Effective Date of this Notice: 4/14/2003
METROPOLITAN FAMILY PRACTICE, P.A.
NOTICE OF PRIVACY PRACTICE
Metropolitan Family Practice, P.A.
Notice of Privacy Practices as required by the Privacy Regulations Promulgated Pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
PLEASE REVIEW THIS NOTICE CAREFULLY.
Please read this notice carefully. It concerns your individual, private healthcare information and how this information may be used and disclosed by this office. After reviewing this notice you will be asked to sign an acknowledgment form that you have been given this information.
2. In order to provide quality care to you, as well as operate this office in an efficient manner, we will need to access your private health care information for purposes of treatment, payment and operations (such as quality assurance). In using this information this office will comply with all state and federal laws pertaining to your privacy rights, including the Privacy and Security protections provided to you by the Health Insurance Portability and Accountability Act (“HIPAA”).
2) Sharing of Information for Purposes of Payment: We will share all necessary information with your insurer(s), payor(s), governmental entities (such as Medicare, Medicaid, etc.) and their representatives (including, but not limited to benefit determination and utilization review) as well as our representatives involved in the billing process (including, but not limited to claims representatives, data warehouses, billing companies).
3) Sharing Of Information For Purposes Of Operations: We will share all information necessary for ongoing operations of this office, including (but not limited to) credentialing processes, peer review, accreditation and compliance with all federal and state laws.
4) Appointment Reminders/Results: Our practice may use and disclose your identifiable health information to contact you and remind you of an appointment or advise you of recent results of tests you may have had done.
5) Release Of Information To Family/Friends: Our practice may release your health information to a family member or friend that is helping you pay for your health care or who assists in taking care of you.
3. Your specific authorization will be required for the release of any information not included above. Your authorization will need to be in writing and it will be specific to the disclosure requested. Incidences which may require your authorization under the HIPAA regulations include (but are not limited to) some marketing purposes, the disclosure of any psychotherapy records in our possession and disclosures for fundraising by any entity.
4. This office will not release any information other than those incidents described above, unless disclosure is required by law, a court, a legal process or government agencies.
5. When the HIPAA privacy rule becomes effective in this office, you will have the right to inspect and copy your protected information, amend your record, have reasonable requests for confidential communications accommodated and may obtain an accounting of disclosures. All other rights afforded to you by state and federal law will be honored as they are created. This office will attempt to comply with any of your requests before the HIPAA compliance date if feasible. Please contact the Privacy Officer if you have any question about your rights, the compliance date(s) for this office or any other privacy related questions you may have.
6. This office has policies and procedures in place to facilitate compliance with the law, as well as assure that this office consistently treats you with respect for you and your privacy and confidentiality. These policies and procedures are available for you to review. If you would like to read them please notify the Privacy Officer.
7. The Privacy Officer is the person in the office responsible for your privacy and the security of your information. Any complaints you or your family may have in this area should be directed to the Privacy Officer by calling 227-9214 or in writing to: Privacy Officer, 1303 McCullough Ave., Ste 135, San Antonio, TX 78212. The front office staff will assist you in contacting them.