MCGILLIGAN MD, INC.’S DIRECT PRIMARY CARE PRACTICE IS NOT INSURANCE. PATIENT ACKNOWLEDGES AND UNDERSTANDS THAT MEMBERSHIP IN THE DIRECT PRIMARY CARE MODEL DOES NOT PROVIDE HEALTH INSURANCE COVERAGE, A HEALTH INSURANCE POLICY, A HEALTH BENEFIT PLAN, NOR IS IT A CONTRACT OF INSURANCE. MEMBERSHIP IN THE DIRECT PRIMARY CARE MODEL IS NOT AVAILABLE TO KENTUCKY MEDICAID ENROLLEES.
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.
McGilligan MD, Inc. (the “Company”) is required by law to maintain the privacy of your protected health information (“PHI”) and to provide you with this Notice of Privacy Practices (“Notice”) of its legal duties and privacy practices with respect to your PHI. The Company is required to abide by the terms of the privacy notice currently in effect. The Company reserves the right to change the terms of this Notice for all records and will inform you by posting the revised notice on our website or by providing it to you in the same manner this Notice was provided to you.
This Notice is effective March 1, 2018.
USES AND DISCLOSURES
The Company is permitted to use and disclose your PHI for treatment, payment and health care operations of the Company.
For Treatment: The Company will use and disclose your PHI in providing you with treatment and services. We may disclose your PHI to practitioners who may be involved in your care, such as physicians, nurses, nurses’ aides, and therapists. For example, a nurse caring for you may request information regarding the results of a particular lab test and we will disclose information to help interpret the test results.
For Payment: The Company may use and disclose your PHI so that we can bill and receive payment for the services we perform. For billing and payment purposes, we may disclose your PHI to your personal representative, an insurance or managed care company, Medicare, Medicaid, or another third-party payor. For example, we may contact Medicare or your health plan to confirm your coverage or to request prior approval for a proposed service. We may also send invoices to another person who health insurance policy also covers your health services.
For Health Care Operations: The Company may use and disclose your PHI for operational purposes. These uses and disclosures are necessary to manage and monitor our quality of care. For example, we may use PHI to evaluate our services, to perform quality reviews on testing and the performance of our staff.
The Company may also use or disclose your PHI incident to a permitted use or disclosure. For example, we may use your PHI to inform you about possible treatment alternatives, or health-related benefits and services that may be of interest to you. We may also contact you for fundraising, unless you opt out of receiving fundraising solicitations.
The Company will also share and disclose your PHI with third party “Business Associates” which perform various activities on behalf of the Company (for example, billing, collections, and network and software services). This includes communication with patients or person(s) identified as point of contact, as well as other health care professionals. The Company will take every precaution to prevent disclosure without authorization or consent, including using encrypted email accounts.
DISCLOSURES MADE WITHOUT YOUR AUTHORIZATION – The Company may use or disclose your PHI in the following situations without your authorization:
- As Required By Law. As required by law, we will use and disclose your PHI, but we will limit our use or disclosure to the relevant requirements of the law. When the law requires us to report abuse, neglect or domestic violence, respond to judicial or administrative proceedings, or to law enforcement officials, we will comply with the requirement concerning those activities. When we report suspected elder or dependent adult abuse or domestic violence, we will inform you or your personal representative promptly unless in our best professional judgment, we believe the notification would place you at risk of serious harm or would require informing a personal representative we believe is responsible for the abuse or harm.
- Public Health Activities. We may, and are sometimes required by law, to disclose your information to public health authorities for preventing or controlling disease, infection, injury or disability. We may also be required to disclose your information for reporting problems with products and reactions to medications to the Food and Drug Administration.
- Reporting Victims of Abuse, Neglect or Domestic Violence. If we believe that you have been a victim of abuse, neglect or domestic violence, we may use and disclose your PHI to notify a government authority, if authorized by law.
- Health Oversight Activities. We may disclose your PHI to a health oversight agency for activities authorized by law, such as audits, investigations, inspections and licensure actions or for activities involving government oversight of the healthcare system.
- To Avert a Serious Threat to Health or Safety. When necessary to prevent a serious threat to your health or safety or the health or safety of the public or another person, we may use or disclose PHI and limit such disclosures to those able to help lessen or prevent the threatened harm.
- Judicial and Administrative Proceedings. We may, and are sometimes required by law, to disclose your PHI in the course of any administrative order. We may also disclose information about you in response to a subpoena, discovery request or other lawful process if reasonable efforts have been made to notify you of the request and you have not objected, or if your objections have been resolved by a court or administrative order.
- Law Enforcement. We may, and are sometimes required by law, to disclose your PHI to law enforcement officials for purposes such as identifying of locating a suspect, fugitive, material witness or missing person, complying with a court order, warrant, grand jury subpoena and other law enforcement purposes.
- Research. We may use and disclose your PHI to researchers if an institutional review board has approved such use and disclosures, whose approval ensures adequate safeguards have been taken to protect your PHI.
- Coroners, Medical Examiners, Funeral Directors. We may, and are often required by law, to disclose your PHI to coroners, medical examiners and to funeral directors in connection with the fulfillment of their duties.
- Organ and Tissue Donation. We may disclose your PHI to organizations involved in procuring, banking, or transplanting organs and tissues.
- Specific Government Functions. We may disclose your PHI to military officials if you are an active member of the military or to determine eligibility and/or benefits for veterans. We may also disclose your PHI for national security, intelligence activities, the protection of the President, and to determine officials’ suitability to serve in public office. If you are an inmate of a correctional facility, we may disclose your PHI to officials at the correctional facility.
- Workers' Compensation. We may disclose your PHI as authorized to comply with worker’s compensation laws or similar programs that provide benefit for work related injuries or illness.
- Notification and Communication with Family. We may disclose your PHI to notify or assist in notifying a family member, your personal representative or another person responsible for your care. In the event of a disaster, we may disclose information to a relief organization so that they may coordinate these notification efforts. We may disclose your PHI to individuals who are involved in your care or pay for your care. If you are able and available to agree or object, we will give you the opportunity to object prior to making these disclosures, although we may disclose this information in a disaster even over your objection if we believe it is necessary to respond to emergency circumstances. If you are unable or unavailable to agree or object, our health care professionals will use their best judgment in communication with your family and others.
DISCLOSURES MADE ONLY WITH YOUR WRITTEN AUTHORIZATION
Other uses and disclosures of your PHI will be made only with your written authorization, unless otherwise permitted or required by law as described in this Notice. These uses and disclosures include most uses and disclosures of psychotherapy notes (where applicable), uses and disclosures for marketing purposes, and disclosures that constitute a sale of your PHI. You may revoke the authorization at any time, provided that the revocation is in writing, except to the extent that (i) the Company has taken action in reliance thereon, or (ii) if the authorization was obtained as a condition of obtaining insurance coverage, other law provides the insurer with the right to contest a claim under the policy or the policy itself.
INDIVIDUAL RIGHTS – The following are statements of your rights about PHI:
- Request Restrictions. You have the right to request restrictions on certain uses and disclosures of your PHI, by a written request specifying what information you want to limit and what limitations on our use or disclosure of that information you wish to have imposed. We reserve the right to accept or reject your request, and will notify you of our decision. However, we will honor your request if your request restricts disclosure to your insurance company for payment or health care operations provided that you have fully paid for such payment for the service that is the basis for your request for restriction.
- Right to Inspect and Copy. You have the right to inspect and copy your records, with limited exceptions. In certain circumstances, we may deny your request and we will respond, in most cases, within thirty (30) days of your request. We may charge a reasonable fee to accommodate your request.
- Request Amendment. If you believe our records are incomplete or inaccurate, you request that we change your PHI by submitting a written request and explaining the reason in support of the requested revision. We reserve the right to deny your request in certain circumstances, including if the information you asked us to amend was not created by us.
- Request an Accounting of disclosures. You have the right to receive an accounting of certain disclosures of your PHI that we have made. If you would like to have an accounting of disclosures we have made regarding your PHI, please contact our Privacy Officer listed at the bottom of this Notice.
- Request a Paper Copy of This Notice. You have the right to obtain a paper copy of this Notice, even if you have agreed to receive this Notice electronically. You may request a copy of this Notice at any time. In addition, you may obtain a copy of this Notice at our website at: https://mcgilligan.md/privacy-practices/
- Request Confidential Communications. You have the right to request that you receive your PHI in a specific way or at a specific location. For example, you may ask that we send information to a particular e-mail or to your work address. We will comply with all reasonable requests submitted in writing which specify how or where you wish to receive these notifications, but we will verify the authenticity of such request. You do not need to provide us with an explanation as to the basis for your request.
COMPLAINTS AND CONTACT
If you believe your privacy rights have been violated, you may make a written complaint by delivery to the Company or to the Secretary of HHS. You will not be retaliated against if you file a complaint. You may also request additional information by written request to:
Privacy Officer McGilligan MD, Inc. 7529 State Rd, Suite B Cincinnati, Ohio 45255