David B. Stoeckle, M.D., F.A.C.S., F.A.C.G.
David B. Stoeckle, M.D., P.A., P.C.
New River Surgical Associates
General, Breast, Thoracic, & Laparoscopic Surgery - Diagnostic & Therapeutic
Gastrointestinal Endoscopy
820 Hospital Drive, Blacksburg, VA 24060-7023
(540) 552-0005 Fax (540) 951-2215
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.
We are committed to preserving the privacy of your health information
generated and maintained by David B. Stoeckle, M.D., P.A., P.C., dba, New River Surgical
Associates. We are required by law to maintain the privacy of your health information and
provide you with this notice of our legal duties and privacy practices with respect to
your protected health information.
David B. Stoeckle, M.D., P.A., P.C., dba, New River Surgical Associates will abide by the
terms of this notice; however, we reserve the right to change the terms of this notice at
any time. The new notice will be effective for all protected health information we
maintain at that time. You may request a copy of the revised notice by contacting our
office. This notice describes the ways in which we may use or disclose your health
information and also describes your rights and our duties regarding use and disclosure of
your health information. This notice will also be published on our website,
www.newriversurg.com.
WRITTEN ACKNOWLEDGMENT
You will be asked to sign a statement acknowledging receipt of a copy of this
notice.
A. USES AND DISCLOSURES OF YOUR HEALTH INFORMATION
The following describes the different ways we may use and disclose your health information
and includes some examples of types of uses and disclosures:
Treatment: Your health information may be used and disclosed by us for
providing and coordinating your healthcare. We may disclose health information about you
to doctors, nurses, healthcare students and other providers involved in your care and
treatment. For example, a nurse may disclose your health information to an x-ray
technician or another physician providing medical treatment to you.
Payment: Your health information may be used and disclosed by us for the
purpose of determining coverage, billing, claims management, reimbursement and collections
of unpaid account or to assist another health care provider in obtaining payment for their
health care bills. For example, we may send a bill to your insurance company that may
include information that identifies you, your diagnosis, and any procedures performed. We
may also disclose your health information as required by your health insurance plan before
it approves or pays for the health care services we recommend for you.
Health care operations: Your health information may be used and disclosed
during routine operations including quality assessment review, employee performance
review, training of healthcare students, licensing, and other activities necessary for our
operations. For example, we may use your health information to review our treatment and
services and to evaluate our performance in providing care to you.
Appointment reminders: We may use or disclose your health information to
contact you regarding your appointment by mail or by telephone.
Treatment alternatives: We may disclose your health information for
purposes of contacting you to inform you of treatment alternatives or other health-related
benefits and services that may be of interest to you. For example, we may contact a home
health agency to discuss services they provide which might assist you.
Business associates: We will share your health information with
“business associates” that perform various activities (e.g., billing,
transcription services) for the practice. Whenever an arrangement between our office and a
business associate involves the use or disclosure of your health information, we will have
a written agreement that contains terms that will protect the privacy of your health
information. For example, our medical practice may hire a billing company to submit claims
to your health care insurer. Your health information will be disclosed to this billing
company, but a written agreement between our office and the billing company will prohibit
the billing company from using your health information in any way other than what we
allow.
Individuals involved in your health care: Unless you object, we may
disclose your health information to a member of your family, a close friend or any other
person you identify who is directly involved in your health care. If you are unable to
agree or object to such a disclosure, we may disclose such information as necessary if we
determine that it is in your best interest based on our professional judgment. We may also
use or disclose your protected health information to assist in notifying family members,
personal representative or any other person that is responsible for your care of your
location, general condition or death. Finally, we may use or disclosure your protected
health information to an authorized public or private entity to assist in disaster relief
efforts to coordinate uses and disclosures to family or other individuals involved in your
health care.
Required by law: We may also use and/or disclose your health information
to the extent that the use and disclosure is required by law and the use or disclosure
complies with and is limited to the relevant requirements of such law.
Public health activities: We may disclose your health information to
public health authorities authorized to receive and collect health information for the
purpose of controlling disease, injury or disability. We may also disclose your health
information, at the direction of the public health authority, to any other government
agency that is collaborating with the public health authority.
Food and Drug Administration: We may disclose your health information to
a person subject to the jurisdiction of the Food and Drug Administration to collect or
report product defects for problems, track products, enable product
recalls/repairs/replacements or to conduct post marketing surveillance, etc.
Communicable disease: We may disclose your health information to a person
who may have been exposed to a communicable disease or may otherwise be at risk of
contracting or spreading the disease or condition if authorized by law to notify such
person.
To your employer: As required by law, we may disclose your health
information at the request of your employer to conduct an evaluation relating to medical
surveillance of the workplace or to evaluate whether you have a work related injury or
illness.
Abuse or neglect: We may disclose your health information to a public
health or government body authorized to receive reports of abuse or neglect as required or
permitted by state or federal law if we reasonably believe that you have been a victim of
abuse, neglect, or domestic violence.
Health oversight: We may disclose your health information to a health
oversight agency authorized by law to conduct health oversight activities. These may
include activities necessary for oversight of the health care system, government benefit
programs relevant to beneficiary eligibility, entities subject to government regulatory
programs for which health information is necessary for determining compliance with program
standards and entities subject to civil rights laws.
Judicial or administrative proceedings: We may disclose your health
information in response to an order of a court or administrative tribunal to the extent
expressly authorized and in certain conditions in response to a subpoena, discovery
request or other lawful request.
Law enforcement: We may also disclose your health information to law enforcement
officials as required by law. Examples of law enforcement requirements include:
- information requests for identification and location of a suspect, fugitive or missing
person;
- pertaining to victims of a crime, if under limited circumstances, we are unable to
obtain the individual’s agreement;
- suspicion that death has occurred as a result of criminal conduct;
- evidence of criminal conduct on the premises, and in an medical emergency to alert law
enforcement that a crime has been committed.
Coroners and funeral directors: We may disclose your health
information to a coroner or medical examiner for the purpose of identifying a deceased
person, determining cause of death or for the coroner or medical examiner to perform other
duties authorized by law. We may also disclose your health information to funeral
directors, as required by law, as necessary to carry out their duties.
Organ donation: We may disclose your health information to organ
procurement organizations or other entities engaged in the procurement, banking or
transplantation of cadaveric organs, eyes or tissue for the purpose of facilitating organ,
eye or tissue donation or transplantation.
Criminal activity: Consistent with applicable laws and ethical conduct,
we may disclose your health information if we believe, in good faith, that the use or
disclosure is necessary to prevent or lessen a serious and imminent threat to the health
or safety of a person or the public. We may also disclose your health information if it is
necessary for law enforcement authorities to identify or apprehend an individual.
Military activity and national security: We may use or disclose health
information of individuals who are Armed Forces personnel for activities deemed necessary
by appropriate military command authorities. We may also disclose your health information
for the purpose of a determination by the Department of Veterans Affairs of your
eligibility for benefits or to foreign military authority if you are a member of foreign
military services. We may also disclose your health information to authorized federal
officials for purposes of national security and intelligence activities, including for the
provision of protective services to the President or other persons as authorized by law.
Workers’ Compensation: Your health information may be disclosed to
the extent necessary to comply with laws relating to worker’s compensation or as
required by law that provide benefits for work-related injuries or illness.
Inmates: We may use or disclose your health information if you are an
inmate of a correctional facility and your physician created or received your health
information in the course of providing care to you.
Research: We may disclose your health information for research purposes
when it has been established that the research meets the requirements of federal and state
laws.
B. Use and disclosures of your health information for any reason
other than those set forth above will be made only with your written authorization. You
may revoke your authorization in writing at any time. You understand, however, the
revocation will not apply to any actions we have already taken.
C. Your Rights
The following is a statement of your rights with respect to your health information and a
brief description of how you may exercise these rights.
Right to inspect and copy your health information: You may inspect and
obtain a copy of your health information that may be used to make decisions about your
health care. Usually this information includes health and billing records but does not
include psychotherapy notes; information compiled related to a civil, criminal, or
administrative action; and health information that is subject to law that prohibits access
to health information in certain circumstances. You must submit your request in writing.
We may deny your request in limited circumstances. You may request to have this decision
reviewed. We may charge a fee for the copying, postage or other supplies associated with
your request. Please contact our Privacy Officer if you have questions about access to
your health record.
Right to request restrictions: You may request a restriction or
limitation on the health information we use or disclose about you for purposes of
treatment, payment or health care operations. You may also request that health information
not be disclosed to family members or friends who may be involved in your care. Your
request must state the specific restriction and to whom the restriction is to apply.
We are not required to agree to your request. If we do agree to your request, we will
abide by the restriction unless the information is needed to provide emergency treatment
to you or unless we otherwise notify you that we can no longer honor your request. You
must make your request in writing to our Privacy Officer.
Right to request confidential communications: You may request that we
communicate with you about your health care in a certain way or at a certain location. You
must make your request in writing to our Privacy Officer and specify how or where you wish
to be contacted. We may condition this accommodation by asking you for information as to
how payment will be handled or other information necessary to honor your request.
Right to request amendment of your health information: If you feel your
health information maintained by us is incorrect or incomplete, you may ask us to amend
the information. You have the right to request an amendment for as long as we maintain
this information. To request an amendment, your request must be in writing and submitted
to our Privacy Officer. In addition, you must provide a reason to support your request. We
may deny your request for an amendment. If we deny your request, you have the right to
file a disagreement with us.
Right to receive an accounting of disclosures: This accounting of
disclosures is for purposes other than treatment, payment or health care operations as
described in this Notice of Privacy Practices. It excludes information we may have
disclosed pursuant to your authorization or made directly to you. The right to receive
this information is subject to certain exceptions, restrictions, and limitations. To
receive this listing, your request must state a time period, which may not be longer than
six years and may not include dates prior to April 14, 2003. You must submit your request
in writing to our Privacy Officer.
Right to a paper copy of this notice: You may ask us to give you a paper
copy of this notice at any time. Please request one from our Privacy Officer or request
one when you are in our office.
Complaints: You may complain to us if you believe your privacy rights
have been violated by us. To file a complaint, please contact our Privacy Officer who will
assist you. You may file a complaint in writing to include as much detail as possible why
you believe your privacy rights were violated. We will not retaliate against you for
filing a complaint. If you do not wish to file a complaint with us, you may contact the
Secretary of Health and Human Services.
Privacy Contact: If you have any questions about this Notice,
please contact our Privacy Officer at 820 Hospital Drive, Blacksburg, Virginia
24060, at (540) 552-0005. Our Privacy Officer will discuss with you any of your
privacy questions, concerns, or complaints.
Effective Date of this Notice: April 14, 2003 |
