Dr. Thomas Wind, D.O. - Privacy Notice
This Notice describes how medical information about you may be used and disclosed and how you can get access to this information.
This notice is effective July 1, 2003
I. Who We Are
This Notice describes the privacy practices of Thomas S. Wind, D.O., Child, Adolescent and Adult Psychiatrist, and his Associates.
While treating you, our employees follow this Notice. Any person involved in your care with us may share medical information about you with each other for treatment, payment or health care operations as described in this notice.
We are required by law to maintain the privacy of your health information and to provide you with this Notice.
II. Our Duties to Safeguard Your Protected Health Information (PHI)
Protected Health Information is any information related to your health care that is shared or maintained in any manner. It includes your insurance information as well. This Notice applies to all of your medical information generated by Thomas S. Wind, D.O., Associates, and other employees. This Notice will tell you about the ways in which we may use and disclose your medical information. We also describe your rights and certain obligations we have regarding the use and disclosure of your medical information.
We are required by law to:
make sure that medical information that identifies you is kept private;
give you this Notice of our legal duties and privacy practices related too your medical information; and,
follow the terms of the Notice that are currently in effect.
III. How We May Use and Disclose Medical Information About You - Treatment, Payment and Health Care Operations
Treatment - We may use and disclose protected health information (PHI) about you in connection with your treatment, for example to diagnose you. In addition, we may contact you to remind you about appointments, give you instructions prior to tests, or inform you about treatment alternatives or other health related benefits or services. We may also disclose your medical information to other providers, doctors, nurses, technicians, medical students, hospital personnel or other health care facilities involved in your treatment. We may need to communicate this medical information to other health care providers using phone, fax, or electronic means.
Payment - We may use and disclose medical information about you to obtain payment for services we provide to you. For example, we may contact your Insurance Company to pay for the services you receive, to verify that your insurer will pay for the services, to coordinate benefits or to collect any outstanding accounts.
Health Care Operations - We may use and disclose your PHI for health care operations which include: activities related to evaluating treatment effectiveness, teaching and learning purposes, evaluating the quality of our services, investigating complaints related to service, and marketing activities.
IV. Other Uses and Disclosures of Your PHI for which Authorization is Not Required
Minors - If you are an unemancipated minor, there may be circumstances in which we disclose health information about you to a parent, guardian, or other person acting in loco parentis, in accordance with our legal and ethical responsibilities.
Parents - If you are a parent of an unemancipated minor, and are acting as the minor's personal representative, we may disclose health information about your child to you under certain circumstances. For example, if we are legally required to obtain your consent as your child's personal representative in order for your child to receive care from us, we may disclose health information about your child to you.
In some circumstances, we may not disclose health information about an unemancipated minor to you. For example, if your child is legally authorized to consent to treatment (without separate consent from you), consents to such treatment, and does not request that you be treated as his or her personal representative, we may not disclose health information about your child to you without your child's written authorization.
Personal Representative - If you are an adult or emancipated minor, we may disclose health information about you to a personal representative authorized to act on your behalf in making decisions about your health care.
Incapacity or Emergency Circumstances - If you are not present, or the opportunity to agree or object to a use or disclosure cannot practicably be provided because of your incapacity or an emergency circumstance, we may exercise our professional judgment to determine whether a disclosure to relatives and/or close friends is in your best interests. If we disclose information to a family member, other relative or a close personal friend, we would disclose only information that is directly relevant to the person's involvement with your health care.
Marketing - We may use or disclose Protected Health Information to identify health-related services that may be beneficial to your health, such as notification of a new physician and/or additional services, and then contact you about those services. If you do not wish to receive information of this type, please let us know.
Public Health Activities - We may disclose information about you for public health activities including the following:
To prevent or control disease, injury or disability
To report child abuse or neglect
To report reactions to medications or problems with products
To notify individuals who may have been exposed to a disease or may be at risk for contracting a disease or condition
Reporting information to your employer as required by laws addressing work-related illnesses and injuries or workplace medical surveillance
Victims of Abuse, Neglect or Domestic Violence - If we reasonably believe you are a victim of abuse, neglect or domestic violence, we may, in accordance with current Pennsylvania law, disclose your PHI to agovernmental authority, including a social service or protective services agency, authorized by law to receive reports of such abuse, neglect, or domestic violence.
Health Oversight Activities - We may disclose your PHI to a health oversight agency that is responsible for ensuring compliance with rules of government health programs such as Medicare and Medicaid. These oversight activities include, for example, audits, investigations, inspections and licensure.
Legal Proceedings and Law Enforcement - We may disclose your PHI in response to a court order, subpoena, or other lawful process.
Deceased Persons - We may release medical information to a coroner or medical examiner authorized by law to receive such information.
Public Safety - We may use or disclose your PHI to prevent or lessen a serious or imminent threat to the safety of a person or the public.
Research - We will ask for your permission or authorization before using your PHI for research purposes.
Disaster Relief Efforts - We may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.
Military, National Defense and Security - We may release medical information about you if required for military, national defense and security and other special government functions.
Workers' Compensation - We may release medical information about you for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illnesses.
As Required by Law - We may use and disclose your PHI when required to do so by any other laws not already referenced above.
V. Uses and Disclosures Requiring Your Specific Authorization
Disclosure to Relatives and Close Friends - We may disclose your PHI to a family member, other relative, a close personal friend or any other person if we (1) obtain your agreement; (2) provide you with the opportunity to object to the disclosure.
Highly Confidential Information - Federal and State laws require special privacy protections for certain highly confidential information about you. This includes PHI that is: (1) maintained in psychotherapy notes; (2) documentation related to mental health or developmental disabilities services; (3) drug and alcohol abuse, prevention, treatment and referral information; (4) information related to HIV status, testing, treatment as well as any information related to the treatment or diagnosis of sexually transmitted diseases; and (5) PHI related to genetic testing. Generally, we must obtain your authorization to release this type of information. However, there are limited circumstances under the law when this information may be released without your consent. For example, certain sexually transmitted diseases must be reported to the Department of Health.
Psychotherapy Notes - In the course of your care with us, you may receive treatment from a mental health professional (such as a psychiatrist) who keeps separate notes during the course of your therapy sessions about your conversations. These notes, know as "psychotherapy notes" are kept apart from the rest of your medical record, and do not include basic information such as your medication treatment record, counseling session start and stop times, the types and frequencies of treatment you receive, or your test results. They also do not include any summary of your diagnosis, condition, treatment plan, symptoms, prognosis, or treatment progress.
Psychotherapy notes may be disclosed by a therapist only after you have given written authorization to do so. (Limited exceptions exits, e.g. in order for your therapist to prevent harm to yourself or others, and to report child abuse/neglect.) You cannot be required to authorize the release of your psychotherapy notes in order to obtain health insurance benefits for your treatment, or enroll in a health plan. Psychotherapy notes are also not among the records that you may request to review or copy (see discussion of your rights in section VI below.) If you have any questions feel free to discuss this subject with Dr. Wind and/or his Associates..
VI. Your Rights Regarding Medical Information About You
You have the following rights regarding medical information we maintain about you:
Right to Inspect and Copy - You have the right to inspect and copy medical information that may be used to make decisions about your care excluding psychotherapy notes.
You must submit your request in writing. You may be charged a fee for the costs of copying, mailing or other supplies associated with your request.
We may deny your request to inspect and copy in certain very limited circumstances. You may request that the denial be reviewed. We will comply with the outcome of the review.
Right to Amend - You have the right to request that we amend the PHI we keep about you in your medical and billing records. To request an amendment, your request muse be made in writing to this office. We may deny your request if we believe the information you wish to amend is accurate, current and complete, if the PHI was not created by Thomas S. Wind, D.O., P.C. or his Associates or if other special circumstance apply.
Right to an Accounting of Disclosures - You have the right to request a record of all disclosures of your PHI. We are not required to give you an accounting of information we have used or disclosed for treatment, payment or health care operations or information you authorized us to disclose.
To request this list or accounting of disclosures, you must submit your request in writing. Your request may cover any disclosures made in the six years prior to the date of your request. However, we are not required to give you a record of disclosures that occurred before July 1, 2003.
Right to Request Restrictions - You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations. 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 emergency treatment.
To request restrictions, you must make your request in writing. 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, for example, disclosures to your spouse.
Right to Request Confidential Communications - You have the right to request that we communicate with you about medical matters in a certain way or at a certain location.
Right to Revoke Your Authorization - You may revoke your authorization for us to use and disclose your PHI at any time by submitting a request in writing.
VII. Changes to This Notice
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will have a copy of the current Notice in the office.
If you believe your privacy rights have been violated, you may file a complaint, in writing with our office.
You will not be penalized for filing a complaint.
Other uses and disclosures of medical information not covered by this Notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical 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 permission, and that we are required to retain a record of the care that we provided to you.
In order to exercise any of your rights described above, you must summit your request in writing to our office. If you have questions about your rights, please speak with Dr. Wind and/or his Associates.
Addendum to the Privacy Notice
If there is a breach of your confidentiality, then T.S. Wind Associates/Dr. Thomas Wind must inform you as well as Health and Human Services. A breach means that information has been released without authorization or without legal authority unless T.S. Wind Assoc/Dr. Thomas Wind (the covered entity) can show that there was a low risk that the PHI has been compromised because the unauthorized person did not view the Phi or it was de-identified.
If you are self pay, then you may restrict the information sent to insurance companies.
Most uses and disclosures of psychotherapy notes and protected health information for marketing purposes and the sale of protected health information require an authorization. Other uses and disclosuresnot described in the notice will be made only with your written authorization. You must sign an authorization (release of information form) for releases that are not mentioned in this Privacy Notice (such as mandated reporting of child abuse, reporting of elder abuse, reporting of impaired drivers, etc.)
You have a right to receive a copy of Protected Health information in electronic format or through a wirtten authorization designate a third party who may receive information.