Therapeutic Pain Management Medical Clinic (TPM) Privacy Policy
Your Personal Information, Privacy, and Medical Records
This clinic, in order to evaluate
and treat you here as a patient, collects certain information about you and
your health. The use and distribution of
this information is governed by regulatory standards, including HIPAA (Healthcare
Insurance Portability and Accountability Act of 1996).
What information does
this clinic (TPM) collect from you?
Some of the information
collected includes your Name, Age, Date of Birth, Tel Numbers, address, Social
Security Number, information about your health, work, employment, family,
medication use, diagnostic data, health insurance, email address, digital
facial photographs.
From where do we collect
information about you?
The information is obtained
from you, your referring physician and other related healthcare providers,
insurance carriers, pharmacies, and diagnostic facilities – where you have been
evaluated medically.
What is the purpose of
the information collected?
The information is used for:
Evaluation and
treatment at this clinic
Identifying a
particular patient to locate him/her within waiting areas
Discussing diagnosis
and treatment plan with staff and other health providers at TPM
Discussing diagnosis
and treatment with your family members or guardian
Referring you for
further diagnostic studies (X-Ray, MRI, CAT Scan, Blood Work etc)
Referral to other
providers such as Consultants, Physical Therapists, Surgeons, Psychologists etc
Calling in, Faxing, or
confirming prescriptions to pharmacies
Billing and collection
firms’ use
Sending reports to your
attorney, insurers, nurse case manager, W/C adjuster
Dictation transcribing
companies’ use
Sending information to
other persons or firms where you have signed a valid “Release of Information”
How is this information
stored?
The information is stored in
paper charts and in computers at TPM.
How do you transfer
this information to others?
It is shared via Fax, E-Mail,
Mail, Telephone, Internet, and personal communications. We share as minimum information as possible
for an appropriate use.
Do you sell the
information to any one?
TPM does not to provide, or
sell, or market the information to any one, including commercial firms for
marketing reasons.
With whom do we share
your information?
The copies of reports
generated by this clinic (such as initial consultation, follow-up visits,
results of diagnostic tests ordered by us) during your treatment here are routinely
sent to your referring physician, your primary care physician and in case of
work comp, to your adjuster, and to our billing firm “EMMI”. Some of the consultation and procedure reports
are also sent to the facilities where we perform the procedures for their
records and billing purpose.
If this information
further forwarded to any one?
Usually most of the insurance
companies ask for copies of consultation reports and procedure reports in order
for them to make payments or authorize further treatments to us. At their request, we forward them the
necessary reports.
Do you keep a log of
data disclosure by your office?
As of January 01, 2003, a log
will be kept of all non-routine disclosure in your file.
What security
precautions are in place to protect against the loss, misuse, or alteration of
your information?
Your information is stored in
computers as well as in your chart as a hard copy paper chart. The computers and some of the databases are
password protected and the data is constantly backed up. Our Internet connection uses firewall and the
transcription system servers are secured and use 128bit encryption. The employees are trained regarding privacy
rules.
How can you update or
correct your Information?
We believe you should have the
ability to access and edit the personal information that you have provided to
us. Please contact the Privacy Officer
at TPM for further information. In
addition, as a security measure, we "back up" the data stored on our
systems, and such prior information cannot be completely removed from our
databases. As a result, you should not expect that all of your Information will
be completely removed from our backed-up databases.
Can you update or correct
any information you desire?
We
may deny your request for an amendment if it is not in writing or does not
include a reason to support the request.
In addition, we may deny your request if you ask us to amend information
that: a) We did not create, unless the person or entity that created the
information is no longer available to make the amendment. b) Is not part of the
health information that we keep. c) You would not be permitted to inspect and
copy. d) Is accurate and complete.
How can I restrict use
and disclosure of my information?
You have the right to request
a restriction or limitation on the health information we use or disclose about
you for treatment, payment, or health care operations. You also have the right
to request a limit on the health information we disclose about you to someone
who is involved in your care or the payment for it, like a family member or
friend. We are not required to agree to
your request If we do agree; we will comply with your request unless the
information is needed to provide you emergency treatment. To request restrictions, you may complete and
submit the Request for Restriction on
Use/Disclosure Of Medical Information.
How can I obtain a copy
of my medical records?
A written request is
required. You may fill out a request for
copies of the medical records at the clinic or send us a similar Medical
Records Release form. Once we receive
the request and the required fees, it takes about 48 hours for the copies to be
available.
Are there any charges
for the copies of the medical records?
We send some of the
information to other treating physicians at no charge as a courtesy. However, if you wish to obtain a copy of your
medical records, the charge is $ 25 flat fee for paper copies. If you also like to have your records in a
digital format (Adobe Acrobat PDF) on a CD-ROM, there is an extra $ 10 charge
and 7 days processing time. We accept
cash or checks only.
What is included in the
copies of medical records?
Only the reports generated by
this office (such as consultation reports, procedure reports) and the results
of diagnostic tests ordered by this office are included. Any other data in your file, which is a copy
of data from other sources, is not included.
How can I obtain a copy
of disclosure log?
A written request is
required. You may fill out a request for
a disclosure log at the clinic or send us a form. Once we receive the request, it takes about
48 hours for the log to be available.
There is no fee for a copy of the log.
Privacy Policy changes
This Privacy Policy was last
changed on August 20, 2002. If TPM makes changes to any terms or conditions of
the Privacy Policy, the changes will be posted in this document so that you
will always know what information we gather, how we might use that information
and to whom we will disclose it. We may
change, modify, add, or remove portions of this Policy at any time, and any
changes will become effective immediately upon being posted unless we tell you
otherwise.
Contacting TPM about
privacy questions or concerns
If you have any questions
about this Privacy Policy, the practices of this clinic, or your dealings with
this clinic, please contact TPM Privacy Officer at this clinic. You may write us at:
Attn:
Privacy Compliance Officer
TPM
Medical Clinic
1335
Buenaventura Blvd., Suite 100
Redding, CA 96001