Francisco Cano, M.D., P.C.
59 West Main Street, Greenville, PA 16125
Phone: 888-588-7531 Fax: 724-588-5914
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. If you have any questions about this Notice of Privacy Practices, please contact Risa Barker our HIPAA officer at 888-588-7531.
This Notice of Privacy Practices describes how this facility may use and disclose your protected health information (PHI) to carry out treatment, payment, or healthcare operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. “Protected Health Information” is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health or condition and related healthcare services.
We are required to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice at any time. The new notice will be effective for all protected health information that is maintained at that time. You are encouraged to ask for an updated version at every appointment. Upon your request, this facility will provide you with any revised Notice of Privacy Practices by calling the practice and requesting that a revised copy be sent to you in the mail, via our website, or asking for one at your next appointment.
I. Uses and Disclosures of Protected Health Information
Uses and Disclosure of Protected Health Information Based Upon Your Electronic Signature or Verbal Consent:
You will be asked by this facility to sign electronically that you had the opportunity to review this notice. In the event you are not able to sign electronically, we will ask for verbal consent. We will then use and disclose your protected health information for treatment, payment and healthcare operations. Your protected health information may be used and disclosed by this facility, the office staff and others outside of our office that are involved in your care and treatment for the purpose of providing medical care services to you. Your protected health information may also be used and disclosed to pay your medical care bills and to support the operation of this facility.
We will use and disclose your protected health information to provide, coordinate or manage your medical care and any related services. This includes the coordination or management of your medical care with a third party that has already obtained your permission to have access to your protected health information. In addition, this facility may disclose your protected health information to another physician or healthcare provider (e.g., a specialist or lab) who, at the request of this facility becomes involved in your care by providing assistance with your medical care services this facility recommends for you.
Your protected health care information will be used, as needed, to obtain payment for your medical care services. This may include activities that your health insurance plan may undertake before it approves or pays for the medical care services this facility recommends for you. You do have the right to restrict certain disclosures of protected health information to your health plan when you pay in full, out of pocket for the services we provide.
We may use or disclose, as needed, your protected health information in order to support the business activities of this facility’s practice. In addition, this facility 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 staff is ready to see you. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment. We will share your protected health information with third party “business associates” that perform various activities for the practice. Whenever an arrangement between our office and a business associate involves the use or disclosure of your protected health information, our practice has asked our associates to comply with HIPAA regulations.
Other Permitted and Required Uses and Disclosures That May Be Made With Your Consent, Authorization, or Opportunity to Object:
We may use and disclose your protected health information in the following instances. You have the opportunity to agree or object to the use or disclosure of all or part of your protected health information. If you are not present or able to agree to the use or disclosure of the protected health information, then this facility may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the protected health information that is relevant to your medical care will be disclosed.
Others Involved in Your Healthcare:
Unless you object, this facility may disclose to a member of your family, a relative, a close friend or any other person you identify, your protected health information that directly relates to that person’s involvement in your medical care. If you are unable to agree or object to such a disclosure, this facility may disclose such information as necessary if it determines that it is in your best interest based on its 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 use or disclose your protected health information in an emergency treatment situation. If this happens, this facility will try to obtain your consent as soon as reasonably possible, after the delivery of treatment. If this facility is required by law to treat you and it has attempted to obtain your consent but is unable to obtain your consent, it may still use or disclose your protected health information to treat you.
We may use and disclose your protected health information if this facility attempts to obtain consent from you but is unable to do so due to substantial communication barriers and it determines, using professional judgment, that you intend to consent to use or disclose under the circumstances.
Other Permitted and Required Uses and Disclosures That May Be Made Without Your Consent, Authorization or Opportunity to Object:
We may use or disclose your protected health information in the following situations without your consent or authorization. These situations include:
–Required by Law
We may disclose your protected health information to the extent that law requires the use or disclosure. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, as required by law, of any uses or disclosures.
We may disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. This disclosure will be made for the purpose of controlling disease, injury or disability.
We may disclose your protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.
This facility may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations and inspections.
–Abuse or Neglect
We may disclose your protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, this facility may disclose your protected health information if it believes that you have been a victim of abuse, neglect or domestic violence to the government agency authorized to receive such information.
–Food and Drug Administration
We may disclose your protected health information to a person or company required by the Food and Drug Administration to report adverse events, product defects or problems, biologic deviations, track products, product recalls, or to make repairs or replacements, or to conduct post marketing surveillance, as required.
We may disclose protected health information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal, in certain conditions in response to a subpoena, discovery request or other lawful process.
We may also disclose protected health information, so long as applicable legal requirements are met, for law enforcement purposes.
This facility may disclose protected health information to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties required by law.
Consistent with the applicable federal and state laws, this facility may disclose your protected health information, if it believes 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. This facility may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.
–Military Activity and National Security
When the appropriate conditions apply, this facility may use or disclose protected health information of individuals who are Armed Forces personnel. This facility may also disclose your protected health information to authorized federal officials for conducting national security and intelligence activities.
This facility may disclose your protected health information as authorized to comply with workers’ compensation laws and other similar legally established programs.
–Required uses and Disclosures
Under the law, this facility must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of HIPAA Privacy Rule.
2. Your Rights
You Have the Right to Inspect and Copy Your Protected Health Information
EXCEPT: information compiled in reasonable anticipation of, or use in, a civil, criminal or administrative action or proceeding.
EXCEPT: Protected Health information that is subject to law that prohibits access to protected health information.
Our staff will comply in a timely manner, not to exceed 30 days.
You Have the Right to Request a Restriction of Your Protected Health Information
This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. Your request must state the specific restriction requested and to whom you want the restriction to apply. This facility is not required to agree to a restriction that you may request. BUT if this facility does agree to the requested restriction, it may not use or disclose your protected health information unless it is needed to
provide emergency treatment. A restriction may be made by contacting our HIPAA Officer and filling out a formal request form.
You Have the Right to Request Confidential Communications from Us by Alternative Means or at an Alternative Location
We will accommodate reasonable requests. Please make this request by contacting our HIPAA Officer.
You Have the Right to be notified of a Breach
We are required to notify you as soon as possible and no later than 60 days following the discovery of a breach.
You May Have the Right to Request This Facility to Amend Your Protected Health Information
This means you may request an amendment of protected health information about you in a designated record set for as long as this facility maintains this information. In certain cases, this facility may deny your request for an amendment.
Please contact our HIPAA Officer if you have questions about amending your medical record.
You have the Right to Receive an Accounting of Certain Disclosures This Facility Has Made, If Any, of Your Protected Health Information
This right applies to disclosures for purposes other than treatment, payment, or healthcare operations as described in the Notice of Privacy Practices. It excludes disclosures this facility may have made to you, family members or friends involved in your care or for notification purposes.
You have the Right to a Paper Copy of This Notice
You may ask for a copy of this notice at any time. Even if you agreed to receive this Notice electronically, you are still entitled to a paper copy of this Notice. You may obtain a copy at our website: www.canoasthmaallergy.com.
3. Additional Uses and Disclosures Specific to the Treatment of Minors
In your absence, unless you object, this facility may treat your minor and disclose protected health information that directly relates to your minors medical care. This facility will treat the minor as necessary, if it is in the minor’s best interest, based on our professional judgment.
Any uses and disclosures not described in this notice will only be made with your authorization.
You may complain to us if you believe your privacy rights have been violated by us. You may file a complaint with us by contacting our privacy officer Risa Barker at 888-588-7531. We do not retaliate against you for filing a complaint. Please contact us for further information regarding the complaint process including how to contact the Secretary of Health and Human Services. Also further information regarding HIPAA and the complaint process at www.hhs.gov.
5. You Have the Right to Obtain a Paper Copy of This Notice
6. This Form Becomes Effective July 2012, Revised March 2014,October 2015.