HeartCare of Viginia

HEARTCARE OF VIRGINIA
(A/K/A WILLIAM G. FRANKLIN, M.D., LTD.)
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 CAREFUL

I. WE HAVE A LEGAL DUTY TO SAFEGUARD YOUR PROTECTED HEALTH INFORMATION (PHI)

The Health Insurance Portability &Accountability Act of 1996 ("HIPAA") is a federal law that requires that all medical records and other identifiable health information used or disclosed by us be kept properly confidential. We call this information "Protected Health Information" or "PHI" for short, and it includes information that can be used to identify you that we have created or received about your past, present, or future health or condition, the provision of health care to you, or the payment for this healthcare. We must provide you with this notice about our privacy practices that explains how, when, and why we use and disclose your PHI. With some exceptions, we may not use or disclose any more of your PHI than necessary to accomplish the purpose of the use or disclosure. We are legally required to follow the privacy practices that are described in our current Notice and to abide by HIPAA and other applicable state law requirements.

We have designated a member of staff to serve as Privacy Officer whom you may reach by calling the main office number at 703-527-1400.

Uses and Disclosures

We use and disclose health information for many different reasons. For some of these uses or disclosures, we need your prior authorization, and for others, we do not.

We may use and disclose your PHI without your authorization for the following reasons(TPO):

Treatment. Your health information may be used by staff members or disclosed to other health care professionals for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. For example, we disclose PHI to your referring doctor, hospitals serving you, and to covering physicians providing care at night, on weekends, or during vacations. We also respond by telephone to a request for PHI from health care providers regionally or nationally who are responsible for providing you timely services.

Payment. Your health information may be used to seek payment. For example, we may provide portions of your PHI to your health plan regarding information on dates of service, the services provided, and the medical condition being treated, to get paid for the health care services we provide to you. We may tell your health plan about a treatment you are going to receive in order to obtain prior approval or to determine whether your plan will cover the treatment. We may also provide your PHI to our business associates, such as billing companies, claims processing companies and others that process our health care claims.

Health care operations. Your health information may be used as necessary to support the day-to-day activities and management of HeartCare of Virginia. For example, we audit charts and discuss challenging illnesses with other healthcare providers in order to ensure quality and appropriateness of care.

Additional Uses and Disclosures of Information

Communications and Appointment Reminders. We may contact you at the address and phone number you have given us in your registration sheet as a reminder that you have an appointment or to give you other information about your treatment or payment matters. You have the right to request that we change the manner in which we contact you and we will accommodate any reasonable requests. You may make such request to our reception staff or Privacy Officer. Regardless of any request you make and we agree to, we will return requests for communication with you using the means you most recently direct us to do, if reasonable.

We may also use and disclose your PHI without your authorization for these additional reasons:

We will disclose PHI to third parties when we are required or permitted to do so by law, for example, consistent with an order of a court, a HIPAA compliant subpoena, a warrant, and an audit request accompanied by evidence of the legal authority of the entity requiring the audit information. We may make disclosures without a patient authorization to comply with public health requirements that may be applicable to this practice. In limited cases we may disclose PHI after a patient has given oral permission that we do so.

Other Uses and Disclosures Require Your Authorization

Disclosure of your health information or its use for any purpose other than for TPO and that is not authorized or permitted by law requires your specific written authorization. If you change your mind after authorizing in writing a use or disclosure of your information you may submit a written revocation of the authorization. However, your decision to revoke the authorization will not affect or undo any use or disclosure of information that occurred before you notified us of your decision. You may obtain a form to authorize or revoke an authorization of the use/disclosure of PHI from the Reception staff or the Privacy Officer.

We will obtain your verbal agreement before using or disclosing limited PHI to others involved in your care or payment for it, such as a family member or a close friend. However, in certain circumstances when it is not practical to obtain your oral authorization, such as in an emergency, we may use and disclose limited PHI for these purposes without your prior specific agreement We may also provide limited PHI, such as your treatment, location, condition and status, to a family member, friend, or other person that you indicate is involved in your care or the payment for your health care.

II. WHAT RIGHTS YOU HAVE REGARDING YOUR PHI

You have specific rights under HIPAA in your PHI. Beside the right to receive a current notice of privacy practices, you have these other rights:

1. To request a change in how we communicate with you
2. To request restrictions on certain of our uses and disclosure of your PHI
3. To request access to inspect your PHI
4. To request a copy of your PHI
5. To request an amendment of your PHI
6. To request an accounting of our disclosure of your PHI after April 14,2003
7. To file a complaint about how your PHI is handled
8. To obtain a copy of this or any revised Notice from us within a reasonable time
   of your request

III. RIGHT TO REVISE NOTICE OF PRIVACY PRACTICES

As permitted by law, we reserve the right to amend or modify our Notice of Privacy Practices at any time. These changes in our Notice may be required by changes in federal and state laws and regulations. The terms of our revised Notice will be applied to all of your PHI that we maintain, whether it was obtained or developed by us prior to the Revised Notice. We will post a Memo at our Reception area whenever we revise this Notice and you may request a copy of the revised Notice from our Reception staff or Privacy Officer at any time.


IV. COMPLAINTS AND CONTACT PERSON

If you would like to submit a complaint about our Privacy Practices, you can do so by submitting your written complaint or concern on the form provided at our Reception area or from our Privacy Officer to:

You may also send a written complaint to the Secretary of the Department of Health and Human Services, Office of Civil Rights.

You will not be penalized or otherwise retaliated against for filing a complaint.

V. EFFECTIVE DATE
The effective date of this Notice April 14, 2003.

VI. ACKNOWLEDGEMENT OF RECEIPT OF THIS NOTICE

HeartCare of Virginia, William G. Franklin, MD, LTD., is committed to the privacy of your health information and will abide by applicable laws, including HIPAA, to achieve this. We therefore ask that you sign and return the attached "Notice of Privacy Practices Acknowledgment" form acknowledging that you have received our "Notice of Privacy Practices."