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.
DRAKE E. BELLANGER, M.D., L.L.C., AND ADVANCED VIDEOSCOPIC SURGERY OF BATON ROUGE, L.L.C., is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information. If you have questions about any part of this notice or you want more information about the privacy practices please contact: DRAKE E. BELLANGER, M.D., L.L.C., AND ADVANCED VIDEOSCOPIC SURGERY OF BATON ROUGE, L.L.C.
I. How DRAKE BELLANGER, M.D., L.L.C. AND ADVANCED VIDEOSCIPIC SURGERY OF BATON ROUGE, L.L.C. may use or disclose your health information.
DRAKE E. BELLANGER, M.D., L.L.C., AND ADVANCED VIDEOSCOPIC SURGERY OF BATON ROUGE, L.L.C., collects health information from you and stores it in a chart and on a computer. This is your medical record. The medical record is property of AVS, but the information in the medical record belongs to you. AVS protects the privacy of your health information. The law permits AVS to use or disclose your health information for the following purposes:
Means providing, coordinating, or managing health care and related services by one or more health care providers. An example of this would include a physical examination.
Means such activities as obtaining reimbursement of services, confirming coverage, billing or collection activities and utilization review. An example of this would be sending a bill for your visit to your insurance company for payment.
3. Regular Health Care Operations
Includes the business aspects of running our practice, such as conducting quality assessment and improvement activities, auditing functions, cost-management analysis, and customer services. An example would be an internal quality assessment review.
4. Notification and communication with family
We may disclose your health information 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. If you are able and available to agree or object, we will give you the opportunity to object prior to making this notification. If you are unable or unavailable to agree or object, our health professional will use their best judgment in communication with your family and others.
5. Required by law
As required by law, we may use and disclose your health information.
6. Public health
As required by law, we may disclose your health information to public health authorities for purposes related to: preventing or controlling disease, injury or disability; reporting child abuse or neglect; reporting domestic violence; reporting to the Food and Drug Administration problems with products and reacts to medications, and reporting disease or infection exposure.
7. Health oversight activities
We many disclose your health information to health agencies during the course of audits, investigations, inspections, licensure and other proceedings.
8. Judicial and administrative proceedings
We may disclose your health information in the course of any administrative or judicial proceeding.
9. Law enforcement
We may disclose your health information to a law enforcement official for purposes such as identifying or locating a suspect, fugitive, material witness or missing person, complying with a court order or subpoena and other law enforcement purposes.
10. Deceased person information
We may disclose your health information to coroners, medical examiners, and funeral directors.
11. Organ donation
We may disclose your health information to organizations involved in procuring, banking, or transplanting organs and tissues.
We may disclose your health information to researchers conducting research that has been approved by an Institutional Review Board or AVS privacy board.
13. 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.
14. Worker’s compensation
We may disclose your health information as necessary to comply with worker’s compensation laws.
We may contact you to provide appointment reminders or to give you information about other treatments or health-related benefits and services that may be of interest to you.
II. When AVS may not use or disclose your health information
Except as described in the Notice of Privacy Practices, AVS will not use or disclose your health information without your written authorization. If you authorize AVS to use or disclose your health information for another purpose, you may revoke your authorization in writing at any time.
III. Your health information rights
1. You have the right to request restrictions on certain uses and disclosures of your health information. AVS is not required to agree to the restriction that you request.
2. You have the right to receive your health information through a reasonable alternative means or at an alternative location.
3. You have the right to inspect and copy your health information.
4. You have a right to request that AVS amend your health information that is incorrect or incomplete. AVS is not required to change your health information and will provide you with information about AVS denial and how you can disagree with the denial.
5. You have a right to receive and account of disclosures of your health information made by AVS, except that AVS does not have to account for the disclosures described in Parts 1 (treatment), 2 (payment), 3 (health care operations) of section I of the Notice of Privacy Practices.
6. You have a right to a paper copy of this Notice of Privacy Practices.
IV. Changes to this Notice of Privacy Practices
AVS reserves the right to amend this Notice of Privacy Practices at any time in the future. Until such amendment is made, AVS is required by law to comply with this Notice.
If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint to:
Department of Health and Human Services
Office of Civil Rights
Hubert H. Humphrey Bldg.
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201
You may also address your complaint to one of the regional Offices for Civil Rights. A list of these offices can be found online at www.hhs.gov/ocr/regmail.html.
Effective Date of this notice: June 1, 2004.