HIPAA Privacy Notice

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

This notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment or health care operations (TPO) and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected heath information.

“Protected Health Information” or PHI is information about you that may identify you and relates to your past, present or future physical or mental health or condition and related health services.

Uses and Disclosures
MD2U is permitted to use and disclose your PHI for treatment, payment and health care operation of the Practice. For examples, MD2U may disclose your PHI to other physicians to facilitate treatment and MD2U may use PHI about you so we may bill and collect payment from an insurance company, health plan or other third party payer. We may disclose your PHI to review treatment and services to evaluate performance of MD2U staff and other management and administrative purposes. In addition, MD2U may use or disclose your PHI which is incident to a permitted use or disclosure.

Mandatory (with out consent of patient) Uses and Disclosures
We may use or disclose your PHI in the following situations without your authorization. These situations include:

By MD2U for training or to defend itself in a legal action or other proceeding brought by you or if required by law.
For public heath activated, social service or protective service agencies and to ha heath oversight agency for oversight activities. For example reporting communicable disease, abuse or neglect or criminal activity.

In the course of any judicial or administrative proceeding and for law enforcement purposes.
For identifying a deceased person and to organ procurement organizations. For example reporting to a coroner, funeral director and organ donation.

As authorized to comply with laws relating to workers’ compensation or similar programs that provides benefits for workplace injuries.

Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500. Other permitted and required uses and disclosures will be made only with your consent, authorization or opportunity to object unless required by law. You may revoke this authorization, at any time in writing except to the extent that your physician or the physician’s practice has taken an action in reliance on the use or discourse indicated in the authorization.

HIPAA Notice of Privacy Practices
Phone: 502-327-9100
8902 Denington Drive
Louisville, KY 40222

Optional Uses and Disclosures
MD2U may use and disclose your PHI in the following instances. In each of these examples, you have the opportunity to agree or prohibit or restrict the use or disclosure. If you are not present or able to agree or object to the use or disclosure MD2U may determine whether the disclosure is in your best interest. Emergency disclosures may also be made due to your incapacity or emergency treatment situation. Disclosure will be consistent with your prior expressed preference and in your best interest as deterred by MD2U.

Facilities Directory-Unless you object, MD2U will use and disclose certain PHI to maintain a directory of patients.

Family Members-Unless you object, MD2U will disclose certain PHI to a family member, other relative, close friend, or other person you identify. Such information disclosed will be directly relevant to such person’s involvement with your health care and well being. If you are unable or unavailable to agree or object, MD2U may disclose information as necessary if we determine it is in your best interest. MD2U may use or disclose information to notify, or assist in the notification of a family member, your personal representative or other responsible person for your care, your address or phone number, general condition or death.

Business Associates
MD2U will share and disclose your health information with third party “business associates” which perform various activities on behalf of you the patient and MD2U (for example, billing, collections, network and software services, laboratory testing and imaging).

Treatment
We will use and disclose your PHI to provide, manage and coordinate your health care and any related services. This includes the coordination or management of your health care with a third party. For example, we would disclose your PHI to a laboratory for testing or a radiology group to order imaging. We may also disclose your PHI to another physician (specialist) whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.

Your Rights
Following is a statement of your rights with respect to your protected health information. You have the right to inspect and copy your protected health information. Under federal law, however, you may not inspect or copy the following records; psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action of proceeding, and protected health information that is subject to law that prohibits access to protected health information. You have the right to request a restriction of you protected health information. This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want that restriction to apply.

Your physician is not required to agree to a restriction that you may request. If physician believes it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted. You then have the right to use another Healthcare Professional.

You have the right to request to receive confidential communication from us by alternative location. You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice alternatively i.e. electronically.

You may have the right to have your physician amend your protected health information. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you a copy of any such rebuttal. You have the right to receive and accounting of certain disclosures we have made, if any, of your protected health information.

We reserve the right to change the terms of this notice and will inform you by mail of any charges. You then have the right to object or withdraw as provided in this notice.

Complaints
You may complain to us or the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our privacy contact of your complaint. We will not retaliate against you for filing a complaint.

This notice was published and becomes effective on/or before April 14, 2003. We are required by law to maintain the privacy of, and provide individuals with, this notice of our legal duties and privacy practices with respect to protected health information. If you have any objections to this form, please ask to speak with our HIPAA Compliance Officer, Debbie Wagner, in person or by phone at our Main Phone Number.