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Notice of Privacy Practice
Purpose:
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.
Effective date of this notice is April, 14, 2003 and remains in effect
until we replace it.
I. Our Pledge Regarding Medical Information:
The Privacy of your medical information is important to us. We understand that
your medical information is personal and we are committed to protecting it.
Norman L Dykes, MD, APMC is 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
at Norman L. Dykes, MD, APMC please contact:
Cindy Randall, Medical Practice manager (337) 234-1119
Norman L. Dykes, MD APMC creates a record of the care and services you receive
at this organization and stores it in a chart and on a computer.
This is your medical record. We need this record to provide you
with quality care and to comply with certain legal requirements.
The medical record is the property of Norman L. Dykes, MD, APMC,
but the information in the medical record belongs to you. Norman
L. Dykes, MD, APMC protects the privacy of your health information.
II. Our Legal Duty:
The law permits Norman L. Dykes, MD, APMC to keep your medical information
private and give you this notice describing our legal duties, privacy practices,
and your rights regarding your medical information.
We have the right to change our privacy practices and the terms of this notice
at any time, provided that the changes are permitted by law. We also have the
right to make the changes in our privacy practices and the new terms of our
notice effective for all medical information that we keep, including information
previously created or received before the changes.
Before we make an important change in our privacy practices, we will change
this notice and make the new notice available upon request.
III. Use and disclosure of Your Medical Information:
- Treatment - We may use medical information about you
to provide you with medical treatment or services. We may disclose
medical information about you to pharmacies, doctors, nurses,
technicians, medical students or other people who are taking care
of you. (Example: We call in a prescription for you at your local
drug store. They may need you name, date of birth, social security
number and address).
- Payment - We may use and disclose your medical information for payment
purposes. (Example: You come in to the office for a visit. We
call to verify your coverage with your insurance company. We nay
need to let the insurance company know the reason why you are
in the office for a visit).
- Regular Health Care Operations - We may use and disclose your medical
information for our health care operations. This may include measuring
and improving quality, evaluating the performance of employees,
conducting training programs, and getting the accreditation, certificates,
licenses and credentials we need to serve you.
- 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, we will use our best judgment in communication
with your family and others. We will also use our professional
judgment to make decisions in your best interest about allowing
someone to pick up medicine, medical supplies, results, reports,
or any other medical information about you.
- Required by Law - Norman L. Dykes, MD, APMC, as required
by law, may disclose your health information to appropriate authorities
if we reasonable believe that you are a possible victim of any
forms of abuse, neglect, or domestic violence or the possible
victim of other crimes. We may share your medical information
if it is necessary to prevent a serious threat to your health
or safety of others.
- Public Health - 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. We may also, when we are authorized
by law to do so, notify a person who may have been exposed to
a communicable disease or otherwise by at risk of contracting
or spreading a disease or condition.
- Health Oversight Activities - Norman L. Dykes, MD, APMC
may disclose your health information to health agencies during
the course of audits, investigations, inspections, licensure and
other proceedings.
- Judicial and Administrative Proceedings - Norman L. Dykes,
MD, APMC may disclose your health information in the course of
any administrative or judicial proceedings. (Examples are court
ordered requests for medical records).
- Law Enforcement - Norman L. Dykes, MD, APMC 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.
- Deceased Person Information - Norman L. Dykes, MD, APMC
may disclose your health information to coroners, medical examiners
and funeral directors.
- Research - Norman L. Dykes, MD, APMC may disclose your health information
to researchers conducting research that has been approved by an
Institutional Review Board or Norman L. Dykes, MD, APMC privacy
board.
- Public Safety - Norman L. Dykes, MD, APMC may disclose
your health information to appropriate persons in order to prevent
or lessen a serious and imminent threat to the health or safety
of a particular person or the general public.
IV. Patient's Individual Rights:
- You may inspect and/or copy your medical information, except
for psychotherapy notes. You must submit written request to the
Privacy Officer. Copies will be provided free of charge for the
first request. Additional copies are for a fee of $1.00
for the first pages $.50 per page thereafter, $7.50 handling fee
and actual postage if mailed.
- You may obtain a list of all the times we shared your medical information
for the purposes other than treatment, payment, and health care operations
and other specified exceptions.
- You may request that we place additional restriction on our use or disclosure
or your medical information. We are not required to agree to these additional
restrictions, but if we do, we will abide by our agreement (except in the
case of an emergency).
- You may request, in writing to the Privacy Officer, for an amendment
or records.
Requests may be denied, if the provider did
not create the records, not part of the medical information kept
by the provider, not part of information that can be amended (psychotherapy
notes) or if the information is accurate and complete.
If we deny your request, we will provide you a written explanation.
You may respond with a statement of disagreement that will be
added to the information you wanted changed. If we accept your
request to change the information, we will make reasonable efforts
to tell others, including people you name, or the change and to
include that changes in any future sharing of that information.
- You may request that we communicate with you about your medical information
by different means or to different locations. Your request must by made in
writing addressed to the Privacy Officer.
- If you have received this notice electronically, and wish to receive a paper
copy, you have the right to obtain a paper copy by making a request in writing
to the contact person listed at the end of this notice.
V. Procedure of Complaints:
If you think that we may have violated your privacy rights, contact the person
named below. All complaints must be submitted in writing and addressed to the
Privacy Officer listed below. You may also submit a written complaint to the
US Department of Health and Human Services. We will provide you with the address
to file your complaint. Norman L. Dykes, MD, APMC will not retaliate in any
way if you choose to file a complaint.
IV. Health Insurance Portability and Accountability Act (HIPAA)
Privacy Officer
For the practice of Norman L. Dykes, MD, APMC, Contact:
Cindy Randall, HIPPA Privacy Officer
501 West Saint Mary Blvd., Suite 308
Lafayette, LA 70506
Phone: (337) 234-1119
Fax: (337) 234-1477
Effective date of this notice is 04/14/03. Norman L. Dykes, MD, APMC has the
right to change the terms of this notice. Patients will be given any revised
notices.