Watertown Family Practice Associates, S.C. Notice of Privacy Practices
Protecting Your Privacy
It is your right as a patient to be informed of the privacy practices of your health care provider as well as to be informed of your privacy rights with respect to your personal health information. This Notice of Privacy Practices is intended to provide you with this information. We are required by law to:
- Maintain the privacy of your health information.
- Provide you with a notice of the legal duties and privacy practices regarding protected health information collected and maintained about you.
- Notify you in writing of a breach of unsecured medical information about you.
- Abide by the terms of this notice.
Watertown Family Practice Associates, S.C. (WFP) reserves the right to change the terms of the notice of privacy practices and make the new notice provisions effective for all protected health information that it maintains. WFP also reserves the right to change the terms of its notice with respect to any applicable more limited uses and disclosures.
WFP will promptly revise and make available its notice whenever a substantial change is made to any of its privacy practices and post the new notice on our web site at www.watertownfamilypractice.com. WFP will not use or disclose your health information without your authorization, except as described in this notice.
Your Health Information Rights
You have the right to:
- Request a restriction on certain uses and disclosures of your health information. You have the right to request restrictions on certain uses and disclosures of protected health information, even if the restriction affects your treatment or WFP’s payment or health care operation activities. However, WFP is not required to agree to your requested restriction, unless you request in writing, that we not disclose to a health plan for payment of health care operations purposes medical information about you that pertains to health care provided to you for which you or someone on your behalf has paid in full.
- Receive Confidential Communications. You have the right to request that WFP communicate your health information to you by alternative means or at alternative locations. WFP shall accommodate reasonable requests. For example, you may request to be contacted at a phone number that is different from the phone number listed in your health care record.
- Inspect and obtain a copy of your health record. You have the right to inspect and obtain a copy of your health care record. This request for access to your health care must be submitted in writing to Medical Records. This right may not apply to certain types of psychotherapy notes and WFP may charge you a reasonable fee for a copy of your health care record. For example, you may request a copy of your health care record from your family physician.
- Amend your health record. You have the right to request an amendment to your health care record if you believe your health information is incorrect for incomplete. You may be asked to make this request in writing and state the reason why your health record should be changed. If WFP did not create the health information you believe is incorrect, or if WFP disagrees with you, WFP may deny your request. For example, if you believe that information in your medical history is incorrect, such as your birth date, you may request that this information be amended.
- Obtain an accounting of disclosures of your health information. You have the right to receive a list of disclosures of your health information that WFP has made during the previous 6 years in compliance with state and federal law. The accounting will describe the dates of each disclosure, a brief description of information disclosed and the reason for disclosure. You will receive one accounting per year at no charge and WFP may charge you a reasonable fee for each subsequent request.
- Obtain a copy of the notice upon request. You have the right to obtain a paper copy of the notice upon request. For example, if you received the notice electronically, you may request that WFP provide a paper copy of the notice. This notice is available on our website at www.watertownfamilypractice.com.
Uses and Disclosures for Treatment, Payment and Health Care Operations
WFP is permitted by the federal privacy rule to use or disclose your protected health information for treatment, payment or health care operations. WFP may not disclose HIV test results, psychotherapy notes, alcohol or other drug abuse treatment records without your written authorization, unless required by law.
Watertown Family Practice Associates, S.C. may use or disclose your health information for treatment.
WFP may use or disclose your health information in the provision, coordination or management of your health care.
Example: Your information may be disclosed from one physician to another if they are consulting each other in relation to your care and treatment. Example: WFP may use your health information to provide you with an appointment reminder. Example: WFP may send you information about treatment alternatives or other health related services that may be of interest to you.
Watertown Family Practice Associates, S.C. may use or disclose your health information for payment.
WFP may use or disclose your health information to obtain reimbursement for the provision of health care services. The bill may include information that identifies you, your diagnosis and your treatment. Example: WFP may use or disclose your information to your insurer to obtain payment for the provision of health care services.
Watertown Family Practices Associates, S.C. may use or disclose your health information for routine heath care operations.
WFP may use or disclose your health information for evaluation of patient care services, evaluating the performance of health care providers, activities relating to compliance with the law and business planning and development. Example: WFP may review your health record to determine the efficiency of the services provided to you in the emergency room.
Uses or Disclosures of Your Protected Health Information Permitted Without Your Authorization
WFP may use or disclose your health information for the following purposes when required by law:
- Disclosures about victims of elderly or child abuse.
- Disclosures to the State of Wisconsin for the purpose of statutory reporting.
- Disclosures to a state or federal public health agency for the purpose of preventing or controlling disease, injury or disability.
- Disclosures to the Food and Drug Administration (FDA).
- Disclosures related to a work related illness or injury.
- Disclosures to coroners, medical examiners and funeral directors.
- Disclosures in response to a court order or subpoena from a state or federal agency.
- Disclosure to law enforcement officials to avert a serious threat to health or safety.
- Disclosures for research in certain circumstances, including contacting you about participation in a research project.
- Disclosures for specialized government functions; national security, military and other federal officials.
- Disclosures to limited staff of a correctional institute or a custodial law enforcement official for the provision of health care and transport of inmates.
- Disclosures to organ procurement organizations.
- Disclosures to a health care oversight agencies
Other uses of medical information:
.In any other situation not covered by this notice, we will ask for your written authorization before using or disclosing medical information about you. These situations include certain uses and disclosures of your medical information for marketing purposes and disclosures that involve the sale of medical information. You may opt out of receiving fundraising materials from WFP. If you choose to authorize use or disclosure of your medical information, you can later revoke that authorization by notifying us in writing of your decision. Your revocation will not affect any use or disclosure permitted by your authorization while it was in effect.
If you believe your privacy rights have been violated, you may file a complaint with WFP or with the Secretary of the Department of Health and Human Services. There will be no retaliation against you for filing a complaint. To file a complaint with WFP please contact the clinic’s Privacy Officer who will provide you with the necessary assistance.
All sales are final.
Questions or Concerns
If you have questions or concerns regarding your privacy rights or the information in this notice, please contact:
Watertown Family Practice Associates, S.C.
127 Hospital Drive
Watertown, WI 53098
This Notice of Privacy Practices is Effective as of April 14, 2003 Revised September 23, 2013