Privacy Policy
PLEASE REVIEW THIS NOTICE CAREFULLY.
A. OUR COMMITMENT TO YOUR PRIVACY
DR. CRAIG J. DONNELLY, LLC / DBA: MEDICAL MASSAGE CENTER OF CHARLESTON
is dedicated to maintaining the privacy of your individually
identifiable health information ( IIHI ). In conducting our business,
we will create records regarding you and the treatment, information
and services we provide to you or your dependants. We are required by
law to maintain the confidentiality of health information that
identifies you and your dependants. We also are required by law to
provide you with this notice of our legal duties and the privacy
practices that we maintain in our practice concerning your IIHI. By
federal and state law, we must follow the terms of the notice of
privacy practices that we have in effect at the time. We realize that
these laws are complicated, but we must provide you with the following
important information:
How we may use and disclose your IIHI
Your privacy rights in regard to your IIHI
Our obligations concerning the use and disclosure of your IIHI
The terms of this notice apply to all records containing your IIHI
that are created or retained by our practice. We reserve the right to
revise or amend this Notice of Privacy Policy. Any revision or
amendment 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. This webpage
http://www.medicalmassagecharleston.com/privacy_policy.html will
always contain the current version of our privacy policy.
B. IF YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT IN WRITING
OUR
PRIVAY OFFICER Dr. Craig Donnelly DC, 49 Calhoun Street, Suite B,
Charleston, SC 29401.
C. WE MAY USE AND DISCLOSE YOUR INDIVIDUALLY IDENTIFIABLE HEALTH
INFORMATION ( IHII ) IN THE FOLLOWING WAYS
1. Treatment. Our practice may use your IIHI to treat you. For
example, we may ask you to have laboratory tests (such as blood or
urine tests), and we may use the results to help us reach a diagnosis.
Many of the people who work for our practice, including, but not
limited to, our chiropractors, licensed massage therapists may use or
disclose your IIHI in order to treat you or to assist others in your
treatment. Additionally, we may disclose your IIHI to others who may
assist in your care, such as your spouse, children or parents. Policy
will be Effective as of April 1, 2003
2. Payment. Our practice may use and disclose your IIHI in order to
bill and collect payment for the services and items you may receive
from us. For example, we may contact your health insurer to certify
that you are eligible for benefits (and for what range of benefits),
and we may provide your insurer with details regarding your treatment
to determine if your insurer will cover, or pay for, your treatment.
We also may use and disclose your IIHI to obtain payment from third
parties that may be responsible for such costs, such as family
members. Also, we may use your IIHI to bill you directly for services
and items.
3. Health Care Operations. Our practice may use and disclose your IIHI
to operate our business. As examples of the ways in which we may use
and disclose your information for our operations, our practice may use
your IIHI to evaluate the quality of care you received from us, or to
conduct cost-management and business planning activities for our
practice.
4. Appointment Reminders. Our practice may use and disclose your IIHI
to contact you and remind you of an appointment.
5. Treatment Options. Our practice may use and disclose your IIHI to
inform you of potential treatment options or alternatives.
6. Health-Related Benefits and Services. Our practice may use and
disclose your IIHI to inform you of health-related benefits or
services that may be of interest to you.
7. Release of Information to Family /Friends. Our practice may release
your IIHI to a friend or family member that is involved in your care,
or who assists in taking care of you. For example, a parent or
guardian may ask that a babysitter take their child to the
pediatrician's office for treatment of a cold. In this example, the
babysitter may have access to this child's medical information.
8. Disclosures Required By Law . Our practice will use and disclose
your IIHI when we are required to do so by federal, state or local
law.
D. WE MAY USE AND DISCLOSE YOUR INDIVIDUALLY IDENTIFIABLE HEALTH
INFORMATION ( IIHI ) IN CERTAIN SPECIAL CIRCUMSTANCES
1. Public Health Risks. Our practice may disclose your IIHI to public
health authorities that are authorized by law to collect information
for the purpose of:
· maintaining vital records, such as births and deaths
· reporting child abuse or neglect
· preventing or controlling disease, injury or disability
· notifying a person regarding potential exposure to a communicable
disease
· notifying a person regarding a potential risk for spreading or
contracting a disease or condition
· reporting reactions to drugs or problems with products or devices
· notifying individuals if a product or device they may be using has
been recalled
· notifying appropriate government agency( ies) and authority( ies)
regarding the potential abuse or neglect of an adult patient
(including domestic violence); however, we will only disclose this
information if the patient agrees or we are required or authorized by
law to disclose this
information
· notifying your employer under limited circumstances related
primarily to workplace injury or
illness or medical surveillance.
2. Health Oversight Activities. Our practice may disclose your IIHI to
a health oversight agency for activities authorized by law. Oversight
activities can include, for example, investigations, inspections,
audits, surveys, licensure and disciplinary actions; civil,
administrative, and criminal procedures or actions; or other
activities necessary for the government to monitor government
programs, compliance with civil rights laws and the health care system
in general.
3. Lawsuits and Similar Proceedings. Our practice may use and disclose
your IIHI in response to a court or administrative order, if you are
involved in a lawsuit or similar proceeding. We also may disclose your
IIHI in response to a discovery request, subpoena, or other lawful
process by another party involved in the dispute, but only if we have
made an effort to inform you of the request or to obtain an order
protecting the information the party has requested.
4. Law Enforcement. We may release IIHI if asked to do so by a law
enforcement official:
· Regarding a crime victim in certain situations, if we are unable to
obtain the person's agreement
· Concerning a death we believe has resulted from criminal conduct
· Regarding criminal conduct at our offices
· In response to a warrant, summons, court order, subpoena or similar
legal process
· To identify/locate a suspect, material witness, fugitive or missing
person
· In an emergency, to report a crime (including the location or
victim(s) of the crime, or the
description, identity or location of the perpetrator).
5. Deceased Patients. Our practice may release IIHI to a medical
examiner or coroner to identify a deceased individual or to identify
the cause of death. If necessary, we also may release information in
order for funeral directors to perform their jobs.
6. Organ and Tissue Donation Our practice may release your IIHI to
organizations that handle organ, eye or tissue procurement or
transplantation, including organ donation banks, as necessary to
facilitate organ or tissue donation and transplantation if you are an
organ donor.
7. Research. Our practice may use and disclose your IIHI for research
purposes in certain limited circumstances. We will obtain your written
authorization to use your IIHI for research purposes except when: (a)
our use or disclosure was approved by an Institutional Review Board or
a Privacy Board; (b) we obtain the oral or written agreement of a
researcher that (i) the information being sought is necessary for the
research study; (ii) the use or disclosure of your IIHI is being used
only for the research and (iii) the researcher will not remove any of
your IIHI from our practice; or (c) the IIHI sought by the researcher
only relates to decedents and the researcher agrees either orally or
in writing that the use or disclosure is necessary for the research
and, if we request it, to provide us with proof of death prior to
access to the IIHI of the decedents.
8. Serious Threats to Health or Safety. Our practice may use and
disclose your IIHI when necessary to reduce or prevent a serious
threat to you or your child’s health and safety or the health and
safety of another individual or the public. Under these circumstances,
we will only make disclosures to a person or organization able to help
prevent the threat.
9. Military. Our practice may disclose your IIHI if you are a member
of U.S. or foreign military forces (including veterans) and if
required by the appropriate authorities.
10. National Security. Our practice may disclose your IIHI to federal
officials for intelligence and national security activities authorized
by law. We also may disclose your IIHI to federal officials in order
to protect the President, other officials or foreign heads of state,
or to conduct investigations.
11. Inmates. Our practice may disclose your IHII to correctional
institutions or law enforcement officials if you are an inmate or
under the custody of a law enforcement official. Disclosure for these
purposes would be necessary: (a) for the institution to provide health
care services to you, (b) for the safety and security of the
institution, and/or (c) to protect your health and safety or the
health and safety of other individuals.
12. Workers' Compensation Our practice may release your IIHI for
workers' compensation and similar programs.
E. YOUR RIGHTS REGARDING YOUR INDIVIDUALLY IDENTIFIABLE HEALTH
INFORMATION ( IIHI )
1. Confidential Communications. You have the right to request that our
practice communicate with you about your health and related issues in
a particular manner or at a certain location. For instance, you may
ask that we contact you at home, rather than work. In order to request
a type of confidential communication, you must make a written request
to Dr. Craig Donnelly DC, 49 Calhoun Street, Suite B, Charleston, SC
2940, Ph. 843.579.9166 specifying the requested method of contact, or
the location where you wish to be contacted. Our practice will
accommodate reasonable requests. You do not need to give a reason for
your request.
2. Requesting Restrictions. You have the right to request a
restriction in our use or disclosure of your IIHI for treatment,
payment or health care operations. Additionally, you have the right to
request that we restrict our disclosure of your IIHI to only certain
individuals involved in your care or the payment for your care, such
as family members and friends. We are not required to agree to your
request; however, if we do agree, we are bound by our agreement except
when otherwise required by law, in emergencies, or when the
information is necessary to treat you. In order to request a
restriction in our use or disclosure of your IIHI, you must make your
request in writing to Dr. Craig Donnelly DC, 49 Calhoun Street, Suite
B, Charleston, SC 29401. Your request must describe in a clear and
concise fashion:
(a) the information you wish restricted
(b) whether you are requesting to limit our practice's use, disclosure
or both and
(c) to whom you want the limits to apply.
3. Inspection and Copies. You have the right to inspect and obtain a
copy of the IIHI that may be used to make decisions about you or your
child, including patient medical records and billing records, but not
including psychotherapy notes. You must submit your request in writing
to Dr. Craig Donnelly DC, 49 Calhoun Street, Suite B, Charleston, SC
29401, in order to inspect and/or obtain a copy of your IIHI. Our
practice may charge a fee for the costs of copying, mailing, labor and
supplies associated with your request. Our practice may deny your
request to inspect and/or copy in certain limited circumstances;
however, you may request a review of our denial. Another licensed
health care professional chosen by us will conduct reviews.
4. Amendment. You may ask us to amend your health information if you
believe it is incorrect or
incomplete, and you may request an amendment for as long as the
information is kept by or for our practice. To request an amendment,
your request must be made in writing and submitted to Dr. Craig
Donnelly DC, 49 Calhoun Street, Suite B, Charleston, SC 29401. You
must provide us with a reason that supports your request for
amendment. Our practice will deny your request if you fail to submit
your request (and the reason supporting your
request) in writing. Also, we may deny your request if you ask us to
amend information that is in our opinion: (a) accurate and complete;
(b) not part of the IHII kept by or for the practice; (c) not part of
the IIHI which you would be permitted to inspect and copy; or (d) not
created by our practice, unless the individual or entity that created
the information is not available to amend the information.
5. Accounting of Disclosures. All of our patients have the right to
request an "accounting of
disclosures." An "accounting of disclosures" is a list of certain
non-routine disclosures our
practice has made of your IHII for non-treatment or operations
purposes. Use of your IIHI as
part of the routine patient care in our practice is not required to be
documented. For example, the doctor, chiropractor or therapist sharing
information with the nurse; or the billing department using your
information to file your insurance claim. In order to obtain an
accounting of disclosures, you must submit your request in writing to
our Privacy Officer. All requests for an '"accounting of disclosures"
must state a time period, which may not be longer than six (6) years
from the date of disclosure and may not include dates before April 14,
2003. The
first list you request within a 12-month period is free of charge, but
our practice may charge you for additional lists within the same
12-month period. Our practice will notify you of the costs involved
with additional requests, and you may withdraw your request before you
incur any costs.
6. Right to a Paper Copy of This Notice. You are entitled to receive a
paper copy of our notice of privacy practices / policy. You may ask us
to give you a copy of this notice at any time. To obtain a paper copy
of this notice, contact Dr. Craig Donnelly DC, 49 Calhoun Street,
Suite B, Charleston, SC 29401 .
7. Right to File a Complaint. If you believe your privacy rights have
been violated, you may file a
complaint with our practice or with the Secretary of the Department of
Health and Human Services. To file a complaint with our practice,
contact [insert the name, title, and phone number of the contact
person or office responsible for handling complaints]. All complaints
must be submitted in writing. You will not be penalized for filing a
complaint.
8. Right to Provide an Authorization for Other Uses and Disclosures.
Our practice will obtain your written authorization for uses and
disclosures that are not identified by this notice or permitted by
applicable law. Any authorization you provide to us regarding the use
and disclosure of your IIHI may be revoked at any time in writing.
After you revoke your authorization, we will no longer use or disclose
your IIHI for the reasons described in the authorization. Please note,
we are required to retain records of your care.
If you have any questions regarding this notice or our health
information privacy policies, please contact our Privacy Officer:
Dr. Craig Donnelly DC
49 Calhoun Street, Suite B
Charleston, SC 2940
