DENNIS SAGER, M.D.
2013 SEPTEMBER 16
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.
We are required by the Health Insurance Portability & Accountability Act (HIPAA) to protect the confidentially of your medical records, also known as protected health information (PHI), and to provide you this notice. This policy is effective September 16, 2013. You are entitled to a copy of this policy. We reserve the right to change the policy at any time and must abide by any revised policy. Any change would be posted in the office and would apply to all PHI that we maintain.
We may use and disclose your PHI for the following purposes:
Treatment – The physicians, nurses, and staff of this office may use your records for your medical treatment. In addition, we may contact other doctors (for example, a cardiologist) and provide them with your PHI to facilitate your care.
Payment – We may use your PHI to collect payment from you. We may provide PHI to your health insurance company for payment purposes as well.
Health Care Operations – We may use your PHI for health care operations, such as quality control.
To Contact You – We may contact you to remind you of appointments or to discuss treatment alternatives or other health care benefits.
Legal Requirements – There are certain legal situations where we are required to disclose your PHI. Examples include public health reporting of infectious disease, subpoenas, and certain police and national security circumstances.
Other disclosures of your PHI require your written authorization. You may revoke an authorization at any time, but we may have already disclosed your PHI based on the prior authorization.
You may request restrictions on certain uses and disclosures of your PHI, but we do not have to agree to these requests. As a matter of policy, we feel restricting our ability to discuss your care with other doctors, for example, would not be in your best interest and would be confusing in a multi-doctor office. We would not likely agree to such a restriction. However, we are obligated to honor your request to not report your treatment to your health plan. In that circumstance, you must pay the entire cost of the visit at the time of the visit. We strongly discourage this, as this would also cause you to be responsible for laboratory and other studies, as they cannot be billed to your insurance without a diagnosis.
You may request an accounting of all disclosures of your PHI that were not for treatment, payment, or health care operations, and that were not authorized by you. (There will not likely be many disclosures that would fall into this category.) This disclosure would cover the prior 6 years, but would not include disclosures made before April 14, 2003. You may receive this without charge once per 12 month period. You will be charged for additional requests.
You have a right to inspect your PHI. Because of the limitations of space and personnel, prior arrangements will be required. You have a right to a copy of your PHI. While we may give you a copy of a laboratory result, for example, we will charge to make a full copy of records. You may request to see or obtain a copy of your minor child’s PHI. Please note, however, that you will often not have access to your minor’s records without the minor’s consent. In some circumstances, PHI containing certain items, such as birth control, pregnancy, and sexually transmitted disease, cannot be disclosed to parents without the minor’s consent. Since we usually ask teenage girls about potential pregnancy before prescribing medication, there is a chance that the PHI cannot be automatically released to you.
You have the right to make a written request to amend your PHI. We can accept your amendment and make changes to your PHI, or we can reject it. You will be notified of our decision. If we do not accept your amendment, you can request that we include a brief statement from you that you disagree with the PHI.
We are obligated to inform you that we need your written permission to market to you or to sell your PHI. However, we do not market to patients, and we do not sell PHI.
We are required to advise you if there has been a breach of the security of your PHI, unless, upon risk analysis, it has been determined that there is a low probability that your PHI has actually been compromised. If you feel that we have not protected your PHI, please contact us. You may file a written complaint at the contact address below. If you wish, you may file a complaint with the Secretary of Health and Human Services. We will not retaliate against you for filing a complaint.
Questions, requests, or complaints can be addressed to:
Office Manager, Dennis Sager, M.D., 1800 Town Center Drive, Suite 313, Reston, VA 20190-3200, 703-471-5340