Hastings Medical Park
Suite 203
2115 N. Kansas Ave
Hastings, NE 68901
402.463.2431
800.348.0368
402.463.2486 fax
midwestent@windstream.net

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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 THIS CAREFULLY


Words and Terms to know:

Business Associates: People or companies who do work for Midwest Ear, Nose & Throat Clinic (Midwest ENT) but are not employees.

Disclose: Sharing medical information with your permission with those who need to know.

Medical Information: Health Information, which may include your name, age, religion and information about your care.

Notice: This information hand out.

Provider: Companies and agencies that provide care such as doctors, nurses and home health services.

UNDERSTANDING YOUR MEDICAL RECORD INFORMATION:

Each time you visit Midwest ENT, a record of your visit is made. Typically, this record describes your symptoms, examination, test results, diagnosis, treatment and a plan for future care or treatment. This information, often referred to as your health or medical record or designated record set, also includes your financial record and serves as a:
  • Basis for planning care and treatment
  • Means of communication among health professionals who help with the care
  • Legal documents describing the care you received
  • Record by which you or a third party payer, such as your insurance company, can verify that services billed were actually provide
  • Source of information to:
    • Educate health professionals
    • Provide date for medical research
    • Improve public health
    • Improve the care we give

UNDERSTANDING HOW YOUR HEALTH INFORMATION IS USED HELPS YOU TO:
  • Ensure accuracy
  • Follow the agreed upon treatment
  • Know who, what, when, where and why others may use all or part of your health information
  • Make a more informed decision when giving permission for your health information to be sent or released to others
  • Understand that other uses and disclosures will be made only with your written authorization and that a revocation will be made in writing and will not apply to information that has already been released in response to this authorization

YOUR HEALTH INFORMATION RIGHTS:

Although your medical and financial records are property of Midwest ENT the information belongs to you. Midwest ENT has developed procedures as described in the federal law that allows you several rights. We have policies that give you the right to request your desire to:
  • Restrict with whom we share your health information
  • Look at and get all or part of your health information
  • To receive confidential communication about health information
  • Amend/correct your health information
  • To obtain a paper copy of this notice
  • Receive a list of companies/agencies/persons, who have received your health
  • information .
  • Have us communicate with you in a certain way or at a certain location .
  • Change your mind about sharing health information except for what has already been
  • shared.

OUR RESPONSIBILITIES

CAAC is required to:
  • Protect the privacy of your health information
  • Provide you with a current copy of the Notice of Information Practices
  • Do what we say we will do in this notice
  • Notify you if we are unable to agree to your written request.

We will use and share your health information only with your permission, except as described in this notice or as required by state or federal regulation.

We have the right to change this notice and apply it to the health information we already have about you and any we receive in the future.
 
EXAMPLES OF SHARING INFORMATION FOR TREATMENT AND PAYMENT

1. We will use your health information for treatment:

For example:
  • Information obtained by a nurse or doctor will be written in your medical record and used to determine the best treatment for you. Members of your healthcare team will document their actions, your progress and response to treatment. We will provide any facility or provider involved in your care with information that may assist in your treatment .
  • When you are no longer receiving care from Midwest ENT, we will provide information to the next provider or facility that cares for you. These copies of your medical record are to help them continue your plan of care after discharge.

2. We will use your health information for payment.

For example:
  • We will send a bill to you and/or to a third party payor (insurance company). The information may include your name, diagnosis, procedures and supplies used .
  • We will provide needed information to other health care providers for their billing purposes.

3. We will allow our business associates to use your health information if needed.

For example:
  • Some services are provided by people or companies, known as business associates, who are not employed by us. Midwest ENT requires business associates to protect patient's health information.

4. We will give your health information to:
  • A family member or friend who is involved in your care.
  • Persons who help pay for your care.

5. We may share your health information with organ transplant organizations .
  • Following state law, we may share health information with organizations or groups that manage, bank or transplant organ and tissue donations.

6. We will share your health information about you to assist public health activities or as required by law.

For example:
  • Prevent or control disease, injury or disability.
  • Report child abuse or neglect.
  • Report reactions to medications or problems with faulty products .
  • Notify people of recalls of products they may be using .
  • Notify a person who may have been exposed to disease or may be at risk for getting or spreading a disease or condition .
  • Notify an appropriate government authority if we believe a patient has been a victim of abuse, neglect or domestic violence.

7. We may use your health information for Worker's Compensation.

For example:
  • If you are injured on the job, we may share medical information about you for worker's compensation or similar programs that provide benefits for work related injuries or illnesses.

8. We may share your health information with a correction institution.

For example: If you are an inmate or in the custody of law enforcement, your information will be shared to:
  • Provide you with health care
  • Protect your health and safety
  • Protect the health and safety of others
  • Assist in the safety and security of the correctional institution.

9. We will give your health information to law enforcement.

For example, we may share your health information as needed.
  • In response to a court order, subpoena, warrant, summons or similar process
  • To identify or locate a suspect, fugitive, material witness or missing person
  • If we suspect that you are a victim of an accident or crime
  • If death occurs, which we believe may be the result of a crime
  • In an emergency to report a crime committed on the premises; the location of the crime or victims; or identity; description or location of the person who committed the crime.

COMPLAINTS OR QUESTIONS ABOUT YOUR PRIVACY RIGHTS ARE TO BE MADE IN WRITING TO THE PRIVACY OFFICER AT:
Midwest Ear, Nose & Throat Specialists, P.C. HASTINGS MEDICAL PARK -- 2115 NORTH KANSAS
HASTINGS, NEBRASKA,
IF YOU HAVE QUESTIONS ABOUT THIS PROCESS, CALL 402/463-2431
IF YOU BELIEVE YOUR PRIVACY RIGHTS HAVE BEEN VIOLATED, YOU HAVE THE RIGHT TO FILE A COMPLAINT IN WRITING WITH THE SECRETARY OF HEALTH AND HUMAN SERVICES. NOTHING WILL BE HELD AGAINST YOU FOR FILING A COMPLAINT.

REFERENCE: `CODE OF FEDERAL REGISTER 164.70

EFFECTIVE DATE 04-13-2003 VERSION #1