THIS NOTICE DESCRIBES HOW RAY H. CAMERON, MD and KAREN STEBER, FNP MAY USE AND DISCLOSE YOUR HEALTHCARE INFORMATION AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
RAY H. CAMERON, MD and KAREN STEBER, FNP are required by law to maintain the privacy of your protected health information (PHI). This information consists of all records related to your health, including demographic information, either created by RAY H. CAMERON, MD and KAREN STEBER, FNP or received by RAY H. CAMERON, MD and KAREN STEBER, FNP from other health care providers.
We are required to provide you with notice of our legal duties and privacy practices with respect to your PHI. These legal duties and privacy practices are described in this NOTICE. RAY H. CAMERON, MD and KAREN STEBER, FNP will abide by the terms of this NOTICE or the NOTICE currently in effect at the time of the use or disclosure of your PHI.
RAY H. CAMERON, MD and KAREN STEBER, FNP reserves the right to change the terms of this NOTICE and to make any new provisions effective for all PHI that we maintain. Patients will be provided a copy of any revised NOTICES UPON REEQUEST. An individual may obtain a copy of the current NOTICE from our office at any time.
RAY H. CAMERON, MD and KAREN STEBER, FNP may use and disclose your PHI for treatment, payment, and healthcare operations with an individual's signed consent.
TREATMENT. Your health information may be used by staff members or disclosed to other health care providers for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. It also includes referrals to nursing homes, foster care treatment, or home health agencies. For example, RAY H. CAMERON, MD and KAREN STEBER, FNP may determine that you require the services of another provider. In referring to another provider, RAY H. CAMERON, MD and KAREN STEBER, FNP may share or transfer your healthcare information to that provider.
Your health information may be used to send you information that you may find interesting on the treatment and management of you medical condition. We may also send you information describing other health-related products and services that we believe may interest you.
PAYMENT. Your health information may be used to seek payment from your health plan, from other sources of coverage such as an automobile insurer or worker's comp carrier, or from credit card companies that you may use to pay for services. It may be used to determine your eligibility for benefits or health insurance coverage. It may be used for collection activities to obtain payment for services provided to you. It may be used for obtaining pre-certification and pre-authorization of service to be provided to you. For example, your health plan may request and receive information on dates of service, the services provided, and the medical condition being treated.
HEALTHCARE OPERATIONS may include contacting health care provider and patient with information about treatment alternatives; conducting quality assessment and improvement activities; conducting outcomes evaluation and development of clinical guidelines; protocol development, case management or care coordination; conducting or arranging for medical review, legal services, and auditing functions. For example, the staff of RAY H. CAMERON, MD may contact you by telephone or mail to provide appointment reminders. You must notify us if you do not wish to receive appointment reminders.
We may not disclose your PHI to family members or friends who may be involved with your treatment or care without your written permission. Health information may be released without written permission to a guardian, or legal custodian of a child; the guardian of an incompetent adult; the healthcare agent designated in an incapacitated patient's healthcare power of attorney; or the personal representative or spouse of a deceased patient.
There are additional situations when RAY H. CAMERON, MD and KAREN STEBER, FNP are permitted or required to use or disclose your PHI without your consent or authorization. Examples include the following:
As permitted or required by law.
- In certain circumstances we may be required to report individual health information to legal authorities, such as law enforcement officials, court officials, or government agencies. For example, we have to report abuse, neglect, domestic violence or certain physical injuries if there is reasonable cause to believe that the patient is in danger.
For public health activities.
- We may release healthcare records to certain government agencies or public health authority authorized by law, upon receipt of written request from that agency.
Judicial and Administrative Proceedings.
- Patient healthcare records, including treatment records and HIV test results, maybe disclosed pursuant to a lawful court order. A subpoena signed by a judge is sufficient to permit disclosure of all healthcare records except for HIV test results.
For activities related to death.
- We may disclose patient healthcare records, except for treatment records, to a coroner or medical examiner for the purpose of completing a medical certificate or investigating a death.
To avoid a serious threat to health or safety.
- We may report a patient's name and other relevant data to the Department of Transportation if it is believed the patient's vision or physical or mental condition affects the patient's ability to exercise reasonable or ordinary control over a motor vehicle. Healthcare information, including treatment records and HIV test results, may be disclosed where disclosure is necessary to protect the patient or community from imminent and substantial danger.
RAY H. CAMERON, MD and KAREN STEBER FNP are not to make any other use of disclosure of your PHI without your written authorization. You may revoke such authorization at any time. However, your decision to revoke the authorization will not affect or undo any use or disclosure of information that occurred before you notified us of your decision to revoke your authorization.
YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION.
- You are permitted to request that restrictions be placed on certain uses or disclosures of your PHI by RAY H. CAMERON, MD and KAREN STEBER, FNP to carry out treatment, payment of healthcare operations. You must request such a restriction in writing. We are not required to agree to your request, but if we do agree, we must adhere to the restriction, except when your PHI is needed in an emergency treatment situation. In this event, information may be disclosed only to healthcare providers treating you. Also, a restriction would not apply when we are required by law to disclose certain healthcare information.
- You have the right to review and/or obtain a copy of your healthcare records, with the exception of psychotherapy notes, or information compiled for use or in anticipation for use in a civil, criminal, or administrative action or proceeding. RAY H. CAMERON, MD and KAREN STEBER, FNP may deny an access under other circumstances, in which case you have the right to have such a denial reviewed. We may charge a reasonable fee for copying your records.
- You may request that RAY H. CAMERON, MD and KAREN STEBER, FNP amend portions of your healthcare records, as long as such information is maintained by us. You must submit this request in writing and under certain circumstances the request may be denied.
- Any person or patient may file a complaint with RAY H. CAMERON, MD or KAREN STEBER, FNP and/or the Secretary of Health and Human Services if they believe their privacy rights have been violated. To file a complaint with RAY H. CAMERON, MD or KAREN STEBER, FNP, please contact the Privacy Officer at the following:
Privacy Officer
Ray H. Cameron, MD
1711 S. Stephenson Ave, Suite 320
Iron Mountain, MI 49801
906-779-7080
It is the policy of RAY H. CAMERON, MD and KAREN STEBER, FNP that no retaliatory action will be made against any individual who submits or conveys a complaint of suspected or actual non-compliance or violation of the privacy standards.
This notice of Privacy Practices is effective April 14, 2003.
Ray H. Cameron, MD
Karen Steber, FNP
