance efforts.

4. OFFICE ADMINISTRATION. IPA physicians and staff may use and disclose medical information to contact and remind you about appointments. If you are not home, they may leave this information on your answering machine or in a message left with the person answering the phone. IPA physicians and staff may use and disclose medical information about you by having you sign in when you arrive at the office and may call out your name when they are ready to see you.

5. NOTIFICATION AND COMMUNICATION WITH FAMILY. We may disclose your healthinformation to notify or assist in notifying a family member, your personal representative or another person responsible for your care about your location, your general condition or in the event of your death. In the event of a disaster, we may disclose information to a relief organization so that they may coordinate these notification efforts. We may also disclose information to someone who is involved with your care or helps pay for your care. If you are able and available to agree or object, we will give you the opportunity to
PAGE 3 OF 6 EFFECTIVE DATE: JANUARY 1, 2010 object prior to making these disclosures, although we may disclose this information in a disaster even over your objection if we believe it is necessary to respond to the emergency circumstances. If you are unable or unavailable to agree or object, our health professionals will use their best judgment in communication with your family and others.

6. MARKETING. We may contact you to give you information about products or services related to your treatment, case management or care coordination, or to direct or recommend other treatments or health-related benefits and services that may be of interest to you. We may also encourage you to purchase a product or service when we see you. We will not use or disclose your medical information for marketing without your written authorization.

7. REQUIRED BY LAW. As required by law, we will use and disclose your health information, but will limit our use or disclosure to the relevant requirements of the law. When the law requires us to report abuse, neglect or domestic violence, or respond to judicial or administrative proceedings, or to law enforcement officials, we will further comply with the requirement set forth below concerning those activities.

Public health.

We will disclose your health information to public health authorities for purposes related to: preventing or controlling disease, injury or disability; reporting child, elder or dependent adult abuse or neglect; reporting domestic violence; reporting to the Food and Drug Administration problems with products and reactions to medications; and reporting disease or infection exposure. When we report suspected elder or dependent adult abuse or domestic violence, we will inform you or your personal representative promptly unless in our best professional judgment, we believe the notification would place you at risk of serious harm or would require informing a personal representative we believe is responsible for the abuse or harm.

Health oversight activities.

We will disclose your health information in the course of audits, investigations, inspections, licensure and other proceedings, subject to the limitations imposed by federal and California law.

Judicial and administrative proceedings.

We will disclose your health information to the extent expressly authorized by a court or administrative order. We may also disclose information about you in response to a subpoena, discovery request or other lawful process if reasonable efforts have been made to notify you of the request and you have not objected, or if your objections have been resolved by a court or administrative order.

Law enforcement.

We will disclose your health information for purposes such as identifying or locating a suspect, fugitive, material witness or missing person, complying with a court order, warrant, grand jury subpoena and other law enforcement purposes.

Coroners.

We will disclose your health information in connection with their investigations of deaths.

Organ or tissue donation.

We may disclose your health information to organizations involved in procuring, banking or transplanting organs and tissues.

Public safety.

We may disclose your health information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or the general public.

Specialized government functions.

We may disclose your health information for military or national security purposes or to correctional institutions or law enforcement officers that have you in their lawful custody.

Workers’ compensation.

We may disclose your health information as necessary to comply with workers’ compensation laws. For example, to the extent your care is covered by workers' compensation, we will make periodic reports to your employer about your condition. We are also required by law to report cases of occupational injury or occupational illness to the employer or workers' compensation insurer.

Change of Ownership.

In the event that a medical practice is sold or merged with another organization, your health information/record will become the property of the new owner, although you will maintain the right to request that copies of your health information be transferred to another physician or medical group.

Research.

We may disclose your health information to researchers conducting research with respect to which your written authorization is not required as approved by an Institutional Review Board or privacy board, in compliance with governing law.

Fundraising.

We may use or disclose your demographic information and the dates that you received treatment in order to contact you for fundraising
activities. If you do not want to receive these materials, notify the Privacy Officer listed at the top of this Notice of Privacy Practices.

B. WHEN WE MAY NOT USE OR DISCLOSE YOUR HEALTH INFORMATION

Except as described in this Notice of Privacy Practices, we will not use or disclose health information that identifies you without your written authorization. If you do authorize us to use or disclose your health information for another purpose, you may revoke your authorization in writing at any time, except to the extent that we have already relied on that authorization. C. YOUR HEALTH INFORMATION RIGHTS 1. RIGHT TO REQUEST RESTRICTIONS. You have the right to request restrictions on the uses and disclosures of your health information for treatment, payment, or health care operations. You also may request that any part of your protected health information not be disclosed to family members or friends involved in your care. Requests must be made in writing to the Privacy Officer and state the specific information you want restricted and to whom you want the restriction to apply. We are not required to agree with your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.

C. YOUR HEALTH INFORMATION RIGHTS

1. RIGHT TO REQUEST RESTRICTIONS

You have the right to request restrictions on the uses and disclosures of your health information for treatment, payment, or health care operations. You also may request that any part of your protected health information not be disclosed to family members or friends involved in your care. Requests must be made in writing to the Privacy Officer and state the specific information you want restricted and to whom you want the restriction to apply. We are not required to agree with your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.

2. RIGHT TO REQUEST CONFIDENTIAL COMMUNICATIONS.

You have the right to request that you receive your health information in a specific way or at a specific location. For example, you may ask that we send information to a particular e-mail account or to your work address. We will comply with all reasonable requests submitted in writing to the Privacy Officer that specify the alternative means whereby you wish to receive these communications. We will not ask you the reason for the request.

3. RIGHT TO INSPECT AND COPY.

You may inspect and obtain a copy of PHI about you that is contained in a designated record set for as long as we maintain the PHI. A “designated record set” contains medical or billing records or any other records that the IPA uses for making decisions about you. Under federal law, however, you may not inspect or copy the following records: psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information. Depending on the circumstances, a decision to deny access may be reviewable by another health care professional. Please contact our Privacy Officer if you have questions about access to your medical record. Requests to inspect or copy PHI must be made in writing to the Privacy Officer and we may charge you a reasonable fee for copies, summaries, explanations, and postage.

4. RIGHT TO AMEND.

You have a right to request that we amend your health information that you believe is incorrect or incomplete for as long as we maintain this information. You must make a request to amend in writing to the Privacy Officer, and include the reasons you believe the information is inaccurate or incomplete. We are not required to alter your health information. We may deny your request if we do not have the information, if we did not create the information (unless the person or entity that created the information is no longer available to make the amendment), if you would not be permitted to inspect or copy the information at issue, or if the information is accurate and complete as is. We will inform you in writing about our denial and how you can disagree with the denial. You also have the right to request that we add to your record a statement of up to 250 words concerning any statement or item you believe to be incomplete or incorrect. We may provide a rebuttal to your statement.

5. RIGHT TO AN ACCOUNTING OF DISCLOSURES.

You have a right to receive an accounting of disclosures of your health information made by us, except for those described in Section A of this notice (and all others permitted by law) and for disclosures made to you or pursuant to your written authorization. Only disclosure made after April 14, 2003 can be requested. Requests for an accounting must be made in writing to the Privacy Officer.

6. NOTICE OF PRIVACY PRACTICES.

You have a right to a paper copy of this notice even if you have previously agreed to receive it electronically. If you would like to have a more detailed explanation of these rights or if you would like to exercise one or more of these rights, contact our Privacy Officer listed at the top of this notice.

D. CHANGES TO THIS NOTICE OF PRIVACY PRACTICES

We reserve the right to change this Notice of Privacy Practices at any time in the future. Until such change is made, we are required by law to comply with this notice. After a change is made, the revised Notice of Privacy Protections will apply to all protected health information that we maintain, regardless of when it was created or received. A copy of the revised notice will be provided upon request. E. COMPLAINTS Complaints about this Notice of Privacy Practices or how we handle your health information must be directed in writing to our Privacy Officer listed at the top of this Notice of Privacy Practices. If you are not satisfied with the manner in which we handle a complaint, you may submit a complaint to the Secretary of the U.S. Department of Health and Human Services in Washington, DC. You will not be retaliated against for filing a complaint

 

FCI Notice of Privacy Practices