THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
If you have any questions about this notice, please
contact the Comprehensive Care Center’s Privacy Officer at (615) 321-9556.
For Treatment: We may disclose or share information about
you with all staff who are involved in taking care of you. We may also disclose
information about you to people outside of the medical center who are involved
in your care.
For Payment: We may use and disclose information about you to an
insurance company or a third party to collect payment for services you receive
here, or to get prior approval or to determine whether your health plan
(insurance) will cover the treatment sought.
For Healthcare Operations (Administrative
Functions): We
may use and share your personal information in order to promote quality care
and perform certain administrative functions.
Communications with You, Your Family, and the
Community: Your
information may be used to notify you for appointment reminders or for other
communications, such as satisfaction surveys, or fundraising. In addition,
information may be shared with your family or friends, with your approval, or
if we believe it is in your best interest.
Research: Under certain circumstances, we may use and disclose
information about you for research purposes. For any research that involves the
care we provide you, we will ask for your permission and fully explain how your
information will be used. Research that uses information about you will receive
a special review to ensure that your privacy is protected.
Other Situations: There are other special situations in which
we may share your information. These include disclosures required by law or for
public heath purposes. These will be detailed further in this Notice of Privacy
Practices.
OTHER USES AND DISCLOSURES OF INFORMATION NOT
COVERED IN THIS NOTICE OR REQUIRED BY LAW WILL BE MADE ONLY WITH YOUR WRITTEN
PERMISSION.
As a patient here, you have certain rights regarding
the information we keep about you. Further details follow in this Notice of Privacy
Practices.
You have a right to review and obtain copies of
information we keep that may be used to make decisions about your healthcare or
payment for your healthcare. If you feel that information we have about you is
incorrect, you may ask us to amend our records.
You have the right to receive a list of certain
non-routine disclosures of your information. You have the right to request
restrictions on how we use and disclose your information for treatment,
payment, or healthcare operations (administrative functions).
You have the right to request that we communicate
with you in another more confidential way. If you believe your privacy rights
have been violated, you should contact the Comprehensive Care Center’s Privacy
Officer. You may also file a complaint with the Department of Health and Human
Services. This Notice is effective April 14, 2003.
This notice applies to all of the paper and
electronic medical records of your care kept by us, whether created by Comprehensive
Care Center staff or some other physician or clinician outside the
Comprehensive Care Center. Physicians outside of the Comprehensive Care Center
involved in your care may have different policies or notices about the use and
disclosure of your health information they keep outside of the Comprehensive
Care Center. This notice describes the Comprehensive Care Center’s privacy
practices, those of our Medical Staff while practicing at
the Comprehensive Care Center, and those of any
other Comprehensive Care Center healthcare professional, staff member,
volunteer, or trainee authorized to manage your health information.
The following categories describe ways that we use
and disclose your health information. We cannot list every use or disclosure in
a category. However, all of the ways we are permitted to use and disclose
information will fall into one of the categories.
For Treatment. We may use information about you to provide you with
medical treatment or services. We may disclose information about you to the
doctors, nurses, technicians, residents, care managers and case managers,
students, or other staff who take care of you at the Comprehensive Care Center.
For example, a doctor treating you for a particular condition may need to know
if you have diabetes, because diabetes may slow the healing process. The doctor
may also need to tell the nutritionist if you have diabetes so that you may
receive instruction about appropriate meals to help control your diabetes.
Other departments may also share information about you in order to coordinate
the different care that you need, such as prescriptions, lab work, and x-rays.
For Payment. We may use and disclose information about you so
that the treatment and services you receive here may be billed and payment may
be collected from you, an insurance company, or a third party payer. For
example, we may need to give your health plan (insurance provider) information
about a procedure you received here so your health plan will pay us or
reimburse you for the procedure. We may also tell your health plan about a
treatment you are going to receive to obtain prior approval or to determine
whether your plan will cover the cost of the
treatment. We may also allow your health plan to
review your records to make sure that they have paid the correct amount to the
Comprehensive Care Center.
For Health Care Operations. We may use and share
information about you for administrative functions necessary to run the
Comprehensive Care Center and promote quality care. For example, we may use
your information or combine it with other clinics’ or hospitals’ patient
information to review the effectiveness of our treatment and services, to
evaluate the performance of our staff in caring for you, or to make decision
about what additional services we should offer. We may also combine the
information we have about you with information from other clinics or hospitals
to compare how we are doing and see where we might make improvements in the
care and services that we offer. Wherever it is practical, we may remove
information that identifies you. We may also disclose information to doctors,
nurses, technicians, medical students, and other trainees for education and
training purposes. We may share information with business associates who
provide services necessary to run the Comprehensive Care Center, such as office
management software or billing agencies. We will contractually bind these third
parties to protect your information as we would. We may also permit your health
plan or other providers to review medical records that contain information
about you to help them to improving the quality of service provided to you.
Appointment Reminders, Notices About New Services,
Other Health News. We may try to contact you to remind you of, or to cancel or
reschedule, an appointment you have with us. We may also use or share your
information to recommend possible treatment options or health-related services
or to provide information that may be of interest to you. We may also contact
you to ask about the quality of the services we have provided you.
Fundraising Activities. We may use your name and
address to contact you in an effort to raise money for the Comprehensive Care
Center. We use only your name, address, and phone number, and the dates you
received treatment or services from us. If you do not want to be contacted for
fundraising efforts, please notify the Administrative Assistant at the
Comprehensive Care Center, 345 24th Avenue North, Suite 103,
Nashville, TN 37203 (615) 321-9556.
Individuals Involved In Your Care Or Payment For
Your Care.
In certain
situations, we may disclose information about you with a friend or family
member who is involved in your care or the payment for your care. Whenever
possible, we will allow you to designate who you would like to have involved in
your care. However, in emergencies or other situations in which you are unable
to indicate your preference, we may need to share information about you with
other individuals or organizations to coordinate your care or notify your
family.
Research. Under certain conditions, we may use and disclose
information about you for research purposes. For example, a research study may
compare the health and recovery of patients who received one medication for a
particular condition to those who received another medication for the same
condition. Before we use or disclose information for research, the project will
be approved though a special approval process that evaluates the project and
its use of information and tries to balance the research needs with the
patient’s need for privacy. In most cases, if the research involves your care
or the use and/or disclosure of your identifiable health information, we will
obtain your permission and fully explain how your information will be used. We
may allow access to your health information before the approval process to a
Vanderbilt researcher who is preparing to conduct a research project. For
example, a researcher might want to know how many patients have a specific
medical condition. Health information used for this purpose will not leave the
Comprehensive Care Center.
As Required By Law. We will disclose information about you
when required to do so by federal or state law. For example, we may release
information about you in response to a valid subpoena or for communicable
disease reporting to the health department.
To Avert a Serious Threat to Health or Safety. We may use and disclose
information about you when necessary to prevent a serious threat to your health
and safety or the health and safety of the public or another person. We would
only disclose this information to someone able to help to prevent the threat or
harmful action. These disclosures may be to law enforcement officials to
respond to a violent crime, or to protect the target of a violent crime. For
example, threat of harming another individual must be reported to appropriate
authorities.
Organ and Tissue Donation. If you are an organ donor
or recipient, we may release your information to organizations that handle
organ procurement or organ, eye, or tissue transplantation or to an organ
donation bank, as necessary to assist the organ or tissue donation and
transplantation.
Military and Veterans. If you are a member of
the armed forces, we may release information about you as required by military
authorities. We may also release information about foreign military personnel
to the appropriate foreign military authority.
Workers' Compensation. We may release
information about you to workers' compensation programs to provide benefits for
work-related injuries or illness.
Public Health Risks. We may disclose information
about you for public health activities. These activities may include, but are
not limited to, the following:
•to prevent or control
disease, injury or disability;
•to report births and
deaths;
•to report child abuse or
neglect;
•to report reactions to
medications or problems with products;
•to notify people of recalls
of products they may be using;
•to notify a person who may
have been exposed to a disease or may be at
risk for getting or spreading a disease or condition;
•to notify the appropriate
government authority if we believe a patient has been the
victim of abuse, neglect, or domestic violence.
Health Oversight Activities. We may disclose
information to a health oversight agency for activities authorized by law.
These oversight activities include, for example, audits, investigations,
inspections, and licensure. These activities are necessary for the government
to monitor the health care system, government programs, and compliance with
civil rights laws.
Lawsuits and Civil Proceedings. If you are involved in a lawsuit
or a dispute, we may disclose information about you in response to a court or
administrative order. We may also disclose information about you in response to
a subpoena or other lawful process by someone else involved in the dispute, but
only if efforts have been made to tell you about the request or to obtain an
order protecting the information requested.
Law Enforcement. We may release information about you if
asked to do so by a law enforcement official:
•In response to a court
order, subpoena, warrant, summons, or similar process;
•To identify or locate a
suspect, fugitive, material witness, or missing person;
•If you are suspected to be
a victim of a crime, generally with your permission;
•About a death we believe
may be the result of criminal conduct;
•About criminal conduct at
the clinic; and,
•In emergency circumstances
to report a crime; the location of the crime or victims; or
the identity, description, or location of the person who
committed the crime.
Coroners, Medical Examiners and Funeral Directors. We may release
information to a coroner or medical examiner. This may be necessary, for
example, to identify a deceased person or determine the cause of death. We may
also release information about patients of the clinic to funeral directors as
necessary to carry out their duties.
National Security and Intelligence Activities. We may release
information about you to authorized federal officials for intelligence,
counterintelligence, and other national security activities authorized by law.
Protective Services for the President and Others. We may disclose your
information to authorized federal officials in order to protect the President,
other authorized persons, and foreign heads of state, or to conduct special
investigations.
Inmates. If you are an inmate of a correctional
institution or under the custody of a law enforcement official, we may disclose
information about you to the correctional institution or law enforcement
official. This disclosure would be necessary (1) for the institution to provide
you with health care; (2) to protect your health and safety or the health and
safety of others; or (3) for the safety and security of the correctional
institution.
You have the following rights regarding information
we maintain about you:
Right to Inspect and Obtain Copies. You have the right to
review and obtain copies of information that may be used to make decisions
about your care. Usually, this includes medical and billing records, but does not
include psychotherapy notes. We may deny your request to inspect and copy in
certain limited circumstances. If you are denied access to information, you may
request that the denial be reviewed. Another licensed health care professional
chosen by the Comprehensive Care Center will review
your request and the denial. The person conducting the review will not be the
same person who denied your request. We will comply with the outcome of the
review. To inspect and copy information that may be used to make decisions
about you, you must submit your request in writing to the Medical Records
Manager. If you request a copy of the information, we may charge a fee for the
costs of copying, mailing or other supplies associated with your request. If
your request only concerns billing information, you may call us at (615)
321-9556 and ask to speak with the Billing Specialist.
Right to Request Amendments. If you feel that
information we have about you is incorrect or incomplete, you may ask us to
amend the information. You have the right to request an amendment for as long
as the information is kept by or for the Comprehensive Care Center. To request
an amendment, your request and the reason for your request must be made in
writing and submitted to Medical Records Manager. We may deny your request for
an amendment if it is not in writing or does not include a reason to support
the request. In addition, we may deny your request if you ask us to amend
information that was not created by us, unless the person or entity that
created the information is no longer available to make the amendment. In that
case, we would consider the request. We may deny the request if the information
is not part of the information kept by or for the Comprehensive Care Center. We
may deny the request if the information is not part of the information you
would be permitted to inspect and copy, or if the information is accurate and
complete.
Right to an Accounting of Disclosures. You have the right to
request an "accounting of disclosures." This is a list of certain
disclosures made about you that were not related to the routine uses listed
above. This list will not include disclosures prior to April 14, 2003, those
that you have specifically authorized, or those made directly to you. You must
submit your request for an accounting of disclosures in writing to the Medical
Records Manager. It must state a time period that may not be longer than six
years and should indicate in what form you want the list (for example, on paper
versus in an electronic file). The first list you request within a 12-month
period will be free. For additional lists, we may charge you for the costs of
providing the list. We will notify you of the estimated cost involved and you
may choose to withdraw or modify your request at that time before any costs are
incurred.
Right to Request Restrictions. You have the right to
request a restriction or limitation on the use or disclosure of information
about you for treatment, payment, administrative functions, or with individuals
involved in your care.
We are not required to agree to your request. If we do agree, we will
comply with your request unless the information is needed to provide you with
emergency treatment. To request restrictions, you must make your request in
writing to the Medical Records Manager. In your request, you must tell us (1)
what information you want to limit; (2) whether you want to limit our use,
disclosure, or both; and (3) to whom you want the limits to apply.
Right to Request Confidential Communications. You have the right to
request that we communicate with you in a certain way or at a certain location.
For example, you can ask that we only contact you at work or at a post office
box. To request confidential communications, you must make your request in writing
to the Medical Records Manager. We will not ask you the reason for your
request. We will seek to accommodate all reasonable requests. Your
request must specify how or where you wish to be contacted.
Right to a Paper Copy of This Notice. You have the right to a
paper copy of this notice. You may ask us to give you a copy of this notice at
any time. Even if you have agreed to receive this notice electronically, you
are still entitled to a paper copy of this notice. You may obtain a copy of
this notice at our website, http://www.compclinic.org, or in
person at the Comprehensive Care Center reception desk. You may also request a
copy from us at the Comprehensive Care Center, Medical Records Manager, 345 24th
Avenue North, Suite 103, Nashville, TN 37203
We reserve the right to change this notice. We
reserve the right to make the revised or changed notice effective for
information we already have about you as well as any information we receive in
the future. We will post a copy of the current notice prominently in the
Comprehensive Care Center. The notice will contain the effective date on the
first page, in the top right-hand corner. We will notify you of changes at the
time of your first visit following the change, when you check in at the
reception desk.
If you believe your privacy rights have been
violated, you may file a complaint with the Comprehensive Care Center or with
the Secretary of the Department of Health and Human Services. To file a
complaint with the Comprehensive Care Center, submit your complaint in writing
to us at:
345 24th Avenue North, Suite 103
Nashville, TN 37203.
To file a complaint with the Secretary of the
Department of Health and Human Services:
Region IV, Office for Civil Rights
U.S. Department of Health and Human
Services
Atlanta Federal Center
61 Forsyth Street, SW, Suite 3B70
Atlanta, GA 30303-8909
Telephone: (404) 562-7886. FAX (404) 562-7881. TDD
(404) 331-2867
You will not be penalized for filing a complaint.
Other uses and disclosures of information not
covered by this notice or the laws that apply to us will be made only with your
written authorization. If you provide us specific authorization to use or
disclose information about you, you may revoke that authorization, in writing,
at any time. If you revoke your authorization, we will no longer use or
disclose information about you for the reasons covered by your written
authorization. You understand that we are unable to take back any disclosures
we have already made with your authorization, and that we are required to
retain our records of the care that we provided to you.