Understanding Your Health Record Information

Each time you visit a health care provider, the provider makes a record of your visit. This record contains your health history, current symptoms, examination, test results, diagnoses, and treatment. This information is used as a:

Basis for planning your care and treatment.

Means of communication among your health care providers.

Legal document describing your care.

Means by which you or a third-party payer can verify that you actually received the services billed for.

Tool in medical education.

Source of information for public health officials.

Tool to assess the appropriateness and/or improve the quality of your care.

Be sure that it is accurate and complete.

Understand who, what, where, why, and how others may access your health information.

Make informed decisions about sharing health care information with others.

Better understand the health information rights detailed below.

Your health records are the physical property of the health care provider who completed it. You have the following rights regarding your health record.

1. You may request restriction on uses and disclosures of your health information for treatment, payment, and health care operations. "Health care operations" are activities that are necessary to carry out the operations of Cardiovascular Medicine, P.C. (CVM), such as quality assurance and peer review. You may request restriction or alternate communications on the consent form for treatment, payment, and health care operations. CVM does not have to agree to an unreasonable request.

You do not have the right to request restriction for uses and disclosures permitted or required by law, such as mandatory communicable disease reporting. For more information see the following sections of the federal privacy regulations:

164.502(a)(2)(i), 164.510(a), or 164.512.

3. You may inspect and receive a copy your health information upon request. CVM reserves the right to charge a reasonable fee for making copies.

You do not have a right of access to the following

Records not created by CVM.

Psychotherapy notes. These are notes recorded by a mental health professional.

Information compiled in reasonable anticipation of or for use in civil, criminal, or administrative actions or proceedings.

Protected health information that is subject to the Clinical Laboratory Improvement Amendments of 1988 (" CLIA"), 42 U. S. C. § 263a, to the extent that giving you access would be prohibited by law.

Information that was obtained from someone other than a health care provider under a promise of confidentiality and the requested access would be reasonably likely to reveal the source of the information.

CVM may deny you or your personal representative access, but if we do, we must provide you with a reason. We will also tell you what your rights are and how to seek a review. Reasons include:

A licensed healthcare professional, such as your family doctor, has determined that the access is likely to endanger the life or physical safety of yourself or another person.

Protected health information makes reference to another person (other than a health care provider) and a licensed health care provider has determined that the access is likely to cause substantial harm to that other person.

4. You may request amendment/correction of your health information. CVM does not have to grant the request if the following conditions exist:

CVM did not create the record. You must seek an amendment/ correction from the party creating the record. If the party amends or corrects the record, we will put the corrected record into our records.

The records are not available to you as stated in #3 above.

The record is accurate and complete.

5. You may obtain a listing of nonroutine uses and disclosures, those other than for treatment, payment, and health care operations. CVM does not need to provide a listing for the following disclosures:

To you for disclosures of protected health information to you.

For your location within the CVM clinic, to persons involved in your care or for other notification purposes as provided in § 164.510 of the federal privacy regulations.

For disclosures not requiring consent under federal privacy regulations 164.512(k)(2), (5) including reasons of national security or intelligence purposes and to correctional institutions or law enforcement officials.

That occurred before April 14, 2003.

Date of each disclosure.

Name and address of the organization or person who received the protected health information.

Brief description of the information disclosed. Brief statement of the purpose of the disclosure or a copy of your written authorization or a copy of the written request for disclosure.6. You may revoke your consent or authorization to use or disclose health information unless CVM has already acted on your consent.

CVM's Responsibilities under the Federal Privacy Standard

In addition to providing you your rights, as detailed above, the federal privacy standard requires CVM to take the following measures:

1. Maintain the privacy of your health information, including implementing reasonable and appropriate physical, administrative, and technical safeguards to protect the information.

2. Provide you this notice about our legal duties and privacy practices with respect to your health information that we collect and maintain.

3. Abide by the terms of this notice.

4. Train our personnel concerning privacy and confidentiality.

5. Implement a policy to discipline those who breach privacy/ confidentiality.

6. Mitigate(lessen the harm of) any breach of privacy/ confidentiality.

CVM RESERVES THE RIGHT TO CHANGE OUR PRACTICES AND TO MAKE THE NEW PROVISIONS EFFECTIVE FOR ALL INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION THAT WE MAINTAIN. IF WE CHANGE OUR INFORMATION PRACTICES, WE WILL HAVE A REVISED NOTICE AVAILABLE TO YOU AT YOUR NEXT CVM OFFICE VISIT.

CVM will not use or disclose your health information without your consent or authorization, except as described in this notice or otherwise required by law.

How to Get More Information or to Report a Problem

If you have questions and/ or would like additional information, you may contact the privacy officer or director of health information management of CVM at 563-324-2992 or 1-800-382-0707.

Examples of Disclosures for Treatment, Payment, and Health Operations

1. If you give us consent, CVM willuse your health information for treatment.

Example: Your CVM healthcare team will record information to diagnose your condition, determine and carry out the best treatment plan. This information will be documented, communicated, and evaluated within your CVM healthcare team. This information may also be shared with your referring/family healthcare providers. We will also provide copies of your records to subsequent health care providers to assist them once we are no longer treating you. Communication may be delivered via mail, facsimile, courier or software.

2. If you give us consent, CVM willuse your health information for payment.

Example: We may send a bill to you or to a third-party payer, such as a health insurer. The information on or accompanying the bill may include information that identifies you, your diagnosis, treatment received, and supplies used.

3. If you give us consent, CVM willuse your health information for health operations. We will use this information in an effort to continually improve the quality and effectiveness of the services that we provide.

Example: Members of the CVM staff may use information in your health record to assess the care and outcomes in your cases and the competence of the caregivers.

4. Business associates: CVM provides some services through contracts with business associates.

Examples include certain diagnostic tests, transcription services, technology support, etc. When we use these services, we may disclose your health information to the business associates so that they can perform the functions that we have contracted with them to do and bill you or your third-party payer for services provided. To protect your health information, however, we require the business associates to appropriately safeguard your information.

5. Directory: Unless you notify us that you object, we will use your name, location, and general condition for directory purposes. This information may be provided to other people who ask for you by name.

6. Notification: We may use or disclose information to notify or assist in notifying a family member, a personal representative, or another person responsible for your care, of your location, and general condition.

7. Communication with family: Unless you object, CVM personnel, using their best judgment, may disclose to a family member, another relative, a close personal friend, or any other person that you identify health information relevant to that person's involvement in your care or payment related to your care.

8. Research: CVM may disclose information to researchers. The research must have approval by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.

9. Funeral directors: CVM may disclose health information to funeral directors consistent with applicable law to enable them to carry out their duties.

10. Marketing/continuity of care: CVM may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

11. Food and Drug Administration (" FDA"): CVM may disclose to the FDA health information relative to adverse effects/ events with respect to food, drugs, supplements, product or product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.

12. Workers compensation: CVM may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.

13. Public health: As required by law, CVM may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.

14. Correctional institution: If you are an inmate of a correctional institution, CVM may disclose to the institution or agents thereof health information necessary for your health and the health and safety of other individuals.

15. Law enforcement: CVM may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.

16. Health oversight agenciesand public health authorities: If a member of the CVM work force or a business associate believes in good faith that we have engaged in unlawful conduct or otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers, or the public, they may disclose your health information.

17. The federal Department of Health and Human Services ("DHHS"): Under the privacy standards, CVM must disclose your health information to DHHS as necessary to determine our compliance with those standards.

18. Patient Assistance Program: CVM may disclose your health information to check eligibility and/or enroll you in a drug company.s patient assistance program.