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.
 
 
1. USES AND DISCLOSURES OF PROTECTED
HEALTH INFORMATION
 
A. Uses and Disclosures of Protected Health
Information for Treatment, Payment and Healthcare
Operations
Your protected health information may be used and disclosed
by your physician, our office staff and others outside
of our office who are involved in your care and treatment
for the purpose of providing health care services to
you. Your protected health information may also be used
and disclosed to pay your health care bills and to support
the operation of this facility.
Following are examples of the types of uses and disclosures
of your protected health care information that this
facility is permitted to make. We have provided some
examples of the types of each use or disclosure we may
make, but not every use or disclosure in any of the following
categories will be listed.
 
For Treatment: We will use and disclose your protected
health information to provide, coordinate, or manage your
health care and any related treatment. This includes the
coordination or management of your health care with a
third party that has already obtained your permission to
have access to your protected health information. For
example, we would disclose your protected health information,
as necessary, to the physician that referred you to
us. We will also disclose protected health information to
other health care providers who may be treating you when
we have the necessary permission from you to disclose
your protected health information.
 
For Payment: Your protected health information will be
used, as needed, to obtain payment for your health care
services. This may include certain activities that your
health insurance plan may undertake before it approves or
pays for the health care services we recommend for you
such as; making a determination of eligibility or coverage
for insurance benefits, reviewing services provided to you
for medical necessity, and undertaking utilization review
activities.
 
For Healthcare Operations: We may use or disclose, as
needed, your protected health information in order to support
the business activities of this facility. These activities
include, but are not limited to, quality assessment activities,
employee review activities, legal services, licensing,
and conducting or arranging for other business activities.
We may share your protected health information with
third party "business associates" that perform various
activities (e.g., billing, transcription services) for this
facility. Whenever an arrangement between our facility
and our business associate involves the use or disclosure
of your protected health information, we will have a written
contract that contains terms that will protect the privacy
of your protected health information.
 
Treatment Alternatives: We may use or disclose your protected
health information, as necessary, to provide you with
information about treatment alternatives or other healthrelated
benefits and services that may be of interest to you.
 
Sign In Sheets: We may use a sign-in sheet at the registration
desk where you will be asked to sign your name.
We may also call you by name in the waiting room when
your physician is ready to see you.
 
Marketing and Health Related Benefits and Services:
We may also use and disclose your protected health information
for other marketing activities. For example, we
may send you information about products or services that
we believe may be beneficial to you. You may contact our
Privacy Officer to request that these materials not be sent
to you.
 
B. Uses and Disclosures of Protected Health
Information Based upon Your Written
Authorization
Other uses and disclosures of your protected health information
will be made only with your written authorization,
unless otherwise permitted or required by law as
described below. You may revoke your authorization, at
any time, in writing. You understand that we can not take
back any use or disclosure we may have made under the
authorization before we received your written revocation,
and that we are required to maintain a record of the medical
care that has been provided to you. The authorization
is a separate document, and you will have the opportunity
to review any authorization before you sign it. We will
not condition your treatment in any way on whether or not
you sign any authorization.
 
C. Other Permitted and Required Uses and
Disclosures That May Be Made Either With Your
Agreement or the Opportunity to Object
We may use and disclose your protected health information
in the following instances. You have the opportunity
to agree or object to the use or disclosure of all or part of
your protected health information. If you are not present
or able to agree or object to the use or disclosure of the
protected health information, then your physican may,
using their professional judgment, determine whether the
disclosure is in your best interest. In this case, only the
protected health information that is relevant to your health
care will be disclosed.
 
Others Involved in Your Healthcare: Unless you
object, we may disclose to a member of your family, a relative,
a close friend or any other person you identify, orally
or in writing, your protected health information that
directly relates to that person's involvement in your health
care. If you are unable to agree or object to such a disclosure,
we may disclose such information as necessary if we
determine that it is in your best interest based on our professional
judgment. We may use or disclose your protected
health information to notify or assist in notifying a family
member, personal representative or any other person
that is responsible for your care of your location or general
condition.
 
D. Other Permitted and Required Uses and
Disclosures That May Be Made Without Your
Authorization or Opportunity to Object
We may use or disclose your protected health information
in the following situations without your authorization or
providing you the opportunity to object.
 
Required By Law: We may use or disclose your protected
health information to the extent that the use or disclosure
is required by federal, state or local law. The use or
disclosure will be made in compliance with the law and
will be limited to the relevant requirements of the law. You
will be notified, as required by law, of any such uses or
disclosures.
 
If you have any questions about this Notice please
contact our Privacy Officer at (412) 767-5387.
 
Public Health: We may disclose your protected health
information for public health activities and purposes to a
public health authority that is permitted by law to collect
or receive the information. The disclosure will be made
for the purpose of controlling disease, injury or disability.
A disclosure under this exception would only be made to
somebody in a position to help prevent the threat to public
health
Communicable Diseases: We may disclose your protected
health information, if authorized by law, to a person who
may have been exposed to a communicable disease or
may otherwise be at risk of contracting or spreading the
disease or condition.
 
Health Oversight: We may disclose protected health
information to a health oversight agency for activities
authorized by law, such as audits, investigations, and
inspections. Oversight agencies seeking this information
include government agencies that oversee the health care
system, government benefit programs, other government
regulatory programs and civil rights laws.
 
Abuse or Neglect: We may disclose your protected
health information to a public health authority that is
authorized by law to receive reports of child abuse or neglect.
In addition, we may disclose your protected health
information if we believe that you have been a victim of
abuse, neglect or domestic violence to the governmental
entity or agency authorized to receive such information.
We will only make this disclosure if you agree or when
required or authorized by law. In this case, the disclosure
will be made consistent with the requirements of applicable
federal and state laws.
Military and Veterans: If you are a member of the military,
we may release protected health information about you as
required by military command authorities.
 
Food and Drug Administration: We may disclose your
protected health information to a person or company
required by the Food and Drug Administration to report
adverse events, product defects or problems, biologic
product deviations, track products; to enable product
recalls; to make repairs or replacements, or to conduct
post marketing surveillance, as required.
 
Legal Proceedings: We may disclose your protected
health information in the course of any judicial or administrative
proceeding, in response to an order of a court or
administrative tribunal (to the extent such disclosure is
expressly authorized), in certain conditions in response to
a subpoena, discovery request or other lawful process.
 
Law Enforcement: We may also disclose your protected
health information, so long as applicable legal requirements
are met, for law enforcement purposes. These law
enforcement purposes might include (1) legal processes
and otherwise required by law, (2) limited information
requests for identification and location purposes, (3) pertaining
to victims of a crime, (4) suspicion that death has
occurred as a result of criminal conduct, (5) in the event
that a crime occurs on the premises of the practice, and (6)
medical emergency (not on the facility's premises) and it
is likely that a crime has occurred.
 
Coroners, Funeral Directors, and Organ Donation:
We may disclose your protected health information to a
coroner or medical examiner for identification purposes,
determining cause of death or for the coroner or medical
examiner to perform other duties authorized by law. We
may also disclose protected health information to a funeral
director, as authorized by law, in order to permit the
funeral director to carry out their duties. We may disclose
such information in reasonable anticipation of death.
Protected health information may be used and disclosed
for cadaveric organ, eye or tissue donation purposes.
 
Research: Under certain circumstances, we may disclose
your protected health 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 protected
health information.
 
Criminal Activity: Consistent with applicable federal
and state laws, we may disclose your protected health
information, if we believe that the use or disclosure is necessary
to prevent or lessen a serious and imminent threat
to the health or safety of a person or the public. We may
also disclose protected health information if it is necessary
for law enforcement authorities to identify or apprehend
an individual.
 
Military Activity and National Security: When the
appropriate conditions apply, we may use or disclose protected
health information of individuals who are Armed
Forces personnel (1) for activities deemed necessary by
appropriate military command authorities; (2) for the purpose
of a determination by the Department of Veterans
Affairs of your eligibility for benefits, or (3) to foreign
military authority if you are a member of that foreign military
services. We may also disclose your protected health
information to authorized federal officials for conducting
national security and intelligence activities, including for
the provision of protective services to the President or others
legally authorized.
 
Workers' Compensation: We may disclose your protected
health information as authorized to comply with
workers' compensation laws and other similar legallyestablished
programs that provide benefits for work-related
illnesses and injuries.
 
Inmates: We may use or disclose your protected health
information if you are an inmate of a correctional facility
and your physician created or received your protected
health information in the course of providing care to you.
 
Required Uses and Disclosures: Under the law, we
must make disclosures to you and when required by the
Secretary of the Department of Health and Human
Services to investigate or determine our compliance with
the requirements of the final rule on Standards for Privacy
of Individually Identifiable Health Information.
 
2. YOUR RIGHTS REGARDING HEALTH INFORMATION
ABOUT YOU
Following is a statement of your rights with respect to
your protected health information and a brief description
of how you may exercise these rights.
 
You have the right to inspect and copy your protected
health information. This means you may inspect and
obtain a copy of your protected health information contained
in your medical and billing records and any other
records that your physician uses for making decisions
about you, for as long as we maintain the protected health
information.
To inspect and copy your medical information, you must
submit a written request to the Privacy Officer listed on
the first and last pages of this Notice. If you request a
copy of your information, we may charge you a fee for the
costs of copying, mailing or other costs incurred by us in
complying with your request.
We may deny your request in limited situations specified
in the law. For example, you may not inspect or copy psychotherapy
notes; or information compiled in reasonable
anticipation of, or use in, a civil, criminal, or administrative
action or proceeding, and certain other specified protected
health information defined by law. In some circumstances,
you may have a right to have this decision
reviewed. The person conducting the review will not be
the person who initially denied your request. We will
comply with the decision in any review. Please contact
our Privacy Officer if you have questions about access to
your medical record.
 
You have the right to request a restriction of your
protected health information. This means you may ask
us not to use or disclose any part of your protected health
information for the purposes of treatment, payment or
healthcare operations. You may also request that any part
of your protected health information not be disclosed to
family members or friends who may be involved in your
care or for notification purposes as described in this
Notice of Privacy Practices. Your request must state the
specific restriction requested and to whom you want the
restriction to apply.
 
Your physician is not required to agree to a restriction
that you may request. If the physician believes it is in
your best interest to permit use and disclosure of your protected
health information, your protected health information
will not be restricted. If your physician does agree to
the requested restriction, we may not use or disclose your
protected health information in violation of that restriction
unless it is needed to provide emergency treatment. With
this in mind, please discuss any restriction you wish to
request with your physician. You may request a restriction
by submitting a written request to the Privacy Officer.
 
You have the right to request to receive confidential
communications from us by alternative means or at
an alternative location. We will accommodate reasonable
requests. We may also condition this accommodation
by asking you for information as to how payment will be
handled or specification of an alternative address or other
method of contact. We will not request an explanation
from you as to the basis for the request. Please make this
request in writing to our Privacy Officer.
 
You may have the right to have your physician
amend your protected health information. This means
you may request an amendment of your protected health
information contained in your medical and billing records
and any other records that your physician uses for making
decisions about you, for as long as we maintain the protected
health information. You must make your request
for amendment in writing to our Privacy Officer, and provide
the reason or reasons that support your request.
We may deny any request that is not in writing or does not
state a reason supporting the request. We may deny your
request for an amendment of any information that:
1. Was not created by us, unless the person that created
the information is no longer available to amend the
information;
2. Is not part of the protected health information kept by
or for us;
3. Is not part of the information you would be permitted
to inspect or copy; or
4. Is accurate and complete.
If we deny your request for amendment, we will do so in
writing and explain the basis for the denial. You have the
right to file a written statement of disagreement with us.
We may prepare a rebuttal to your statement and will provide
you with a copy of any such rebuttal. Please contact
our Privacy Officer to determine if you have questions
about amending your medical record.
 
You have the right to receive an accounting of certain
disclosures we have made, if any, of your protected
health information. This right only applies to disclosures
for purposes other than treatment, payment or
healthcare operations as described in this Notice of
Privacy Practices. It also excludes disclosures we may
have made to you, to family members or friends involved
in your care, or for notification purposes. You have the
right to receive specific information regarding these disclosures
that occurred after April 14, 2003. The right to
receive this information is subject to certain exceptions,
restrictions and limitations. You must submit a written
request for disclosures in writing to the Privacy Officer.
You must specify a time period, which may not be longer
than six years and cannot include any date before April 14,
2003. You may request a shorter time frame. Your request
should indicate the form in which you want the list (i.e.,
on paper, etc). You have the right to one free request within
any 12 month period, but we may charge you for any
additional requests in the same 12 month period. We will
notify you about the charges you will be required to pay,
and you are free to withdraw or modify your request in
writing before any charges are incurred.
 
You have the right to obtain a paper copy of this
notice from us, upon request to our Privacy Officer, or in
person at our office, at any time, even if you have agreed
to accept this notice electronically.
 
3. COMPLAINTS
You may complain to us or to the Secretary of Health and
Human Services if you believe your privacy rights have
been violated by us. You may file a complaint with us by
notifying our Privacy Officer of your complaint. We will
not retaliate against you in any way for filing a complaint,
either with us or with the Secretary.
You may contact our Privacy Officer at (412) 767-5387
for further information about the complaint process.
 
4. CHANGES TO THIS NOTICE
We reserve the right to change the privacy practices that
are described in this Notice of Privacy Practices. We also
reserve the right to apply these changes retroactively to
Protected Health Information received before the change
in privacy practices.
You may obtain a revised Notice of Privacy Practices by
calling the office and requesting a revised copy be sent in
the mail, or asking for one at the time of your next
appointment.
This notice was published and becomes effective on
March 31, 2003.
 
OUR COMMITMENT TO PROTECT YOUR HEALTH
INFORMATION
This Notice of Privacy Practices describes how we may
use and disclose your protected health information to
carry out treatment, payment or health care operations and
for other purposes that are permitted or required by law. It
also describes your rights to access and control your protected
health information. Your "protected health information"
means any of your written and oral health information,
including your demographic data that can be used to
identify you. This is health information that is created or
received by your health care provider, and that relates to
your past, present or future physical or mental health or
condition.
We are strongly committed to protecting your medical
information. We create a medical record about your care
because we need the record to provide you with appropriate
treatment and to comply with various legal requirements.
We transmit some medical information about your
care in order to obtain payment for the services you
receive, and we use certain information in our day to day
operations. This Notice will let you know about the various
ways we use and disclose your medical information,
describe your rights and our obligations with respect to
the use or disclosure of your medical information. We
will also ask that you acknowledge receipt of this Notice
the first time you come to or use any of our facilities,
because the law requires us to make a good faith effort to
obtain your acknowledgment.
We are required by law to:
Make sure that any medical or health information that we
have that identifies you is kept private, and will be used or
disclosed only in accord with this Notice of Privacy
Practices and applicable law;
Give you this Notice of our legal duties and our privacy
practices; and
Abide by the terms of the Notice of Privacy Practices that
is in effect from time to time.