Notice of Privacy Practices
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.
Stacey Folk, M.D., P.C. and Michael Bateman, M.D., P.C. are required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information. If you have questions about any part of this Notice or if you want more information about the privacy practices please contact:
Stacey Folk, M.D., 303-321-6608, 4545 East 9th Ave Suite 210, Denver, CO 80220
Michael Bateman, M.D., 303-388-1945, 4545 East 9th Ave Suite 220, Denver, CO 80220
Effective Date of This Notice: October 15, 2002
I. How Stacey Folk, M.D., P.C. or Michael Bateman M.D., P.C., may Use or Disclose Your Health Information:
Stacey Folk, M.D., P.C. and Michael Bateman M.D., P.C., collect health information from you and store it in a chart and on a computer. This is your medical record. The medical record is the property of Stacey Folk, M.D., P.C. and Michael Bateman M.D., P.C., but the information in the medical record belongs to you. Stacey Folk, M.D., P.C. and Michael Bateman M.D., P.C. protect the privacy of your health information. The law permits Stacey Folk, M.D., P.C. and Michael Bateman M.D., P.C. to use or disclose your health information for the following purposes:
1. Treatment. For example, a letter may be sent to your primary care physician regarding an upcoming surgery, or your case may be discussed at a multidisciplinary conference to coordinate your treatment plan.
2. Payment. We may disclose your health information when generating a bill from our office or through an outside billing agency. Financing companies and collection agencies will be given information regarding services rendered as necessary.
3. Regular Health Care Operations. We may disclose your health information in the course of regular health care operations by scheduling and confirming appointments, scheduling surgery with the hospital and anesthesiologists, and with cross covering on-call physicians. Pre and post-operative photos, which are the property of Stacey Folk, M.D., P.C. and Michael Bateman, M.D., P.C. may be used anonymously for teaching purposes with your permission. You may also be contacted in the future to see if you are interested in talking to a prospective patient, but you will be in control of disclosing your health information in that situation.
4. Information Provided to You. (See Section III)
5. Notification and Communication with Family. We may disclose your health information to notify or assist in notifying a family member, your personal representative or another person responsible for your care about your location, your general condition or in the event of your death. If you are able and available to agree or object, we will give you the opportunity to object prior to making this notification. If you are unable or unavailable to agree or object, our health professionals will use their best judgment in communication with your family and others.
6. Required by Law. As required by law, we may use and disclose your health information.
7. Public Health. As required by law, we may disclose your health information to public health authorities for purposes related to: preventing or controlling disease, injury or disability; reporting child abuse or neglect; reporting domestic violence; reporting to the Food and Drug Administration problems with products and reactions to medications; and reporting disease or infection exposure.
8. Health Oversight Activities. We may disclose your health information to health agencies during the course of audits, investigations, inspections, licensure, and other proceedings.
9. Judicial and Administrative Proceedings. We may disclose your health information in the course of any administrative or judicial proceeding.
10. Law Enforcement. We may disclose your health information to a law enforcement official for purposes such as identifying or locating a suspect, fugitive, material witness or missing person, complying with a court order or subpoena and other law enforcement purposes.
11. Deceased Person Information. We may disclose your heath information to coroners, medical examiners and funeral directors.
12. Organ Donation. We may disclose your health information to organizations involved in procuring, banking or transplanting organs and tissues.
13. Research. We may disclose your health information to researchers conducting research that has been approved by an Institutional Review Board or Stacey Folk, M.D., P.C., privacy board.
14. Public Safety. We may disclose your health information to appropriate persons in order to prevent or lessen a serious an imminent threat to the health or safety of a particular person or the general public.
15. Specialized Government Functions. We may disclose your health information for military, national security, prisoner and government benefits purposes.
16. Worker’s Compensation. We may disclose your information as necessary to comply with worker’s compensation laws.
17. Marketing. We may contact you to provide appointment reminders or to give you information about other treatments or health-related benefits and services that may be of interest to you.
18. Change of Ownership. In the event that Stacey Folk, M.D., P.C. and Michael Bateman M.D., P.C., is sold or merged with another organization, your health information/record will become the property of the new owner.
II. When Stacey Folk, M.D., P.C. and Michael Bateman, M.D., P.C., May Not Use or Disclose Your Health Information
Except as described in this Notice of Privacy Practices, Stacey Folk, M.D., P.C. and Michael Bateman M.D., P.C., will not use or disclose your health information without your written authorization. If you do authorize Stacey Folk, M.D., P.C. and/or Michael Bateman M.D., P.C., to use or disclose your health information for another purpose, you may revoke your authorization in writing at any time.
III. Your Health Information Rights
1. You have the right to request restrictions on certain uses and disclosures of your health information. Stacey Folk, M.D., P.C., and Michael Bateman M.D., P.C. are not required to agree to the restriction that you requested.
2. You have the right to receive your health information through a reasonable alternative means or at an alternative location. This must be a written request and payment is required prior to sending the requested information.
3. You have the right to inspect and copy your health information.
4. You have a right to request that Stacey Folk, M.D., P.C. and Michael Bateman M.D., P.C., amend your health information that is incorrect or incomplete. Stacey Folk, M.D., P.C. and Michael Bateman M.D., P.C. are not required to change your health information and will provide you with information about Stacey Folk, M.D., P.C. and Michael Bateman M.D., P.C., denial and how you can disagree with the denial.
5. You have a right to receive an accounting of disclosures of your health information made by Stacey Folk, M.D., P.C. and Michael Bateman M.D., P.C., except that Stacey Folk, M.D., P.C. and Michael Bateman M.D., P.C. do not have to account for the disclosures described in parts 1 (treatment), 2 (payment), 3 (health care operations), (information provided to you), and 15 (certain government functions) of section I of the Notice of Privacy Practices.
6. You have a right to a paper copy of this Notice of Privacy Practices.
If you would like to have a more detailed explanation of these rights or if you would like to exercise one or more of these rights, contact
Stacey Folk, M.D., P.C. and/or Michael Bateman M.D., P.C.
IV. Changes to this Notice of Privacy Practices
Stacey Folk, M.D., P.C. and Michael Bateman M.D., P.C., reserves the right to amend this Notice of Privacy Practices at any time in the future. Until such amendment is made, Stacey Folk, M.D., P.C. and Michael Bateman M.D., P.C., are required by law to comply with this Notice.
V. Complaints
Complaints about this Notice of Privacy Practices or how Stacey Folk, M.D., P.C. and Michael Bateman M.D., P.C., handle your health information should be directed to:
Stacey Folk, M.D., P.C. and/or Michael Bateman M.D., P.C.
If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint to:
Department of Health and Human Services
Office of Civil Rights
Hubert H. Humphrey Bldg.
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201
You may also address your complaint to one of the regional Offices for Civil Rights. A list of these offices can be found online at http://www.hhs.gov/ocr/regmail.html.