THIS FEDERALLY-REQUIRED NOTICE DESCRIBES HOW YOUR PETS MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
WHO WE ARE
To comply with federal law, this Notice describes the privacy practices of, and applies to your protected health information obtained and generated by the employees of Country Estate Kennel, Inc..
This applies to your pets protected health information generated, used, or disclosed by our employees.
OUR PRIVACY OBLIGATIONS
We are required by law to maintain the privacy of your pets protected health information (“PHI”) and to provide you with this Notice of our legal duties and privacy practices with respect to your pets PHI. When we use or disclose your pets PHI, we are required to abide by the terms of this Notice (or the notice in effect at the time of the use or disclosure).
PERMISSIBLE USES AND DISCLOSURES WITHOUT YOUR WRITTEN AUTHORIZATION
In certain situations, described below, we must obtain your written authorization to use and/or disclose your pets PHI. However, unless otherwise specified by Federal or Illinois law, or Memorial policy, we do not need any type of authorization from you for the following uses and disclosures:
We may use and disclose your pets PHI to provide treatment and other services to your pet. In addition, we 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. We may also disclose PHI to other health care providers involved in your pets treatment.
We may use and disclose your pets PHI to obtain payment for services that we provide to your pet, including but not limited to an insurer that arranges or pays for some or all of your pets health care costs. We may also disclose your pets PHI to another covered entity in order for them to bill for services your pet received at our office.
For Health Care Operations
We may use and disclose your pets PHI for our health care operations, which include internal administration and planning and various activities that improve the quality and cost effectiveness of the care that we deliver to you. For example, we may use PHI to evaluate the quality and competence of our veterinarians and staff. We may also disclose PHI to members of our staff in order to resolve any complaints you may have.
We may also disclose PHI to your pets physicians and the specialists selected by you as well as other health care providers when such PHI is required for them to treat you your pet, receive payment for services they render to your pet, or conduct health care operations such as quality assessment and improvement activities, reviewing the quality and competence of health care professionals, or for health care fraud and abuse detection or compliance. We may disclose and discuss your pets PHI during and after your pet receives services with physicians and other health care providers as well as our employees including all aspects of your pets condition, treatment and content of your pets medical records with our management and staff employees as well as our authorized representatives for various specific purposes such as, quality assurance, utilization review, legal, accreditation, licensure, etc. These disclosures and subsequent discussions of your pets PHI are for quality improvement, hospital management, utilization review, risk management, litigation defense evaluation and preparation, complaint resolution, and other operational purposes.
Appointment Reminders and Call Backs
We may use and disclose medical information to contact you as a reminder that your pet has an appointment at our office. .
Disclosure to Individuals Involved in Your Care or Payment for Your Care
Unless you object, we may release medical information about your pet to a friend or family member who is involved in your pets medical care, if that information is relative to your pets care. We may also give information to someone who helps pay for your pets care. We may provide information to family members, physicians, clergy or others that are involved in your pets medical care. We may disclose medical information about your pet to doctors, nurses, technicians, medical students, or other hospital personnel who are involved in taking care of your pet. We also may disclose medical information about your pet to people outside the hospital who may be involved in your pets medical care after it leaves the hospital, such as physicians, family members, or others we use to provide services that are part of your pets care.
Public Health Activities
We may disclose your pets PHI for the following public health activities: to report health information to public health authorities for the purpose of preventing or controlling disease, injury or disability; to report abuse and neglect to government authorities authorized by law to receive such reports; to report information about products and services under the jurisdiction of the U.S. Food and Drug Administration; to alert a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition; and other public health activities that are required by law.
Health Oversight Activities
We may disclose your pets PHI to a health oversight agency that oversees the health care system and is charged with responsibility for ensuring compliance with the rules of government health programs.
Judicial and Administrative Proceedings
We may disclose your pets PHI in the course of a judicial or administrative proceeding in response to a legal order or other lawful process.
Law Enforcement Officials
We may disclose your pets PHI to the police or other law enforcement officials as required or permitted by law or in compliance with a court order or grand jury or administrative subpoena.
We may disclose your pets PHI to a coroner or medical examiner as authorized by law.
Health or Safety
We may use or disclose your pets PHI to prevent or lessen a serious and imminent threat to a person’s or the public’s health or safety.
Specialized Government Functions
We may use and disclose your pets PHI to units of the government with special functions, such as the U.S. military or the U.S. Department of State, under certain circumstances.
As required by law
We may use and disclose your pets PHI when required to do so by any other federal or state law or regulation listed in the preceding categories.
USES AND DISCLOSURES REQUIRING YOUR WRITTEN AUTHORIZATION
Use or Disclosure with Your Authorization
For any purpose other than the ones described above, we only may use or disclose your pets PHI when you grant us your written authorization.
We must obtain your written authorization prior to using your pets PHI to send you any marketing materials. We can, however, provide you with marketing materials in a face-to-face encounter without obtaining your marketing authorization. We are also permitted to give you a promotional gift of nominal value, if we so choose, without obtaining your marketing authorization. In addition, we may communicate with you about products or services relating to your pets treatment, case management, care coordination, alternative treatments, therapies, providers or care settings without your marketing authorization.
YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION
Right to Inspect and Copy Your Health Information
You may request access to your pets designated record set in order to inspect and/or request copies of the records. Under limited circumstances, we may deny you access to all or a portion of your pets records. All requests for access must be made in writing. If you desire access to your pets records, please obtain a Record Access Form and submit the completed form to our office. If you request copies for non-medical or non-payment related reasons, we will charge you reasonable duplication fees.
Right to Request Additional Restrictions
You may request restrictions on our use and disclosure of your pets PHI for: treatment, payment and health care operations; to individuals (such as a family member, other relative, close personal friend or any other person identified by you) involved with your pets care or with payment related to your pets care; or to notify or assist in the notification of such individuals regarding your pets location and general condition. While we will consider all requests for additional restrictions carefully, we are not required to agree to a requested restriction. If you wish to request additional restrictions, please obtain a request form and submit the completed form to our office.
Right to Receive Confidential Communications
You may request, and we will accommodate, any reasonable written request for you to receive your pets PHI by alternative means of communication or at alternative locations.
Right to Revoke Your Authorization
You may revoke your authorization except to the extent that we have taken action in reliance upon it.
Right to Amend Your Records
You have the right to request that we amend PHI maintained in your pets designated record set. Amendment requests must be submitted in writing and clearly identify the information to be amended, as well as the reasons for the amendment. If you desire to amend your records, please obtain a amendment request form and submit the completed form to our office. We will comply with your request unless we believe that the information to be amended is accurate and complete or other special circumstances apply. In the case of a requested amendment concerning the treatment of a mental illness or developmental disability, you have the right to appeal our decision not to amend your PHI to an Illinois court.
Right to Receive an Accounting of Disclosures
Upon your written request, you may obtain an accounting of certain disclosures of your pets PHI made by us during any period of time prior to the date of your request provided such period does not exceed six years and does not apply to disclosures that occurred prior to April 14, 2003. If you request an accounting more than once during a twelve (12) month period, you will be charged a reasonable cost-based fee.
For Further Information and Complaints
If you desire further information about your privacy rights, are concerned that we have violated your privacy rights or disagree with a decision that we made about access to your pets PHI, you may contact us.
Right to Receive Paper Copy of this Notice
You may obtain a paper copy of this Notice, even if you have agreed to receive such notice electronically.
This Notice is effective immediately.
Right to Change Terms of this Notice
We may change the terms of this Notice at any time. If we change this Notice, we may make the new notice terms effective for all Protected Health Information that we maintain, including any information created or received prior to issuing the new notice. If we change this Notice, we will post the new notice on our Internet site. You also may obtain any new notice by contacting us.