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Our office is permitted by federal privacy laws to
make uses and disclosures of your health information for purposes of
treatment, payment, and health care operations. Protected health information
is the information we create and obtain in providing our services to
you. Such information may include documenting your symptoms, examination
and test results, diagnoses, treatment, and applying for future care
or treatment. It also includes billing documents for those services.
Examples of uses of you health information for treatment purposes
are:
- A nurse obtains treatment information about you and records
it in a health record.
- During the course of your treatment, the physician determines
he/she will need to consult with another specialist in
the area. He/she will share the information with such specialist
and obtain his/her input.
Example of use of your health information for payment purposes:
- We submit requests for payment to your health insurance
company. The health insurance company or business associate
helping us obtain payment requests information from us
regarding your medical care given. We will provide information
to them about you and the care given.
Example of Use of Your Information for Health Care Operations:
- We may obtain services from business associates such
as quality assessment, quality improvement, outcome evaluation,
protocol and clinical guidelines development, training
programs, credentialing, medical review, legal services,
and insurance. We will share information about you with
such business associates as necessary to obtain these services.
Your Health Information Rights
The health and billing records we maintain
are the physical property of the doctor's office. You have
the following rights with respect to your Protected Health
Information:
- Request a restriction on certain uses and disclosures
of your health information by delivering the request in
writing to our office - we are not required to grant the
request but we will comply with any request granted;
- Obtain a paper copy of the Notice of Privacy Practices
for Protected Health Information ("Notice") by making a
request at our office;
- Right to inspect and copy your health record and billing
record - you may exercise this right by delivering the
request in writing to our office using the form we provide
to you upon request; appeal a denial of access to your
protected health information except in certain circumstances;
- Right to request that your health care record be amended
to correct incomplete or incorrect information by delivering
a written request to our office using the form we provide
to you upon request. (The physician or other health care
provider is not required to make such amendments); you
may file a statement of disagreement if your amendment
is denied, and require that the request for amendment and
any denial be attached in all future disclosures of your
protected health information;
- Right to receive an accounting of disclosures of your
health information as required to be maintained by law
by delivering a written request to our office using the
form we provide to you upon request. An accounting will
not include internal uses of information for treatment,
payment, or operations, disclosures made to you or made
at your request, or disclosures made to family members
or friends in the course of providing care;
- Right to confidential communication by requesting that
communication of your health information be made by alternative
means or at an alternative location by delivering the request
in writing to our office using the form we give you upon
request.
If you want to exercise any of the above rights,
please contact Phyllis Kirby, 865-549-7536 for Financial
Information and Janet Gryder, 865-549-7522 for Patient Health Information,
in person or in writing, during normal hours. They will provide
you with assistance on the steps to take to exercise your
rights.
Our Responsibilities
The office is required to:
- Maintain the privacy of your health information as required
by law;
- Provide you with a notice as to our duties and privacy
practices as to the information we collect and maintain
about you;
- Abide by the terms of this Notice;
- Notify you if we cannot accommodate a requested restriction
or request; and
- Accommodate your reasonable requests regarding methods
to communicate health information with you.
- Accommodate your request for an accounting of disclosures.
We reserve the right to amend, change, or eliminate
provisions in our privacy practices and access practices and to enact
new provisions regarding the protected health information we maintain.
If our information practices change, we will amend our Notice. You
are entitled to receive a revised copy of the Notice by calling and
requesting a copy of our "Notice" or by visiting our office and picking
up a copy.
To Request Information or File a Complaint
If you have questions, would like additional
information, or want to report a problem regarding the handling
of your information, you may contact Paul Smith, 865-549-7523.
Additionally, if you believe your privacy rights
have been violated, you may file a written complaint at
our office by delivering the written complaint to Paul Smith, 865-549-7523.
You may also file a complaint by mailing it or e-mailing
it to the Secretary of Health and Human Services whose street address
and e-mail address is 200 Independence Avenue, SW, Washington,
DC 20201. Call toll free 1-877-696-6775 or find e-mail at www.hhs.gov.
- We cannot, and will not, require you to waive the right
to file a complaint with the Secretary of Health and Human
Services (HHS) as a condition of receiving treatment from
the office.
- We cannot, and will not, retaliate against you for filing
a complaint with the Secretary of Health and Human Services.
Following is a List of Other Uses and Disclosures
Allowed by the Privacy Rule
Patient Contact
We may contact you to provide you with
appointment reminders, with information about treatment alternatives,
or with information about other health-related benefits and
services that may be of interest to you. We may contact you
as part of a fund raising effort.
Notification - Opportunity to Agree or Object
Unless you object we may use or disclose
your protected health information to notify, or assist in
notifying, a family member, personal representative, or other
person responsible for your care, about your location, and
about your general condition, or your death.
COMMUNICATION WITH FAMILY
Using our best judgment, we may disclose to a family member, other relative,
close personal friend, or any other person you identify, health information
relevant to that person's involvement in your care or in payment for
such care if you do not object or in an emergency.
We may use and disclose your protected health
information to assist in disaster relief efforts.
Opportunity to Agree or Object Not Required
PUBLIC HEALTH ACTIVITIES
CONTROLLING DISEASE
As required by law, we may disclose your protected health information
to public health or legal authorities charged with preventing or controlling
disease, injury, or disability.
CHILD ABUSE & NEGLECT
We may disclose protected health information to public authorities as
allowed by law to report child abuse or neglect.
FOOD AND DRUG ADMINISTRATION (FDA)
We may disclose to the FDA your protected health information relating
to adverse events with respect to food, supplements, products and product
defects, or post-marketing surveillance information to enable product
recalls, repairs, or replacements.
VICTIMS OF ABUSE, NEGLECT, OR DOMESTIC VIOLENCE
We can disclose protected health information to governmental authorities
to the extent the disclosure is authorized by statute or regulation
and in the exercise of professional judgment the doctor believes the
disclosure is necessary to prevent serious harm to the individual or
other potential victim.
OVERSIGHT AGENCIES
Federal law allows us to release your protected health information to
appropriate health oversight agencies or for health oversight activities
to include audits, civil, administrative or criminal investigations:
inspections; licensure or disciplinary actions, and for similar reasons
related to the administration of healthcare.
JUDICIAL/ADMINISTRATIVE PROCEEDINGS
We may disclose your protected health information in the course of any
judicial or administrative proceeding as allowed or required by law,
or as directed by a proper court order or administrative tribunal,
provided that only the protected health information released is expressly
authorized by such order, or in response to a subpoena, discovery request
or other lawful process.
LAW ENFORCEMENT
We may disclose your protected health information for law enforcement
purposes as required by law, such as when required by court order,
including laws that require reporting of certain types of wounds or
other physical injury.
CORONERS, MEDICAL EXAMINERS AND FUNERAL DIRECTORS
We may disclose your protected health information to funeral directors
or coroners consistent with applicable law to allow them to carry out
their duties.
ORGAN PROCUREMENT ORGANIZATIONS
Consistent with applicable law, we may disclose your protected health
information to organ procurement organizations or other entities engaged
in the procurement, banking, or transplantation of organs, eyes, or
tissue for the purpose of donation and transplant.
RESEARCH
We may disclose information to researchers when their research has been
approved by an institutional review board that has reviewed the research
proposal and established protocols to ensure the privacy of your protected
health information.
THREAT TO HEALTH AND SAFETY
To avert a serious threat to health or safety, we may disclose your protected
health information consistent with applicable law to prevent or lessen
a serious, imminent threat to the health or safety of a person or the
public.
FOR SPECIALIZED GOVERNMENTAL FUNCTIONS
We may disclose your protected health information for specialized government
functions as authorized by law such as to Armed Forces personnel, for
national security purposes, or to public assistance program personnel.
CORRECTIONAL INSTITUTIONS
If you are an inmate of a correctional institution, we may disclose to
the institution or it's agents the protected health information necessary
for your health and the health and safety of other individuals.
WORKERS COMPENSATION
If you are seeking compensation through Workers Compensation, we may
disclose your protected health information to the extent necessary
to comply with laws relating to Workers Compensation.
OTHER USES AND DISCLOSURES
Other uses and disclosures besides those identified in this Notice will
be made only as otherwise authorized by law or with your written authorization
which you may revoke except to the extent information or action has
already been taken.
Effective Date: April 14th, 2003.
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