NOTICE OF PRIVACY PRACTICES

LINDA D. GREEN, M.D.

Effective date:    April 14, 2003

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOUMAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TOTHIS INFORMATION. PLEASE REVIEW IT CAREFULLY.If you have any questions about this notice please contact our Privacy Officer as directed by this Notice.

Federal regulations developed under the Health Insurance Portability and Accountability Act (HIPAA) requires that the practice provide you with this Notice of Privacy Practices. The Notice describes (1) how the practice may use and disclose your protected health information, (2) your rights to access and control your protected health information in certain circumstances, and (3) the practices’ duties and contact information.

I. Protected Health Information

"Protected health information" is health information created or received by your health care provider that contains information that may be used to identify you, such as demographic data. It includes written or oral health information that relates to your past, present or future physical or mental health; the provision of health care to you; and your past, present, or future payment for health care.

We are required to abide by the terms of this Notice of Privacy Practices. The Notice will be posted in our office, on our web site at www.sniffles.com, and will be provided to all who come to our office for appointments. You will be asked by our office to sign an acknowledgement form that you have received our Notice of Privacy Practices. We may change the terms of our Notice, at any time. The new Notice will be effective for all protected health information that we maintain at that time. A revised Notice of Privacy Practices may be accessed at our web site, www.sniffles.com or by requesting a paper copy from our practice.

II. The Use and Disclosure of Protected Health Information in Treatment, Payment, and Health Care Operations

Your protected health information may be used and disclosed by the practice in the course of providing treatment, obtaining payment for treatment, and conducting health care operations. Any disclosures may be made in writing, electronically, by facsimile, or orally.  

The practice may also use or disclose your protected health information in other circumstances if you authorize the use or disclosure, or if state law or the HIPAA privacy regulations authorize the use or disclosure.

Treatment. The practice may use and disclose your protected health information in the course of providing or managing your health care as well as any related services. For the purpose of treatment, the practice may coordinate your health care with a third party. For example, the practice may disclose your protected health information to a pharmacy to fulfill a prescription for medication, to an X-ray facility to order an X-ray, or to another physician who is administering your allergy shots which we prepared. In addition, the practice may disclose protected health information to other physicians or health care providers for treatment activities of those other providers.

Payment. When needed, the practice will use or disclose your protected health information to obtain payment for its services. Such uses or disclosures may include disclosures to your health insurer to get approval for a recommended treatment or to determine whether you are eligible for benefits or whether a particular service is covered under your health plan. When obtaining payment for your health care, the practice may also disclose your protected health information to your insurance company to demonstrate the medical necessity of the care or for utilization review when required to do so by your insurance company. Finally, the practice may also disclose your protected health information to another provider where that provider is involved in your care and requires the information to obtain payment.

Health Care Operations. The practice may use or disclose your protected health information when needed for the practice’s health care operations for the purposes of management or administration of the practice and of offering quality health care services. Health care operations may include but are not limited to:

(1) quality evaluations and improvement activities; (2) employee review activities and training programs; (3) accreditation, certification, licensing, or credentialing activities; (4) reviews and audits such as compliance reviews, medical reviews, legal services, and maintaining compliance programs; and (5) business management and general administrative activities. For instance, the practice may use, as needed, protected health information of patients to review their treatment course when making quality assessments regarding allergy care or treatment. In addition, the practice may disclose your protected health information to another provider or health plan for their health care operations.

Other Uses and Disclosures. As part of treatment, payment, and health care operations, the practice may also use or disclose your protected health information to: (1) remind you of an appointment including sending you an appointment reminder card and/or calling and leaving appointment reminder information with those who answer your phone or on your telephone answering machine; (2) inform you of potential treatment alternatives or options; or (3) inform you of health-related benefits or services that may be of interest to you; (4) train student doctors, residents and allied health personnel who may rotate through our office. In addition, we may use a sign-in sheet at the registration area where you will be asked to sign your name. We may also call you by name in the waiting room when you are ready to be seen.

III. Additional Uses and Disclosures Permitted Without Authorization or an Opportunity to Object

In addition to treatment, payment, and health care operations, the practice may use or disclose your protected health information without your permission or authorization in certain circumstances, including:

  When Legally Required. The practice will comply with any Federal, state or local law that requires it to disclose your protected health information. The use and disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law.

  When Necessary to Protect Public Health. The practice may disclose your protected health information for public health purposes, including to, as permitted or required by law:

(1) Prevent, control, or report disease, injury, or disability;

(2) Report vital events such as birth or death;

(3) Conduct public health surveillance, investigations, and interventions;

(4) Collect or report adverse events and product defects, track FDA regulated products, enable product recalls, repairs, or replacements, and conduct post marketing surveillance;

(5) Notify a person who has been exposed to a communicable disease or who may be at risk of contracting or spreading a disease (but only in accordance with state law); and

(6) Report to an employer information about an individual who is a member of the workforce when information is related to a medical surveillance of the workplace or to evaluate whether an illness or injury is work-related.  A separate notice will be provided to you in these circumstances.

  To Report Abuse, Neglect or Domestic Violence. As required or authorized by law or with the patient’s agreement, the practice may inform government authorities if it is believed that a patient is the victim of abuse, neglect or domestic violence.

  To Conduct Health Oversight Activities. The practice may disclose your protected health information to a health oversight agency for use in (1) audits; (2) civil, administrative, or criminal investigations, proceedings or actions; (3) inspections; (4) licensure or disciplinary actions; or (5) other necessary oversight activities as permitted by law.  However, if you are the subject of an investigation, the practice will not disclose protected health information that is not directly related to your receipt of health care or public benefits.

  For Judicial and Administrative Proceedings.The practice may disclose your protected health information for any judicial or administrative proceeding if the disclosure is expressly authorized by an order of a court or administrative tribunal as expressly authorized by such order or a signed authorization is provided.

  For Law Enforcement Purposes. The practice may disclose your protected health information to a law enforcement official for law enforcement purposes when:

(1) Required by law to report of certain types of physical injuries;

(2) Required by court order, court-ordered warrant, subpoena, summons or similar process;

(3) Needed to identify or locate a suspect, fugitive, material witness or missing person;

(4) Needed to report a crime in an emergency situation;

(5) You are the victim of a crime in specific limited instances;

(6) Your death is suspected by the practice to be the result of criminal conduct; or

(7) The practice believes your protected health information is evidence of a crime committed on the premises of the practice.

  To Coroners, Funeral Directors, and for Organ Donation. The practice may disclose protected health information to a coroner or medical examiner for the purpose of (1) identification, (2) determination of cause of death, or (3) performance of the coroner or medical examiner’s other duties as authorized by law. In addition, as permitted by law, the practice may disclose protected health information, including when death is reasonably anticipated, to a funeral director to enable the funeral director to carry out his or her duties. Protected health information may also be used and disclosed for the purpose of cadaveric organ, eye or tissue donation.

  To Prevent or Diminish a Serious and Imminent Threat to Health or Safety. If in good faith the practice believes that use or disclosure of your protected health information is necessary to prevent or diminish a serious and imminent threat to the health and safety of a person or of the public, the practice may use or disclose your protected health information as permitted under law and consistent with ethical standards of conduct.

  For Specified Government Functions. As authorized by the HIPAA privacy regulations or state law, the practice may use or disclose your protected health information to facilitate specified government functions relating to military and veterans activities, national security and intelligence activities, protective services for the President and others, medical suitability determinations, correctional institutions, and law enforcement custodial situations.

  For Worker's Compensation.The practice may disclose your protected health information to comply with worker's compensation laws and other similar legally established programs.

  For 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.

  For Research. 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.

  For Required Uses and Disclosures. Under the law, we must make disclosures to you and when required the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500 et.seq.

IV. Uses and Disclosures Permitted With An Opportunity to Object

Subject to your objection, the practice may disclose your protected health information (1) to a family member or close personal friend if the disclosure is directly relevant to the person's involvement in your care or payment related to your care; or (2) when attempting to locate or notify family members or others involved in your care to inform them of your location, condition or death. The practice will inform you orally or in writing of such uses and disclosures of your protected health information as well as provide you with an opportunity to object in advance. Your agreement or objection to the uses and disclosures can be oral or in writing. The practice may disclose your health information to a friend or family member as described at (1) and (2) if: (a) you are present and do not object to these disclosures; (b) the practice is able to infer from the circumstances that you do not object; or (c) the practice determines, in its professional judgment, that it is in your best interests for the practice to disclose information that is directly relevant to the person's involvement with your care. If you are incapacitated or in an emergency situation, the practice may exercise its professional judgment to determine if the disclosure is in your best interests and, if such a determination is made, may only disclose information directly relevant to your health care.

V. Uses and Disclosures Authorized by You

Other than the circumstances described above, the practice will not disclose your health information unless you provide written authorization. You may revoke your authorization in writing at any time except to the extent that the practice has taken action in reliance upon the authorization.

VI. Your Rights

You have certain rights regarding your protected health information under the HIPAA privacy regulations. These rights include:

  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 a 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 completing the proper forms provided by the Privacy Officer.

  The right to request to receive confidential communications from the practice 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. You are not required to provide an explanation for your request. Requests should be made in writing to the practice’s Privacy Officer.

  The right to inspect and copy your protected health information.This means you may inspect and obtain a copy of protected health information about you as long as we maintain the protected health information, subject to certain limitations. Under federal law, however, you may not inspect or copy the following records: psychotherapy notes, information complied in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information. If we deny your request to inspect and copy your protected health information we will provide you with a written notice of the reason for the denial including an explanation of any appeal rights you may have.  We may impose a fee for copies as permitted by state and federal law.  Requests for review and copying of your protected health information should be directed to the Privacy Officer.

  The right to request an amendment of your protected health information. This means you may request an amendment of protected health information about you in a designated record set for as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have a right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact our Privacy Officer if you have questions about amending you medical record. Requests for amendment must be submitted in writing and must supply a reason to support the requested amendments.

  The right to request an accounting of certain disclosures. You have the right to request an accounting of the practice’s disclosures of your protected health information made for purposes other than treatment, payment or health care operations as described in this Notice. The practice is not required to account for disclosures (1) which you requested, (2) which you authorized by signing an authorization form, (3) for a facility directory, (4) to friends or family members involved in your care, and (5) certain other disclosures the practice is permitted to make without your authorization. The request for an accounting must be made in writing to our Privacy Officer and should state the time period for which you wish the accounting to include up to a six year period. The practice is not required to provide an accounting for disclosures that take place prior to April 14, 2003. The practice will not charge you for the first accounting you request of any 12-month period. Subsequent accountings may require a fee based on the practice’s reasonable costs for compliance with the request. The right to receive this information is subject to certain exceptions, restrictions and limitations.

  The right to obtain a paper copy of this Notice. The practice will provide a separate paper copy of this Notice upon request even if you have already been given a copy of it or have agreed to review it electronically.

VII. 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 for filing a complaint.

VIII. Contact Person

The practice's contact person regarding the practice’s duties and your rights under the HIPAA privacy regulations is the Privacy Officer. The Privacy Officer can provide information regarding issues related to this Notice by request. Complaints to the practice should be directed to the Privacy Officer at the following address:

LINDA D. GREEN, M.D.

850 West Chester Pike, Suite 300

Havertown, PA 19083

ATTN: Paul A. Stieff, Privacy Officer

Phone: (610) 446-4844

IX. Effective Date

This Notice is effective on April 14, 2003.