Notice of Privacy Practices

Privacy of Patient Records

Confidentiality of patient health information is a value we are committed to. Upon your first visit to our clinics you will be presented with our privacy practices. If you have additional questions you may speak to our Health Information Manager.

Western Wisconsin Medical Associates, S.C.
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.  PLEASE REVIEW IT CAREFULLY.

Introduction

        Federal and state laws require Western Wisconsin Medical Associates, S.C. (WWMA) to protect your medical information, and federal law requires WWMA to describe to you how we handle that information.  When state and federal privacy laws differ, and Wisconsin law is more protective of your information or provides you with greater access to your information, then Wisconsin law will override federal law.  The federal government defines protected health information (PHI) as any information, whether written, oral or electronic, which is received or created by WWMA and relates to a patients health care or payment for the provision of health care.  This includes the results of tests and notes written by doctors and nurses, as well as your name, address and telephone number.  This Notice of Privacy Practices explains how WWMA may use and disclose your PHI.  It also explains your rights regarding this kind of information.  WWMA will follow the rules of its Notice of Privacy Policies currently in effect.

WWMA makes every effort to maintain
the confidentiality of medical information.

 Your PHI will be used and disclosed for the following purposes:  

• Treatment:  We may use your PHI, without your permission, to provide, coordinate, and manage your care and treatment.  We may disclose your PHI, without your permission, to a physician or other health care provider for your treatment.  For example, a WWMA physician may share your PHI with another physician for a consultation or a referral.

• Payment:  We may use and disclose your PHI, without your permission, to receive payment for the services we provide.  For example, we will disclose information in order to submit bills or claims to insurance companies and/or Medicare or Medicaid, or to obtain approval from your health plan before providing services.  We may need your written permission to disclose information taken from your mental health treatment records or HIV test results for payment purposes.

• Health Care Operations:  We may use your PHI, without your permission, for certain activities related to the functioning of our business operations.  For example, we may use or disclose information for quality assurance activities, training or performance reviews, legal services, auditing, underwriting, and other business management and administrative activities.

• Appointment Reminders and Other Information:  We may use your information to send you reminders about future appointments or test results.  We may also use your information to provide you with information about new or alternative treatments or other health care services.  We will contact you at the address, telephone number, fax number, email address you provide to us.  If you prefer to be contacted at a different address or telephone number, or if you prefer not to receive certain materials, please contact the HIS Department Manager identified below.

• Family Members or Caretakers:  Unless you object, we may disclose your PHI to people involved in your care, such as family members or caretakers.  We will only disclose medical information that we reasonably believe these people need to know.  We may also use your medical information to let family members or other responsible people know where you are and what your general medical condition is.  If you are able to make your own health care decisions, we will ask your permission before using your medical information for these purposes, unless we infer from the circumstances that you do not object (for example, if you allow a family member to accompany you during an examination or treatment, we will assume that you do not object to that family member having access to PHI that may be disclosed during the examination or treatment).  If you are unable to make health care decisions, we will disclose relevant medical information to family members or other responsible people if we feel it is in your best interest to do so.  For example, we may provide limited medical information to allow a family member to pick up a prescription or x-ray for you.
• Uses or Disclosures of PHI Without Your Authorization or Agreement:  In the following circumstances, we may use or disclose your PHI without first obtaining your authorization or agreement regarding the use or disclosure, to the extent permitted or required by law:

-          Under emergency conditions, to government or other groups assisting in emergencies or disasters;

-       When required by law;

-          For public health activities, including, without limitation, to report disease and vital statistics, child abuse, and adult abuse or neglect or domestic violence;

-          For health oversight activities, such as activities of state licensing and peer review authorities, and fraud prevention enforcement agencies (Wisconsin law allows private pay patients, except residents of nursing homes, to deny access to ceratin health oversight agencies by annually submitting a signed, written request on the appropriate form.);

-          For judicial and administrative proceedings;

-          For organ donation and procurement purposes;

-          To coroners, medical examiners and funeral directors.

-          To avert a serious threat to health or safety;

-          To law enforcement officials with regard to crime victims, crimes on our premises, crime reporting in emergencies, and identifying and locating suspects or other persons;

-          For certain specialized government functions, such as military discharge;

-          To the military, to federal officials for lawful intelligence, counterintelligence, national security activities, and to correctional institutions and law enforcement regarding persons in lawful custody; and

-          As authorized by the states workers compensation laws.  

We may not disclose HIV test results, serving confidential medical information or mental health treatment records for certain of these purposes without your written permission, unless required by law.  Your HIV test results, if any, may be disclosed as set forth in Wisconsin Statutes § 252.15(5)(a).  

• Research:  We may disclose your PHI for certain types of research studies that have been approved by an Institutional Review Board or a Privacy Board as appropriately protective of your privacy rights as otherwise permitted by Wisconsin law.  Under certain conditions permitted by Wisconsin law, we may also disclose your PHI to researchers preparing to begin a research study, or to researchers using information about deceased people.

We will not use or disclose your PHI in other ways unless you authorize us to do so in writing.  If you do give us permission to use or disclose your medical information for another purpose, you have the right to change your mind and revoke the permission at any time.  If you provide us with this written authorization to use or disclose medical information about you, you may revoke that authorization, in writing, at any time.  If you revoke your authorization, we will no longer use or disclose medical information about you for the reasons covered by your written authorization, except to the extent we have already relied on your authorization.  We are unable to take back any disclosures we have already made with your permission, and we are required to retain our records of the care that we provided to you.

  Minors:

State laws allow minors to keep some records confidential from parents or guardians in certain cases.  In most of these cases, minors are responsible for payment for the services and products related to those records.  If a minor chooses to use his or her parents insurance or payment information, WWMA cannot assure that the records will be kept confidential.  In addition, we are permitted in some cases to inform the parent of legal guardian of the minor patient of any treatment given or needed where, in the judgment of the physician, failure to inform the parent or guardian would seriously jeopardize the health of the minor patient.  Minors must notify WWMA in situations where the minor believes the information should be kept confidential so that WWMA can make a determination about whether the information must be shared with a parent or guardian.

 Your privacy rights:  

• You may request restrictions on the ways we use your PHI or on the purposes for which we use your PHI.  You may also request that we not provide your medical information to certain people.  We have the right to refuse your request, and we may use or disclose your PHI in situations requiring emergency treatment, in which case we will ask the person(s) who receive the information not to further use or disclose the information.  Your request for a restriction must be made in writing to the HIS Department Manager identified below.

• You may request that we communicate with you in a confidential manner.  For example, you can request that we send your appointment reminders, bills, and other mailings to a different address or that we notify you of this kind of information in another way, such as by a phone call.  You must make this request in writing to the HIS Department Manager identified below and specify another address or means of communication.  We will not ask you the reason for your request.  We will accommodate all reasonable requests.

• You may request access to your PHI to inspect and copy the information, except for information to which your access is prohibited by law.  You must make these requests in writing to the HIS Department Manager identified below.  We will act upon your request within 30 days, and we may charge you a legally acceptable amount for copying costs.  For more information about our copying fees, please contact the HIS Department Manager identified below.

• You may request an amendment to information in your medical records.  You must make this request in writing to the HIS Department Manager identified below.  If your request is denied, you can write a statement of disagreement with the denial that we will keep with your medical information.

• You may ask us to provide you with information about certain disclosures of your PHI made by us.  You may request an accounting of disclosures made in the past six years, but this accounting will only cover disclosures made after April 14, 2003 .  If you request this accounting more than once in a 12-month period, we may charge you a reasonable, cost-based fee for responding to your additional request.  You must make this request in writing to the HIS Department Manager identified below.

QUESTIONS AND COMPLAINTS  

• If you feel your medical information privacy rights have been violated, you may file a complaint with the Secretary of Health and Human Services, 200 Independence Avenue, SW , Room 509F, Washington , DC 20201 .  You may also contact the Office of Civil Rights Hotline at 1-800-368-1019.  You may also file a complaint with the HIS Department Manager listed below.  Filing a complaint will not affect the quality of the services you receive from us and you will not be retaliated against for filing a complaint.

• You can contact our HIS Department Manager by writing to 403 Stageline Road , Hudson , WI 54016 .

 The effective date of this notice is April 14, 2003 .  We are required by law to maintain the privacy of PHI and to provide individuals with this notice of its legal duties and privacy practices with respect to health information.  We are required to abide by the terms of the notice currently in effect.  WE RESERVE THE RIGHT TO CHANGE THE TERMS OF THIS NOTICE AND TO DEVELOP NEW TERMS EFFECTIVE FOR ALL PHI MAINTAINED BY US.  If the terms of this notice are changed, we will provide individuals with a revised notice upon request and by posting the revised notice in designated locations at near our registration desk.

 If you have received this Notice of Privacy Practices electronically, you may ask us to provide you with a paper copy.  This notice is also available at our website http://www.wwma.org.