Mallers & Swoverland
Summary of
HIPAA NOTICE OF PRIVACY PRACTICES

Effective November 5, 2009
Revised August 15, 2013
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.

A full version (7 pages) of this Privacy Notice is available to you at the front desk of our locations.

Under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) we are required to maintain the privacy of your protected health information and provide you with notice of our legal duties and privacy standards with respect to such protected health information.

We are required to abide by the terms of the notice currently in effect. We reserve the right to change the terms of our notice at any time and to make the new notice provisions effective for all protected health information that we maintain. In the event that we make a material revision to the terms of our notice, a revised notice will be made available to you within 60-days of such revision. If you should have any questions or require further information, please contact our Privacy Officer, Trenton Swoverland at (260) 489-9887.

How We May Use or Disclose Your Health Information

The following describes the purposes for which we are permitted or required by law to use or disclose your health information without your consent or authorization. Any other uses or disclosures will be made only with your written authorization and you may revoke such authorization in writing at any time.

Treatment: We may use or disclose your health information to provide you with medical treatment, evaluation, or services to coordinate and to manage your healthcare or other medical needs. For example, we will record such information gathered by us in rendering care to you and will record that information in your medical record. The medical record we create or gather about you may be shared with other providers, nurses, medical students, technicians, other healthcare entities, or other personnel involved in coordination of your healthcare.

Payment: We may use or disclose your health information in order for services you receive at our offices to be paid by your insurance carrier, by you, or a third party. For example, we may disclose appropriate information for reimbursement, collection or payment purposes to those involved with processing or coordinating payment.

Health Care Operations: We may use or disclose your health information for health care operations. Health care operations include, but not limited to, quality assessment and improvement activities, underwriting, premium rating, management and general administrative activities. For example, members of our quality improvement team may use information in your health record to assess the quality of care that you receive and determine how to continually improve the quality and effectiveness of the services we provide.

Business Associates: There may be instances where services are provided to our office through contracts with third party “business associates” (BA). Whenever a business associate arrangement involves the use or disclosure of your health information, we will have a written contract that requires the business associate to maintain the same high standards of safeguarding and securing your privacy that we require of our own employees and affiliates. An example of a BA would be a collections agency.
Required by Law: We will disclose medical information about you when required to do so by federal, state, or local law.
Communication with Family or Friends: Our professionals, using their best judgment, may disclose to a family member, other relative, close personal friend, or any other person you identify, health information relevant to that person’s involvement in your care or payment of your care.  The clinic may also disclose your condition to family or friends who accompany you to our offices. Our office may leave a message on your phone pertaining to a scheduled appointment or other health related issues.  The message will only be left at the phone number you provided.  You may receive information by mail from our office. You may see or overhear protected health information while in our office, but we make our best attempt to keep our patient information private and confidential as possible.

Research: We may disclose information to researchers when their 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.
Coroners, Medical Examiners and Funeral Directors: We may disclose health information to a coroner, medical examiner. We may also disclose medical information to funeral directors consistent with applicable law to carry out their duties.
Public Health: 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.

Breach Notification: Under certain circumstances we may be required to notify the Indiana Attorney General and/or the Department of Health and Human Services of a breach of your patient information.  You would also receive notification of this breach.

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.
To Avert a Serious Threat to Health or Safety: Consistent with applicable federal and state laws, we may use and disclose health information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.

Military and Veterans: If you are a member of the armed forces, we may disclose health information about you as required by military command.

Health Oversight Activities: We may disclose health information to a health oversight agency for activities authorized by law, including audits, investigations, inspections, and licensure.

Protective Services for the President, National Security and Intelligence Activities: We may disclose health information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations, or for intelligence, counterintelligence, and other national security activities authorized by law.

Law Enforcement: We may disclose health information when requested by a law enforcement official as part of law enforcement activities; investigations of criminal conduct; in response to court orders; in emergency circumstances; or when required to do so by law.

Inmates: We may disclose health information about an inmate of a correctional institution or under the custody of a law enforcement official to the correctional institution or law enforcement official.

Marketing: For marketing activities the patient’s authorization may or may not be needed. Examples of when a authorization for marketing is not required would be the Mallers & Swoverland communicating with you about a service or product we offer that may benefit you.  An example of when the office would need your authorization would be for a communication that is sent to an individual describing a product or service offered by an entity other than our medical practice like a pharmaceutical company, retail pharmacy, health clubs, and suppliers of unrelated medical services such as durable medical equipment that the Mallers & Swoverland might receive remuneration for the communication.  The Mallers & Swoverland will always respect your rights under our Marketing policy.

Fundraising:  If the Mallers & Swoverland participates in fundraising activities,on your first notification of the event, (and in this notice) the Mallers & Swoverland will give you the opportunity to “opt out” from receiving further communications for fund raising communications.

Sale of PHI:  The sale of your PHI will require an authorization except in the event of the practice being sold or for a records copy fee.

Authorizations: Authorizations are always required for the release of psychotherapy notes, for marketing where we receive remuneration, and for disclosures which constitutes the sale of PHI.  Any uses or disclosure not listed in this notice will require an authorization.

Your Rights Regarding Your Health Information

The following describes your rights regarding the health information we maintain about you. To exercise your rights, you must submit your request in writing to our Privacy Officer at 9602 Coldwater Rd., Suite 102 Fort Wayne, IN 46825.

Right to Request Restrictions. You have the right to request that we restrict uses or disclosures of your health information to carry out treatment, payment, health care operations, or communications with family or friends. We are not required to agree to a restriction. You may request a restriction on services you pay for out of your own pocket (not paid by insurance).

Right to Receive Confidential Communications. You have the right to request that we send communications that contain your health information by alternative means or to alternative locations. We must accommodate your request if it is reasonable.

Right to Inspect and Copy. You have the right to inspect and copy health information that we maintain about you. If copies are requested or you agree to a summary or explanation of such information, we may charge a reasonable, cost-based fee for the costs of copying, including labor and supply cost of copying; postage; and preparation cost of an explanation or summary, if such is requested. The cost may be up to $1 per page for pages 1-10, $.50 per page for pages 11-50 and $.25 per page for pages 51 and higher. You may also request an electronic version of your records at a reasonable cost for copying. We may deny your request to inspect and copy in certain circumstances as defined by law. If you are denied access to your health information, you may request that the denial be reviewed. We will fulfill your request within 30 days or no later than 60 days if additional time is required.
Right  to Amend. You have the right to request an amendment to your health information as long as we originated and maintained such information. Your written request must include the reason or reasons that support your request. We may deny your request for an amendment if we determine that the record that is the subject to the request was not created by us, is not available for inspection as specified by law, or is accurate and complete.

Right  to Receive an Accounting of Disclosures. You have the right to receive an accounting of disclosures of your health information made by us in the six years prior to the date the accounting is requested (or shorter period as requested). This does not include disclosures made to carry out treatment, payment and health care operations; disclosures made to you; communications with family and friends; for national security or intelligence purposes; to correctional institutions or law enforcement officials; or disclosures made prior to the HIPAA compliance date of April 14, 2003. Your first request for accounting in any 12-month period shall be provided without charge. A reasonable, cost-based fee shall be imposed for each subsequent request for accounting within the same 12-month period.

Right to Obtain a Paper Copy. You have the right to obtain a paper copy of this Notice of Privacy Practices at any time.

How to File a Complaint if You Believe Your Privacy Rights Have Been Violated
If you believe that your privacy rights have been violated, please submit your complaint in writing to:

Mallers & Swoverland
Attn: Trenton Swoverland
9602 Coldwater Rd., Suite 102
Fort Wayne, IN 46825

You may also file a complaint with the Office of Civil Rights. You will not be retaliated against for filing a complaint.