• Notice of Privacy Practices
  • Patient Rights and Responsibilities
  • No Show Policy
  • Whitefoord Promise

Notice of Privacy Practices

  • THIS NOTICE DESCRIBES HOW PROTECTED MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE, PLEASE REACH OUR PRIVACY ADMINISTRATOR AT (404) 373.2282:
  • Whitefoord Inc. Health Centers are required by law to maintain the privacy of confidential information. The practice is required to abide by this Notice currently in effect; however, we reserve the right to change the terms of the Notice and to make the new provisions effective for all confidential information that it maintains. The confidentiality of your personal health information is important to us. As physicians, we rely on you to provide us with complete and accurate information about your condition, symptoms, and health history, which help us to provide you care and treatment. We appreciate how you trust us with this personal health information. We want you to know about the privacy practices in our office that are intended to safeguard the use and disclosure of your Protected Health Information.
  • We want you to know you to know about HIPAA’s Privacy Rule and the terms used in our Notice of Privacy Practices:
  • HIPAA means Health Insurance Portability and Accountability Act. On August 14, 2002, The Department of Health and Human Services issued the HIPAA Privacy Rule, which describes how Protected Health Information may be used and properly disclosed.
  • “Protected Health Information” means information about you, including your past, present, and future medical condition, treatment of your medical condition, and payment for your medical treatment. This information includes demographic information that may identify you.
  • “Use” means how we (physicians and staff) properly share, employ, examine, utilize or analyze Protected Health Information internally within our office.
  • “DISCLOSE” means how we (physicians and staff) properly release, transfer, divulge, or provide access to Protected Health Information to an outside person or entity such as another doctor, hospital, or insurance company.
  • “Designated Record Set” means medical and billing records created and maintained by our office for treatment and payment.
  • Whitefoord Inc. Health Centers privacy practices for use and disclosure of your Protected Health Information is based upon your consent. You will be asked by your physician to sign a consent form regarding the use and disclosure of your Protected Health Information. As permitted by HIPPA’s Privacy Rule, we will use and disclose Protected Health Information for the purpose of providing health care services to you, acquiring payment for your health care bills, and providing support to the operations of the physician practice.
  • Whitefoord Inc. Health Centers is permitted to make uses and disclosures of protected health information for treatment, payment and health care operations, as described in the following examples. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may occur.
  • Treatment: We will use Protected Health Information to provide, coordinate, or manage your health care. For example, your Protected Health Information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you. We will also disclose Protected Health Information to other health care providers, hospitals, and facilities that are providing or coordinating your treatment.
  • Payment: We will use Protected Health Information, as needed, to obtain payment for health care services. This may include specific information that your health care plan may require before it approves or pays for the health care services that we recommend for you, such as determination of eligibility or coverage for insurance benefits, medical necessity, pre-certification requirements, and undertaking utilization review activities. In addition, we will disclose your Protected Health Information when we submit a claim to your plan for payment of the treatment we provided to you.
  • Health Care Operations: We will use or disclose, as needed, your Protected Health Information to support business activities of the practice. For example, we may call you by name in the reception area when the physician is ready to see you. We may use your Protected Health Information to contact you to remind you of an appointment. Your name and address may be used to send you a notice about services. We may use your Protected Health Information for internal auditing and quality assessment activities. We may use your Protected Health Information, as necessary with third party “business associates” that perform various activities (e.g. collection agencies, transcription services) for the practice. Whenever an arrangement between our office and a business associate involves the use of a disclosure of your Protected Health Information, we will have a written contract that contain terms that will protect the privacy of your Protected Health Information.
  • Whitefoord Inc. Health Centers required, under specific circumstances, to use or disclose protected health information without the individual’s written authorization. Other uses and disclosures will be made only with the individual’s written authorization, and the individual may revoke such authorization.
  • The individual has the following rights regarding protected health information:
  • The right to request restrictions on certain uses and disclosures of Protected Health Information, as applicable. Whitefoord Inc. Health Centers is not required to agree to a requested restriction however;
  • The right to receive confidential communications of Protected Health Information, as applicable. Our general policy is to contact you by telephone at your home telephone number or by mail at your home address. If we contact you by telephone, we will simply identify our office and ask to speak to you. We will leave a message with the person answering the phone or answering machine by identifying our office and telephone number and requesting that you return our call, but we will not disclose any Protected Health Information. You have the right to request that we communicate with you confidentially by alternative means or locations. Our policy is to honor all reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. We will not request an explanation from you as to the basis for the request.
  • The right to inspect and copy Protected Health Information as provided in the Privacy Regulation. This means you may inspect and obtain a copy of health information about you that is contained in a designated set of records for as long as we maintain the Protected Health Information. A “designated record set” contains medical and billing records and any other records that your physician and practice may use for making decisions about you. Under federal law, you may not inspect or copy the following record; psychotherapy notes; information compiled in reasonable anticipation of, or use in civil, criminal, or administrative action or proceeding, and Protected Health Information that is subject to law that prohibits access to Protected Health Information. You may request access to your Protected Health Information by completing the “Request for Access” form. Our practice is to consider all requests according to our legal responsibilities under the Privacy Rule. We will act on your request within 30 days for the time we receive the completed form. If we are able to grant your request, we will contact your to arrange a time for you to inspect your Protected Health Information. Under the Privacy Rule, we charge you copying costs (supplies and labor) and postage.
  • The right to amend Protected Health Information, as provided in the Privacy Regulation. You may request to amend your Protected Health Information by competing the “Request to Amend” form. We will provide a written response to your request within 30 days from the time we receive your completed form. We will honor your request if Protected Health Information is incorrect or incomplete. We may not, under the HIPAA Privacy Rule, amend Protected Health Information if it is not a part of the designated record set; if it would not be available to inspect, or if the information is accurate and complete. For example, if you record mistakenly indicates that you received treatment for a pain and swelling in your right hand when, in fact your treatment was for pain and swelling in your right foot, clearly that information should be amended. If, however, you want to delete a reference contained in the history that you told the doctor that you were feeling “depressed”, it would not be appropriate to delete that reference from the Protected Health Information because it accurately reflected the information you gave the doctor. If we accept the requested amendment, we will: (1) amend the Protected Health Information in the designated record set, (2) inform you we have made the amendment and (3) notify persons who have received and may relied on Protected Health Information that was amended. If we deny your request to amend Protected Health Information, we will (1) notify you in writing of the basis for that denial; (2) inform you of your right to submit a written statement of disagreement which we will maintain with your record and will include with future disclosures requested; (3) inform you of your right to file a complaint. If you file a written statement of disagreement, we may prepare a rebuttal statement.
  • The right to receive an accounting of disclosure of Protected Health Information we have made. That right is limited and does not require us to provide you with an accounting of disclosure for:  (1) treatment, payment, and healthcare purpose; (2) disclosures made to your or your legal representative on your behalf;  (3) disclosures made in accordance with a written authorization you signed; or (4) disclosures made before April 14, 2003.  To request an accounting of disclosures, please complete the “Request for Accounting”.
  • As a patient, you have the right to:
    • take part in your health care and treatment
    • know the names of the people caring for you
    • be treated with respect and dignity in a safe and private setting
    • be informed about your illness and treatment, including options for your care
    • change medical providers at Primary Health Care, Inc.
    • get another opinion about your illness or treatment
    • privacy of your health records
    • talk with the clinic manager about any questions or problems with your care
    • know about services available through PHC
    • respect for your cultural, social, spiritual and personal values and beliefs
    • know about legal reporting requirements
    • ask for special arrangements if you have a disability
    • ask for help with a living will or durable power of attorney for health care
    • refuse treatment, care and services as allowed by law
    • know the cost of your care and ways you may pay for your care
    • refuse to be included in any research program without limiting medical care or treatment

 

  • As a patient, you have the responsibility to:
    • tell your medical provider about your illness or problems
    • ask questions about your illness or care
    • show respect to both care givers and other patients
    • cancel or reschedule appointments so that another person may have that time slot
    • pay your bills on time
    • use medications or medical devices for yourself only
    • inform the medical provider if you become worse or you have an unexpected reaction to a medication
    • give written permission to release your other health records to Primary Health Care, Inc. when necessary

provide PHC a copy of your living will or durable power of attorney for healthcare matters

  • It is the goal and priority of Whitefoord Inc. Health Centers to facilitate consistent access to quality care for all patients. Patients are encouraged to participate in and accept responsibility for their own health care, by making and keeping scheduled appointments.Patients are notified in advance with a reminder of their scheduled appointments.
  • If it is necessary to cancel an appointment, patients are required to call or leave a message at least 24 hours before their appointment time.
  • In addition, if a patient is more than 15 minutes late for a scheduled appointment, they are considered a no show.
  • If a patient is a no show for their scheduled appointment, their appointment will be set for another time during that day or scheduled on another day based on the availability in the clinic schedule.

Patients that have a history of repeated missed appointments (generally defined as 3 consecutive or 5 or more no shows in a 12 month time period) may be subject to access to Same Day or Walk-In appointments only.

Whitefoord Inc. Health Centers promise to:

  • Serve all patients
  • Offer discounted fees for patients who qualify
  • Not deny services based on a person’s:
    • Race
    • Color
    • Sex
    • National origin
    • Disability
    • Religion
    • Sexual orientation
  • Accept insurance, including:
    • Medicaid
    • Medicare
    • Children’s Health Insurance Program (CHIP)