Effective date January 1, 2016
This Notice describes how "protected health information" about you may be used and disclosed, and how you can gain access to this information. Please review it carefully.
"Protected health information" is your health information or other individually identifiable information, such as demographic data, that may identify you. Protected health information relates to your past, present or future physical or mental health or condition related to healthcare services.
This Notice of Privacy Practices describes how (Provider Name) may use and disclose your protected health information to carry out treatment, for payment, for healthcare operations and for other purposes permitted or required by law. This Notice also describes certain rights that you may have to access your protected health information. (Provider Name) is required to abide by the terms of this Notice of Privacy Practices.
The terms of this Notice may change at any time. The new Notice will apply to all protected health information acquired after it goes into effect. Upon your request, we will provide you with any historical Notice of Privacy Practices or you may obtain the most current copy by visiting the (Provider Name) website at (Provider Web)@org
Uses and Disclosures of Protected Health Information
Your protected health information may be used and disclosed by (Provider Name), our staff and others outside of our offices who are involved in your care and treatment for the purpose of providing healthcare services to you. Your protected health information may also be used and disclosed to pay your healthcare bills and to support the operations of (Provider Name). The following list, by way of example rather than limitation, explains certain uses and disclosures of your protected health information that (Provider Name) is permitted to make.
Treatment
(Provider Name) will use and disclose your protected health information to provide, coordinate or manage your healthcare and any related services. This includes the coordination or management of your healthcare with another provider. For example, (Provider Name) may disclose your protected health information, as minimally necessary, to a home health agency that provides care to you.
(Provider Name) will also disclose health information to physicians or other healthcare providers who may be treating you. For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.
In addition, we may disclose your protected health information from time-to-time to another physician or healthcare provider (e.g., specialist or laboratory) who, at the request of your physician becomes involved in your care by providing assistance with your healthcare diagnosis or treatment. As another example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process.
(Provider Name) participates in certain Health Information Exchanges or Organizations (HIEs or HIOs). Specifically, (Practice Name) participates in the Indiana Health Information Exchange (IHIE) and Indiana Network for Patient Care (INPC), which help to make your protected health information available to other healthcare providers who may need access to it in order to provide care or treatment to you.