THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Introduction This Notice of Health Information Practices describes the personal information we collect, and how and when we use or disclose that information. It also describes your rights as they relate to your protected health information.

Understanding your Health Record/Information Each time you visit HAROLD F. LEEPER, M.D., Ph.D., INC., a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnosis, treatment, and a plan for future care or treatment. This information, often referred to as your health or medical record serves as a:

  • Basis for planning your care and treatment,
  • Means of communication among the many health professionals who contribute to your care,
  • Legal document describing the care you received,
  • Means by which you or a third-party payer can verify that services billed were actually provided,
  • Tool in educating health professionals,
  • Source of data for medical research,
  • Source of information for public health officials charged with improving the health of this state and the nation,
  • Tool with which we can assess and continually work to improve the care we render and the outcomes we achieve.
  • Understanding what is in your record and how your health information is used helps you to: ensure its accuracy, better understand who, what, when, where, and why others may access your health information, and make more informed decisions when authorizing disclosure to others.

    Your Health Information Rights

    Although your health record is the physical property of HAROLD F. LEEPER, M.D., Ph.D., INC., the information belongs to you. You have the right to:

  • Obtain a paper copy of this notice of information practices upon request,
  • Inspect and copy your health record as provided for in 45 CFR 164.524,
  • Amend your health record as provided in 45 CFR 164.528,
  • Obtain an accounting of disclosures of your health information as provided in 45 CFR 164.528,
  • Request communications of your health information by alternative means or at alternative locations,
  • Request a restriction or certain uses and disclosures of your information as provided by 54 CFR 164.522, and
  • Revoke your authorization to use or disclose health information except to the extent that action as already been taken.
  • Other Responsibilities
    HAROLD F. LEEPER, M.D., Ph.D., INC., is required to:

  • Maintain the privacy of your health information,
  • Provide you with this notice as to our legal duties and privacy practices with respect to information we collect and maintain about you.
  • Abide by the terms of this notice,
  • Notify you if we are unable to agree to a requested restriction, and
  • Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.
  • We reserve the right to change our practices and to make the provisions effective for all protected health information we maintain. Should our information practices change, we will mail a revised notice to the address you have supplied to us, or if you agree, we will email the revised notice to you. We will not use or disclose your health information without your authorization, except as described in this notice. We will also discontinue to use or to disclose your health information after we have received written revocation of the authorization according to the procedures included in the authorization.

    For More Information or to Report a Problem If you have questions and would like additional information, you may contact the practice's Privacy Officer, Linda Shaver, at (304) 234-2020. If you believe your privacy rights have been violated, you can file a complaint with the practice's Privacy Officer, or with the Office for Civil Rights, U. S. Department of Health and Human Services. There will be no repercussion for filing a complaint with either the Privacy Officer or the Office for Civil Rights. The address for the ORC is listed below:
    Office for Civil Rights
    U.S. Department of Health and Human Services
    200 Independence Avenue, S. W.
    Room 509F, HHH Building
    Washington, D. C. 20201

    Examples of Disclosures for Treatment, Payment and Health Operations

    We will use your health information for treatment. For example: Information obtained by a nurse, physician, or other member of your health care team will be recorded in your record and used to determine the course of treatment that should work best for you. Dr. Leeper will document in your record his expectations of the members of your health care team. Members of your health care team will then record the actions they took and their observations. In that way, the physician will know how you are responding to treatment. We will also provide your physician or a subsequent health care provider with copies of your various reports that should assist him or her in treating you.

    We will use your health information for payment.

    For example: A bill may be sent to you or to a first, second or third-party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.

    Business associates: There are some services provided in our organization through contacts with business associates. Examples include physician services in the emergency department, radiology, and certain laboratory tests. When these services are contracted, we may disclose your health information so that they can perform the health care services that we have asked them to perform. To protect your health information, however, we require that the business associate appropriately safeguard your information.

    Notification: We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location and general condition.

    Communication with family: Dr. Leeper and or his staff, using their best judgment, 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 payment related to your care.

    Workers' compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers' compensation or other similar programs established by law.

    Public health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.

    Law enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.

    Federal law makes provisions for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers, or the public.