Phone: (405) 278-7911
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
The Health Insurance Portability & Accountability Act of 1996 ("HIPAA") is a Federal program that requests that all medical records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper, or orally are kept properly confidential. This Act gives you, the patient, the right to understand and control how your Protected Health Information ("PHI"), Individually Identifiable Health Information (IIHI) is used. HIPAA provides penalties for covered entities that misuse personal health information.
Our Legal Duty
We are required by applicable federal and state laws to maintain the privacy of your protected health information. We are also required to give you this notice about our privacy practices, our legal duties, and your rights concerning your protected health information. We must follow the privacy practices that are described in this notice while it is in effect. This notice takes effect April 14, 2003, and will remain in effect until we replace it.
We realize that these laws are complicated, but we must provide you with the following important information: How we may use and disclose your PHI/ IIHI, your privacy rights in your PHI/IIHI, our obligations concerning the use and disclosure of your PHI/IIHIAs required by HIPAA, we prepared this explanation of how we are to maintain the privacy of your health information and how we may disclose your personal information. This notice is effective as of September 01, 2013 and it is our intention to abide by the terms of the Notice of Privacy Practices and HIPAA Regulations currently in effect. We reserve the right to revise and amend the terms of our Notice of Privacy Practice and to make the new notice provision effective for all PHI/IIHI that we maintain. We will post a copy and you may request a written copy of the revised Notice of Privacy Practice from our office. Any revision or amendments to this notice will be effective for all of your records that our practice has created or maintained in the past, and for any of your records that we may create or maintain in the future. Our practice will post a copy of our current Notice in our offices in a visible location at all times, and you may request a copy of our most current Notice at any time.
We may use and disclose your medical records only for each of the following purposes: treatment, payment and health care operation, and law enforcement.
Treatment: We will use and disclose your protected health information to provide, coordinate or manage your healthcare and any related services. This includes the coordination or management of your health care with a third party. For example, we would disclose your protected health information, as necessary, to a home health agency that provides care to you. We will also disclose protected health information to other physicians who may be treating you. For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.
Health Care Operations: We may use or disclose, as needed, your protected health information in order to conduct certain business and operational activities. These activities include, but are not limited to, quality assessment activities, employee review activities, arranging and/or conducting other business activities.
For example, we may use a sign-in sheet at the registration desk where you will be asked to sign your name. We may also call you by name in the waiting room when the doctor is ready to see you. We may contact you, by phone or in writing, to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you. You do have the right to "opt out" with respect to receiving fundraising communications from us.
Payment: Payment means such activities as obtaining reimbursement for services, confirming coverage, billing or collections activities, and utilization review. An example of this would include sending your insurance company a bill for your visit and/or verifying coverage prior to a surgery. If you have paid for services "out of pocket", in full and in advance, and you request that we not disclose PHI/IIHI related solely to those services to a health plan, we will accommodate your request, except where we are required by law to make a disclosure.
Criminal Activity: Consistent with applicable federal and state laws, we may disclose your protected health information, if we believe 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 protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual. However, we shall do our best to assure its continued confidentiality to the extent possible.
Health Oversight: We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, or investigations. Oversight agencies seeking this information may include government agencies that oversee the health care system, government benefit programs, and other government regulatory programs and civil rights laws.
Unless you object, we may disclose to a member of your family, or any other person you identify, your protected health information that directly relates to that person's involvement 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 use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death. We may also use and disclose your protected health information for other marketing activities. For example, your name and address may be used to send you a newsletter about our practice and the services we offer. We may also send you information about products or services that we believe may be beneficial to you.
You may revoke such authorization in writing and we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your prior authorization.
You may have the following rights with respect to your PHI/IIHI:
• The right to request restrictions on certain uses and disclosures of PHI/IIHI, including those related to disclosures of family members, other relatives, close personal friends, or any other person identified by you. We are, however, not required to honor a request restriction except in limited circumstances which we shall explain if you ask. If we do agree to the restriction, we must abide by it unless you agree in writing to remove it.
• The right to reasonable requests to receive confidential communications of Protected Health Information by alternative means or at alternative locations.
• The right to inspect and copy your PHI/IIHI.
• The right to amend your PHI/IIHI.
• The right to receive an accounting of disclosures of your PHI/IIHI.
• The right to obtain a paper copy of this notice from us upon request.
• The right to be advised if your unprotected PHI/IIHI is intentionally or unintentionally disclosed.
You have recourse if you feel that your protection has been violated by our office. You have the right to file a formal, written complaint with the practice and with the Department of Health and Human Services, Office of Civil Rights. We will not retaliate against you for filing a complaint.
Feel free to contact the Practice Compliance Officer (Cynthia Wiley @ 405-278-7911, Ext. 306) for more information, in person or in writing.
I am consenting that I am a patient (or guarantor to patient) of Dr. Clarence L. Wiley, Sr., and I also hereby acknowledge receipt of Notice of Privacy Practices. I consent to BTHD’s use and disclosure of my PHI/IIHI to carry out treatment, payment, and healthcare operations. I may revoke my consent in writing except to the extent that the practice has already made disclosures in reliance upon my prior consent.
It is up to you whether or not you use the Website. If you do not agree with our policies and practices, please do not use the Website. By accessing or using the Website, you are agreeing to this Policy.
Information You Provide to Us. The information we collect on or through the Website may include information that you provide by filling in forms on the Website, posting material (including comments or questions), records and copies of your correspondence (includes email addresses) if you contact us.
The personally identifiable information that we collect about you is information that you give to us, such as a request for a newsletter, or posting a question.
Use or Disclosure of Information
Our customers are very important to us and we do not sell our customer information. We may use the information that we collect or that you provide to us for such purposes as to respond to your requests and respond to your email.
We may use your information to send you information or offers about our goods and services, or about the goods and services of third parties, that may be of interest to you. If we send you information about third-party goods or services, that notification is done on behalf of those businesses. We do not give those businesses your contact information. If you do not want to receive email messages regarding promotions, please call our office @ 405-278-7911 to request that you do not wish to receive such emails.
We may also disclose your personal information to comply with any court order, law or legal process, including any government or regulatory request; in connection with a copyright infringement claim related to content you have posted or submitted to the Website; or if we believe disclosure is necessary or appropriate to protect the rights, property or safety of the Company, our customers or others. This may include exchanging information with other companies and organizations for the purposes of fraud protection.
We use Secure Sockets Layer (SSL) software, which encrypts information, to protect the security of your information during transmission. Unfortunately, the transmission of information via the Internet is not completely secure. Although we do our best to protect your personal information, we cannot guarantee that transmissions made on or through the Internet are secure.
The Website is intended for adults only. We do not knowingly collect information from children under thirteen (13).
If the Website provides links to or from third-party sites, we encourage you to check the privacy policies of those other sites. Those other sites may collect information from you automatically or you may be asked to give information to the owners of those sites. This Policy only applies to the Website. We are not responsible for the policies or practices of third-party sites that may link from or to the Website.