Call Us: 301.870.0600

Cambridge Professional Center

3500 Old Washington Road, Suite 201 | Waldorf, MD 20602

 

HIPAA Privacy Notice

Don J. Fontana, M.D. PA

Notice of Privacy Practices

Effective: April 13, 2003           Revised: September 2013

As Required by the Privacy Regulations Created as a Result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA)

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU (AS A PATIENT OF THIS PRACTICE) MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION.

WHO WILL FOLLOW THIS NOTICE:

This notice describes Privacy Practices and those of:

  • All employees of Don J. Fontana, M.D. PA
  • All healthcare professionals authorized to enter healthcare information into your record
  • All departments and offices of Don J. Fontana, M.D. PA
  • All Business Associates

PLEASE REVIEW THIS NOTICE CAREFULLY

 

A. OUR COMMITMENT TO YOUR PRIVACY

Our practice is dedicated to maintaining the privacy of your protected health information (PHI).  In conducting our business, we will create records regarding you and the treatment and services we provide to you.  We are required by law to maintain the confidentiality of health information that identifies you.  We also are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your PHI.  By federal and state law, we must follow the terms of the Notice of Privacy Practices that we have in effect at the time.

We realize that these laws are complicated, but 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 with respect to medical information about you.
  • Follow the terms of the notice that are currently in effect
  • In the event your health information is breached, we are required to provide you with notice of the breach.

The terms of this notice apply to all records containing your PHI that are created or retained by our practice.  We reserve the right to revise or amend this Notice of Privacy Practices.  Any revision or amendment to this Notice will be effective for all of your records that our practice has created or maintained in the past, and for any of your records that we may create or maintain in the future.  You may request a copy of our most current Notice at any time.

A. IF YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT OUR PRIVACY OFFICER:

Don J. Fontana, M.D. PA

Attn: Privacy Officer

3500 Old Washington Road, Suite 201

Waldorf, Maryland 20602

(301) 870-0600

B. HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU:

The following categories describe the different ways in which we may use and disclose your PHI.

1. Treatment- Our practice may use your PHI to treat you.  We might use your PHI in order to write a prescription for you, or we might disclose your PHI to a pharmacy when we order a prescription for you.  Dr. Fontana may use or disclose your PHI in order to treat you or to assist others in your treatment.  Finally, we may also disclose your PHI to other health care providers for purposes related to your treatment.

2. Payment- Our practice may use and disclose your PHI in order to bill and collect payment for the services and items you may receive from us.  For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment.  We also may use and disclose your PHI to obtain payment from third parties that may be responsible for such costs, such as family members.  Also, we may use your PHI to bill you directly for services and items.  We may disclose your PHI to other health care providers and entities to assist in their billing and collection efforts.

4. Appointment Reminders- Our practice may use and disclose your PHI to contact you for an appointment.

5. Treatment Options- Our practice may use and disclose your PHI to inform you of potential treatment options or alternatives.

6. Health-Related benefits and Services- Our practice may use and disclose your PHI to inform you of health-related benefits or services that may be of interest to you.

7. Release of Information to Family/Friends- Our practice may release your PHI to a friend or family member that is involved in your care, or who assists in taking care of you. You may restrict sharing your health information with someone who is involved in your care.

In order to share information with family or friends, patient must give written permission to do so.

8. Disclosure Required By Law- Our practice will use and disclose your PHI when we are required to do so by federal, state or local law.

C. USE AND DISCLOSURE WE MAY MAKE WITHOUT YOUR SPECIFIC AUTHORIZATION:

The following categories describe unique scenarios in which we may use or disclose your identifiable health information:

1. Public Health Risks- Our practice may disclose your PHI to public health authorities that are authorized by law to collect information for the purpose of:

  • Maintaining vital records, such as births and deaths
  • Preventing or controlling disease, injury or disability
  • Reporting reactions to drugs or problems with products or devices
  • Notifying individuals if a product or device they may be using has been recalled
  • Notifying your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance.

2. Health Oversight Activities- Our practice may disclose your PHI to a health oversight agency for activities authorized by law.  Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.

3. Lawsuits and Similar Proceedings- Our practice may use and disclose your PHI in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding.  We also may disclose your PHI in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.

4. Law Enforcement- We may release PHI if asked to do so by a law enforcement official:

  • Regarding criminal conduct at our offices
  • In response to a warrant, summons, court order, subpoena or similar legal process
  • In an emergency, to report a crime (including the location or victim(s) of the crime, or the description, identity or location of the perpetrator)

5. Serious Threats to Health or Safety- Our practice may use and disclose your PHI when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public.  Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.

6. Military- Our practice may disclose your PHI if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate authorities.

7. National Security- Our practice may disclose your PHI to federal officials for intelligence and national security activities authorized by law.  We also may disclose your PHI to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.

8. Workers’ Compensation- Our practice may release your PHI for workers’ compensation and similar programs.

D. YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU

You have the following rights regarding the PHI that we maintain about you:

1. Right to Confidential Communication- You have the right to request to receive communications from us on a confidential basis by using alternative means for receipt of information or by receiving the information at alternative locations.  For example, you can ask that we only contact you at work or by mail, or at another mailing address, beside your home address.  We must accommodate your request, if it is reasonable.  You are not required to provide us with an explanation as to the reason for your request.  If you would like to receive copies of your medical information after your treatment, you will specify the method and location that information should be sent to you.

  1. Requesting Restrictions- You have the right to request a restriction in our use or disclosure of your PHI for treatment, payment or health care operations.  Additionally, you have the right to request that we restrict our disclosure of your PHI to only certain individuals involved in your care or the payment for your care, such as family members and friends.  In order to request a restriction in our use or disclosure of your PHI, you must make your request in writing.  Your request must describe in a clear and concise fashion:

a. The information you wish restricted;

b. Whether you are requesting to limit our practice’s use, disclosure or both; and

c. To whom you want the limits to apply

We are not required to agree to your request unless your request pertains to not disclosing health information to a health plan for payment or operations related to services you paid in full from out of pocket.  If we do agree with your request, we are bound by our agreement, except when otherwise required by law, in emergencies, or when the information is necessary to treat you.

3. Inspection and Copies- You have the right to inspect and obtain a copy of the PHI that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes.  You must submit your request in writing in order to inspect and/or obtain a copy of your PHI.  Our practice may charge a fee for the costs of copying, mailing and supplies associated with your request.  Our practice may deny your request to inspect and/or copy in certain circumstances; however, you may request a review of our denial.  Another licensed health care professional chosen by us will conduct reviews.

4. Amendment- You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our practice.  To request an amendment, your request must be made in writing.

You must provide us with your request to amend your PHI. Our practice will deny your request if you fail to submit your request (and the reason supporting your request) in writing.  Also, we may deny your request if you ask us to amend information that is in our opinion: (a) accurate and complete; (b) not part of the PHI kept by or for the practice; (c) not part of the PHI which you would be permitted to inspect and copy; or (d) not created by our practice, unless the individual or entity that created the information is not available to amend the information.

5. Accounting of Disclosures- All of our patients have the right to request an “accounting of disclosures.”  An “accounting of disclosures” is a list of certain non-routine disclosures our practice has made of your PHI for non-treatment, non-payment or non-operations purposes.  Use of your PHI as part of the routine patient care in our practice is not required to be documented.  For example, the doctor sharing information with the nurse; or the billing department using your information to file your insurance claim.  In order to obtain an accounting of disclosures, you must submit your request in writing.  All requests for an “accounting disclosures” must state a time period, which may not be longer than six (6) years from the date of disclosure and may not include dates before April 14, 2003. Our practice will notify you of the costs involved and you may withdraw your request before you incur any costs.

6. Right to a Paper Copy of This Notice- You are entitled to receive a paper copy of our notice of privacy practices.  You may ask us to give you a copy of this notice at any time.  To obtain a paper copy of this notice, contact our privacy officer.

7. Right to file a Complaint- If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services.  To file a complaint with our practice, contact our privacy officer.  All complaints must be submitted in writing.  You will not be penalized for filing a complaint.

8. Right to Provide an Authorization for Other Uses and Disclosures- Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law.  Any authorization you provide to us regarding the use and disclosure of your PHI may be revoked at any time in writing.  After you revoke your authorization, we will no longer use or disclose your PHI for the reasons described in the authorization.  Please note, we are required to retain records of your care.

If you have any questions regarding this notice or our Health Information Privacy Policies, please contact our privacy officer.