Notice of Privacy Practices | Capital City Family Medicine

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.

1. Our commitment to your privacy

Capital City Family Medicine is required by law to protect the privacy of your protected health information (PHI), to give you this notice describing our privacy practices, and to follow the terms of the notice currently in effect. PHI is information that identifies you and relates to your past, present, or future health, treatment, or payment for care. This notice applies to all records of your care generated by the practice.

2. How we may use and disclose your health information

We may use and disclose your health information without your written authorization for the following purposes:

Treatment. We use your information to provide and coordinate your care — for example, sharing information with other providers involved in your treatment, sending prescriptions to your pharmacy, making referrals, and communicating with your supervising or consulting physician.
Payment. We use your information to bill and obtain payment for services — for example, verifying insurance eligibility, obtaining prior authorization, and submitting claims to Medicare, Medicare Advantage, or your commercial plan through our billing systems.
Health care operations. We use your information to run the practice — for example, quality review, training, credentialing, compliance auditing, and general business management.

3. Other uses and disclosures permitted or required by law

We may use or disclose your health information without your authorization in the following circumstances, subject to the limits and conditions the law requires:

As required by federal, state, or local law.
For public health activities, such as reporting communicable diseases, immunizations, and adverse events, and to public health authorities.
To report suspected abuse, neglect, or domestic violence as permitted or required by Kentucky law.
For health oversight activities by agencies such as the Kentucky Board of Medical Licensure, CMS, and the Office of Inspector General.
In response to a valid court order, subpoena, or other lawful process, following the procedures the Privacy Rule requires.
For limited law enforcement purposes as permitted by law.
To avert a serious and imminent threat to the health or safety of a person or the public.
For workers' compensation as authorized by law.
To coroners, medical examiners, funeral directors, and organ procurement organizations as permitted by law.
For specialized government functions, including certain military, national security, and correctional purposes.

4. Uses and disclosures that require your written authorization

Other uses and disclosures are made only with your written authorization, including: any use or disclosure of psychotherapy notes (where applicable); uses and disclosures for marketing; and any sale of your health information, which the practice does not engage in. Most other uses not described in this notice will be made only with your written authorization. You may revoke an authorization in writing at any time, except to the extent we have already acted in reliance on it.

5. Your rights regarding your health information

Right to access and copy. You may inspect and obtain a copy of your health information, including an electronic copy where readily producible. We will act on your written request within 30 days (with one 30-day extension if needed) and may charge a reasonable, cost-based fee permitted by law.
Right to request an amendment. You may ask us to amend information you believe is incorrect or incomplete. We will respond within 60 days. If we deny your request, you may submit a statement of disagreement that becomes part of your record.
Right to an accounting of disclosures. You may request a list of certain disclosures of your health information made in the six years before your request, other than disclosures for treatment, payment, operations, or those you authorized.
Right to request restrictions. You may ask us to restrict how we use or disclose your information. We are not required to agree to all requests, but we must agree to a request to withhold information about a service from your health plan if you pay for that service in full, out of pocket.
Right to confidential communications. You may ask us to contact you at an alternative address or by an alternative means (for example, by cell phone only, or with no voicemail detail). We will accommodate reasonable requests.
Right to a paper copy. You may obtain a paper copy of this notice at any time, even if you agreed to receive it electronically.
Right to be notified of a breach. You have the right to be notified if a breach of your unsecured health information occurs.

To exercise any of these rights, contact the Privacy Officer using the information in Section 8.

6. Our legal duties

We are required to maintain the privacy of your health information, provide you with this notice of our legal duties and privacy practices, abide by the terms of the notice currently in effect, and notify you following a breach of your unsecured health information. We reserve the right to change this notice and to make the revised notice effective for information we already have as well as information we receive in the future. A current copy of the notice will be posted in the office and on the practice website, and a copy will be available on request.

7. Complaints

If you believe your privacy rights have been violated, you may file a complaint with the practice's Privacy Officer or with the Secretary of the U.S. Department of Health and Human Services, Office for Civil Rights. Complaints to HHS may be filed at 200 Independence Avenue SW, Washington, DC 20201, or through www.hhs.gov/ocr. We will not retaliate against you for filing a complaint, and you will not be required to waive your rights as a condition of treatment.

8. Contact and effective date

Privacy Officer: Randall Farmer, Practice Manager
Capital City Family Medicine, LLC — Frankfort, Kentucky
Telephone: [practice phone coming soon] · Email (non-PHI only): info@capcityfm.com

This notice is effective as of the date shown above.