THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAYBEUSED AND DISCLOSED AND
HOW YOU CAN GETACCESS TO THIS INFORMATION.
- Purpose: Native Wound Therapy and its professional staff, employees, and volunteers and all its
affiliated entities (referred to collectively as Clinic) follow the privacy practices described in this
Notice. The Clinic is required by law to maintain the privacy of your medical information. This Notice
describes how we may use and disclose your medical information. Not every use and disclosure in
a category will be listed. Your medical information is stored electronically and is subject to
electronic disclosure. - Organized Health Care Arrangement. The Clinic and its medical staff participate together in an
organized health care arrangement to provide health care to you at the Clinic. This Notice applies to
physicians and other members of the Medical Staff who have agreed to abide by its terms
concerning the services they perform at the Clinic. This Notice does not create an agency
relationship, a joint venture, or any other legal relationship between those covered by this Notice.
Under this arrangement, the Clinic may share your medical information as necessary for treatment,
payment and health care operations relating to the organized health care arrangement. - Uses and Disclosures for Treatment, Payment, and Health Care Operations.We will use and
disclose your medical information for treatment, payment and health care operations. Treatment
involves providing and coordinating your care. For example, we may disclose your information to a
specialist to help diagnose or treat you. Payment involves uses and disclosures to assist in
obtaining payment for our services. For example, we may disclose your information to health plans
or other payors to determine whether you are enrolled with the payor or eligible for health benefits,
submit claims for payment, and provide information to entities that help us submit bills and collect
amounts owed. Health care operations involve our standard internal operations, such as quality
assurance activities, peer review, arranging for legal services, providing appointment reminders
and training. - Other Uses and Disclosures Not Requiring an Authorization. Your medical information may be
used and disclosed as described below:
a. Clinic directory to anyone who asks about you by name (may include your name, general
condition, and your location in the Clinic).
b. Religious affiliation and directory information to a Clinic chaplain or member of the clergy.
c. Family members or close friends involved in your care or payment for your treatment.
d. A government disaster relief agency if you are involved in a disaster relief effort.
e. To information you of treatment alternatives or benefits or services related to your health. If
we receive anything of value for making these communications, we will notify you of this
fact, and you will have an opportunity to opt out of future communications.
f. To contact you to raise funds for the Clinic, but information used and disclosed for
fundraising communications.
g. As required by law.
h. Public health activities, including disease prevention, injury or disability; reporting births
and deaths; reporting child abuse or neglect; reporting reactions to medications or
product problems’ notifications of recalls’ infections disease control; notifying government
authorities of suspected neglect, or domestic violence (if you agree as required by law).
i. Health oversight activities (e.g., audits, inspections, investigations, and licensure activities).
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j. Lawsuits and disputes (e.g., as required by a court or administrative order or in response to a
subpoena or other legal process).
k. Law enforcement (e.g., in response to legal process or as required or allowed by law).
l. Coroners, medical examiners and funeral directors.
m. Organ and tissue donation organizations.
n. Certain research projects as approved by an Institutional Review Board or if certain
conditions are met.
o. To prevent a serious threat to health or safety.
p. To military authorities if you are a member of the armed forces.
q. Nations’ security and intelligence activities.
r. Protection of the President or other authorized persons or foreign heads of state, or to
conduct special investigations.
s. Inmates or others in custody to a correctional institution or law enforcement
t. Workers’ Compensation (in compliance with applicable laws).
u. To business associates (individuals or entities that perform functions on our behalf) (e.g., to
install a new computer system) provided they agree to safeguard the information.
- Substance Abuse Information. Alcohol and drug abuse information has special privacy protections.
The Clinic will not disclose any information identifying an individual as being a substance abuse
patient or provide any medical information relating to the patient’s substance abuse treatment
unless:
a. The patient consents in writing;
b. a court order requires disclosure of the information;
c. medical personnel need the information to meet a medical emergency;
d. qualified personnel use the information for the purpose of conducting scientific research,
management audits, financial audits, or program evaluation; or
e. it is necessary to report a crime or a threat to commit a crime, or to report abuse or neglect
as required by law. - Your Authorization Is Required for Other Uses and Disclosures. Except as described above, we will
not use or disclose your medical information unless you authorize (permit) the Clinic in writing to use or
disclose your information. Subject to compliance with limited exceptions, we will not sue or disclose
psychotherapy notes, use or disclose your health information for marketing purposes or sell your health
information, unless you have signed an authorization. You may revoke your authorization, and thereby stop
any future uses and disclosures, by notifying us in writing. - Your Medical Information Rights. You have the following rights regarding your medical information,
provided that you make a written request to invoke the right on the form provided by the Clinic:
a. Right to request restriction. You may request limitations on how we use or
disclose your medical information for health care treatment, payment, or
operations (e.g., you may ask us not to disclose that you have had a particular
surgery). We are not required to agree to your request, except for requests to
restrict disclosures to a health plan for purposes of payment or health care
operations when you have paid in full out-of-pocketforthe item or service
covered by the request and when the disclosure is not required by law. If we
agree, we will comply with your request unless the information is needed to
provide you with emergency treatment.
b. Right to confidential communications. You may request communications in a
certain way or at a certain location, but you must specify how or where you wish
to be contacted and how payment will be handled.
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c. Right to inspect and copy. You have the right to look at and obtain a copy of
your medical records, billing records, and other records used to make decisions
about your care. We may charge you a fee for our postage and labor costs and
supplies to create the copy. Under limited circumstances, your request may be
denied and you may request review of the denial by another licensed health care
professional chosen by the Clinic. The Clinic will comply with the outcome of the
review. If your information is stored electronically and you request an electronic
copy, we will provide it to you in a readable electronic format.
d. Right to request amendment. If you believe that the medical information we
have about you is incorrect or incomplete, you have the right to request that your
records be amended. Under limited circumstances, the Clinic may deny your
request for amendment. If denied, you will receive an explanation for the
decision and information explaining your options.
e. Right to accounting of disclosures. You may request a list of instances where
we have disclosed your medical information for certain types of disclosures. The
accounting will not include disclosures that we are not required to record, such
as disclosures made pursuant to an authorization. The first accounting you
request within a 12-month period is free, but we will charge a fee for any
additional lists requested within the same 12-month period.
f. Right to a copy of this Notice. You may request a paper copy of this Notice at any
time, even if you have been provided with an electronic copy. You may obtain an
electronic copy of this Notice at our website:
http://www.nativewoundtherapy.com.
- Other Obligations. The Clinic is required by law to provide you with this Notice. We will be governed
by this Notice for as long as it is in effect and are also required to comply with any federal or state laws
that impose stricter standards than those described in this Notice. The Clinic may change this Notice
at any time, and these changes will be effective for medical information we have about you as well as
any information we receive in the future. We will post a copy of the current notice in the Clinic and on
our website. You may also get a current copy by contacting our Privacy Officer at the phone number
at the end of the Notice. We are required by law to notify affected individuals following a breach of
unsecured medical information. - Complaints. If you believe your privacy rights have been violated, you may file a complaint with the
Clinic or with the Secretary of the United States Department of Health and Human Services. You will not
be penalized or retaliated against in any way for making a complaint to the Clinic or the Department of
Health and Human Services.
Contact the Clinic’s Privacy officer at 918.600.2701 or compliance@nativewoundtherapy.com if:
a. You have a complaint;
b. You have any questions about this Notice; or
c. You wish to obtain a form to exercise your individual rights described in section 7 of this
Notice.
