About this Notice
Integrative Pain Center of Alaska, LLC is dedicated to maintain the privacy of your Protected Health Information (PHI). IPCA provides health care items and services through its schools of medicine, nursing and allied health services. IPCA provides services at its main community hospitals, primary care specialty clinics, pharmacies, research units and several community service outreach centers throughout Alaska. IPCA is required by law to maintain the privacy of your PHI and provide you with notice of its legal duties and privacy practices. This notice of privacy practices describes how IPCA may use or disclose your PHI. PHI includes any information that relates to (1) your past, present or future physical or mental health or condition; (2) providing health care to you; (3) the past, present, or future payment for your healthcare. This notice also tells you about your privacy rights and IPCA’s legal duties with respect to your PHI. The terms of notice shall apply to IPCA’s privacy practices until it is changed by IPCA.
CHANGE IN NOTICE OF PRIVACY PRACTICES
IPCA reserves the right to change this notice of privacy practices at anytime. Any changes will apply to all PHI that IPCA created or maintained for you. If this notice changed, it will be posted at our clinics and on our webpage (www.alaskapaincenter.com) and you can request a copy of this notice. IPCA PERMITTED USES AND DISCLOSURES OF PHI FOR TREATMENT, PAYMENT AND HEALTHCARE OPERATION.IPCA may use or disclose your PHI without your written authorization for the following:
Your PHI may be used and disclosed to provide, coordinate or manage your healthcare and related services. This may include talking with other health care providers about your treatment or coordination and managing your healthcare with others. For example, when your family physican refers you to another doctor your family physician may tell the other doctor about any drug allergies you may have so the other doctor can diagnose or treat you
Your PHI may be used and disclosed to obtain payment for your health care services. For example, IPCA may share your PHI with your health insurance plan for payment of health care items or services provide to you.
HEALTH CARE OPERATIONS
Your PHI may be used and disclosed to support our business activities. These include, but are not limited to, quality evaluation, work force reviews, education and training of students and physicians in training, licensing and conducting or arranging for other business activities. For example, IPCAmay use your PHI to evaluate the performance of our staff in caring for you.
OTHER USES AND DISCLOSURES OPPORTUNITY FOR YOU TO AGREE OR OBJECT IPCA MAY USE OR DISCLOSE YOU PHI WITHOUT YOUR AUTHORIZATION FOR THE FOLLOWING PURPOSE UNLESS YOU OBJECT:
- INVOLVEMENT IN PATIENT CARE AND NOTIFICATION PURPOSE - to a family member, other relative, close personal friend or other person you have identified as involved with your treatment or payment for healthcare services. We may also use your PHI to notify or assist in notifying such persons of your location or health.
- DISASTER RELIEF EFFORTS - To public or private relife agencies to assist in disaster relief efforts.
- APPOINTMENT REMINDERS - We may contact you to remind you for your healthcare appointments or to provide you with information about treatment alternatives or other health related benefits and services that may be of interested to you.
USES AND DISCLOSURES OF PHI WITHOUT YOUR WITTEN AUTHORIZATION OR OPPORTUNITY TO AGREE OR OBJECT. IPCA MAY BE ALLOWED OR REQUIRED TO USE OR DISCLOSE YOUR PHI WITHOUT YOUR AUTHORIZATION OR OPPORTUNITY FOR YOU TO AGREE OR OBJECT FOR THE FOLLOWING REASONS:
- REQUIRED OR AUTHORIZED BY LAW - As required by federal, state or local law. Any disclosure must comply with the law and is limited to the requirements of the law.
- PUBLIC HEALTH ACTIVITIES - to public health authorities or other authorized persons to carry out certain public health activities, including the following:
– to report, prevent or control disease, injury or disability;
– to report vital statistics, such as birth and death;
– to report child abuse or neglect;
– to report bad reactions to medications or problems with products or devices regulated by the food and drug administration;
– to locate and notify you of recalls or producs you may be using;
– to notify a person who may have been exposed to a contagious disease in order to control who may be at risk of contracting or spreading the disease; or
– to report to your employer, under limited circumstances, information related primarily to workplace injuries or illness, or workplace medical surveillance.
- ABUSE, NEGLECT, OR DOMESTIC VIOLENCE - in certain cases to proper goverment authorities if we have reason to believe that you have been the victim of domestic violence, abuse or neglect.
- HEALTH OVERSIGHT ACTIVITIES - to a health oversight agency for oversight activities authorized by law such as audits, investigations, inspections and licensure activities or as necessary for certain goverment agencies to monitor the Healthcare system, goverment programs and compliance with civil laws.
- JUDICAL, ADMINISTRATIVE AND LAW ENFORCEMENT PURPOSE - Where requested by law enforcement, and as authorized or required by law, we may disclosure your PHI:
– in response to a court order, subpoena, warrant, summons or similar process;
– in response to requests fo limited information necessary to identify or locate a suspect, fugitive, material witness or missing person;
– if we suspect that you are a victim of a crime and if you agree to the disclosure, or under certain circumstances, where we are unable to obtain your permission;
– about your death if we suspect it is a result of criminal conduct;
– about criminal conduct that occurs at IPCA; and
– in emergency circumstances to report a crime; the location of the crime or victims; or the identity, describtion of the person who committed the crime.
OTHER USES AND DISCLOSURES CONTINUED
DECEDENTS - to a coroner or a medical examiner to identify you and determine the cause of your death in addition, we may disclose your PHI to funeral directors, as authorizedby law, so that they may do their jobs.
- ORGANISATIONS THAT OBTAIN ORGANS - If you are a organ donor, after your death we may use or disclose your PHI to organizations that help get, locate, store and transplant organs to help with organ, eye or tissue donation and transplantation.
- RESEARCH - For research purposes under certain limited circumstances. We must obtain a written authorization to use and disclose PHI about you for research purpose except in situations where a research project meets specific, detailed criteria established by the HIPAA privacy rule.
-TO STOP A SERIOUS THREAT TO HEALTH OR SAFETY - In limited circumstances when necessary to help stop a threat to the health or safety of a person or the public. This disclosure can be made only to a person who is able to help stop the threat.
-NATIONAL SECURITY; INTELLIGENCE ACTIVITIES; AND PROTECTIVE SERVICES – To federal officials for intelligence, counterintelligence, and other national security activities authorized by law, including activities related to the protection of the President, other authorized persons or foreign heads of state , or related to the conduct of special investigations.
-CORRECTIONAL INSTITUTIONS - Of inmates or other individuals under lawful custody to a correctional institution or law enforcement officer for the provision of healthcare, health and safety matters, law enforcement purposes or security of correctional institution.
-WORKER’S COMPENSATION- To comply with worker’s compensation programs or other similar programs that provide benefits for workrelated injuries or illness without regard to fault.
-LIMITED DATA SET – We may use and disclose limkted PHI that does not fully identify you only for purposes of reach, public health or health care operations.
- PARENTAL ACCESS – To your parents or legal guardian if you are under the age of 18,unless it is prohibited by Alaska law. Other than the categories mentioned above, IPCA will not disclose your PHI without your written authorization. You may revoke your written authorization at any time in writing; however, your written revocation will only apply to PHI that has not already been used or disclosed by IPCA under your written authorization.
- YOUR PRIVACY RIGHTS-RIGHTS TO INSPECT AND COPY - You have the right to inspect and request a copy of your PHI that is in a designated record set. This includes your insurance and billing records but not counseling notes of a mental health professional, information preparedby or for our attorneys to defend IPCA, or where prohibited by law. You may be charged a reasonable fee to obtain a copy of your PHI, IPCA reserves the right to deny your request to access or receive a copy of your PHI as provided by law. All requests must be in writing using the IPCA authorization for release of patient information form.
- RIGHT TO REQUEST RESTRICTIONS - You have the right to request IPCA limits its use or disclosureof your PHI for treatment, payment or healthcare operations. You may also request that IPCA limit its disclosure of your PHI to family members, relatives close personal friends or others you have identified as being involved in your care. We are not required to agree to your request. If we disagree to your request, we will limit use or disclosure of your PHI except in certain cases, including where the information is needed to treat you or to verify coverage in the case of an emergency. To request restrictions, you must make your written request to an IPCA privacy official. Your request must include: 1) The information that you want to limit, 2) How you want to limit the information, and 3) To whom you want those limitations to apply.
- RIGHT TO REQUEST CONFIDENTIAL COMMUNICATION - You have the right to request other means or locations to receive communications about your PHI. All requests must be in writing using a IPCA confidential communication request form. IPCA will agree to readable requests for other means or locations to receive communications about your PHI.
-RIGHT TO REQUEST A CHANGE IN YOUR PHI - You have the right to request IPCA change information i your PHI for as long as IPCA keeps your PHI. IPCA can deny your request to change your PHI as provided by law. All requests must be in writing using a IPCA amendment request form.
- RIGHT TO AN ACCOUN T OF DISCLOSURES - you have the right to request an accounting for certain uses and disclosures of your PHI by IPCA. This is a use of disclosure made by IPCA during the past six years; except for uses or disclosures made:
– For treatment, payment and health care operations;
– To Family members or friends involved in your care;
– To you directly;
– Persuant to a written authorization;
– For certain notification purposes (including national security, intelligence, correctional and law enforcement purposes); or
– Before April 14, 2003
If you wish to make a request for an accounting contact the privacy official to obtain a IPCA accounting request form. The first list of accounting that you request in a 12-month period will be free, but we may charge you any additional ones requested during the same 12-month period. We will tell you about these costs, and you may cancel your request at any time before costs are incurred.
– RIGHT TO A PAPER COPY OF THIS NOTICE – You have the right to receive a paper copy of this notice of privacy practices upon request. Even if you have agreed to receive this notice electronically, you can still receive a paper copy of this notice.
if you believe your privacy rights have been violated, you may file a complaint in one of the following ways:
– The IPCA privacy official at the address indicated below;
– Integrative Pain Center of Alaska, LLC
1275 Sadler Way, Suite 101
Fairbanks, Alaska, 99701
We will not retaliate or take action against you for filing a complaint
QUESTIONS- If you have any questions about this notice or would like additional information, please contact the privacy official at the listed above. address and telephone number.
About this Notice