Consumer Notices
Centers for Medicare & Medicaid Services
Notice of Open Payments Database
For informational purposes only, a link to the federal Centers for Medicare and Medicaid Services (CMS) Open Payments web page is provided here. The federal Physician Payments Sunshine Act requires that detailed information about payment and other payments of value worth over ten dollars ($10) from manufacturers of drugs, medical devices, and biologics to physicians and teaching hospitals be made available to the public. External link: https://openpaymentsdata.cms.gov/
Health Insurance Portability and Accountability Act
Notice of HIPAA Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND/OR DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.PLEASE REVIEW IT CAREFULLY.
USES AND DISCLOSURES
This Notice of Privacy Practices is NOT an authorization. It describes how David Crabtree, MD may use and disclose your Protected Health Information to carry out treatment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your Protected Health Information. Protected Health Information is information that identifies you individually, including demographic information that relates your past, present, or future physical or mental health condition and related health care services.
OF YOUR PROTECTED HEALTH INFORMATION
David Crabtree, MD may use and disclose your Protected Health Information in the following situations:
· Treatment: To provide medical treatment and/or services to manage and coordinate your medical care. For example, your medical information may be shared with other physicians and health care providers, DME vendors, surgery centers, hospitals, rehabilitation therapists, home health providers, laboratories, nurse case managers, worker’s compensation adjusters, etc. to ensure that medical providers have the necessary medical information to diagnose and provide treatment to you.
· Health Care Operations: To manage, operate, and support the business activities of the practice. These activities include, but are not limited to, quality assessment, employee review, licensing, fundraising, and conducting or arranging for other business activities. Your information may be used to contact you to remind you of appointments and inform you about treatment alternatives or other health-related benefits and services that may be of interest to you.
· Minors: Protected Health Information of minors may be disclosed to their parents or legal guardians, unless prohibited by law.
· As required by Law: In accordance with and when required to do so by local, state, federal, and international laws.
· Abuse, Neglect, & Domestic Violence: Your Protected Health Information will be disclosed to the appropriate government agency if there is belief that a patient has been or is currently the victim of abuse, neglect, or domestic violence and the patient agrees or it is required by law to do so. In addition, your information may also be disclosed when necessary to prevent a serious threat to your health or safety or the health and safety of others to someone who may be able to help prevent the threat.
· Judicial & Administrative Proceedings: As sometimes required by law, your Protected Health Information may be disclosed for the purpose of litigation to include: disputes and lawsuits; in response to a court or administrative order; to a subpoena; request for discovery; or other legal processes. However, disclosure will only be made if efforts have been made to inform you of the request or obtain an order protecting the information requested. Your information may also be disclosed if required for legal defense in the event of a lawsuit.
· Law Enforcement: Protected Health Information may be disclosed for law enforcement purposes when all applicable legal requirements have been met. This includes, but is not limited to, law enforcement due to identifying or locating a suspect, fugitive, material witness or missing person, complying with a court order or warrant, and grand jury subpoena.
· Coroners and Medical Examiners: Protected Health Information may be disclosed to coroners and medical examiners to assist in the fulfillment of their work responsibilities and investigations.
· Public Health:Protected Health Information may be disclosed and may be required by law to be disclosed for public health risks. This includes: reports to the Food and Drug Administration (FDA) for the purpose of quality and safety of an FDA-regulated product or activity; to prevent or control disease; report births and deaths; report child abuse and/or neglect; reporting of reactions to medications or problems with health products; notification of recalls of products; reporting a person who may have been exposed to a disease or may be at risk of contracting and/or spreading a disease or condition.
· Health Oversight Activities: Protected Health Information may be disclosed to a health oversight agency for audits, investigations, inspections, licensures, and other activities as authorized by law.
· Inmates: If you are or become an inmate of a jail/prison or under the custody of the law, I may disclose Protected Health Information to the facility if the disclosure is necessary for your institutional health care, to protect your health and safety, or to protect the health and safety of others within the facility.
· Military, National Security, & other Specialized Government Functions: If you are in the military or involved in national security or intelligence, I may disclose your Protected Health Information to authorized officials.
· Practice Ownership Change: If my medical practice is sold, acquired, or merged with another entity, your Protected Health Information will become the property of the new owner. However, you will still have the right to request copies of your records and have copies transferred to another physician.
· Breach Notification Purposes: If for any reason there is an unsecured breach of your Protected Health Information, David Crabtree, MD will utilize the contact information you have provided to notify you of the breach, as required by law. In addition, your Protected Health Information may be disclosed as a part of the breach notification and reporting process.
· Research: Your Protected Health Information may be disclosed to researchers for the purpose of conducting research when the research has been approved by an Institutional Review or Privacy Board and in compliance with law governing research.
· Business Associates: Protected Health Information may be disclose to business associates who provide services necessary to operate the medical practice. Only the minimum information necessary is disclosed for the associate(s) to perform their functions as it relates to business operations. Please know and understand that all business associates are obligated to comply with the same HIPAA privacy and security rules.
USES & DISCLOSURES IN WHICH YOU HAVE THE RIGHT TO OPT OUT
· Communication with family and/or individuals involved in your care or payment of your care: Unless you object, disclosure of your Protected Health Information may be made to a family member, friend, or other individual involved in your care or payment of your care in which you have identified.
PROTECTED HEALTH INFORMATION AND YOUR RIGHTS
The following are statements of your rights, subject to certain limitations, with respect to your Protected Health Information:
· You have the right to inspect and copy your Protected Health Information (reasonable fees may apply): Pursuant to your written request, you have the right to inspect a copy your Protected Health Information in paper or electronic format. Under federal law, you may not inspect or copy the following types of records: psychotherapy notes, information compiled as it relates to civil, criminal, or administrative action or proceeding; information restricted by law; information related to medical research in which you have agreed to participate; information obtained under a promise of confidentiality; and information whose disclosure may result in harm or injury to yourself or others. David Crabtree, MD has up to 30 days to provide the Protected Health Information and may charge a fee for the associated costs of printing and/or shipping.
· You have a right to a summary or explanation of your Protected Health Information: You have the right to request only a summary of your Protected Health Information if you do not desire to obtain a copy of your entire record. You also have the option to request an explanation of the information when you request your entire record.
· You have the right to obtain an electronic copy of medical records: You have the right to request an electronic copy of your medical record for yourself or to be sent to another individual or organization when your Protected Health Information is maintained in an electronic format. We will make every attempt to provide the records in the format you request; however, in the case that the information is not readily accessible or producible in the format you request, we will provide the record in a standard electronic format or a legible hard copy form. Record requests may be subject to a reasonable, cost-based fee for the work required in transmitting the electronic medical records.
· You have the right to receive a notice of breach: In the event of a breach of your unsecured Protected Health Information, you have the right to be notified of such breach.
· You have the right to request Amendments: At any time if you believe the Protected Health Information on file for you is inaccurate or incomplete, you may request that the record be amended. Your request for an amendment must be submitted in writing and detail what information is inaccurate and why. Please note that a request for an amendment does not necessarily indicate the information will be amended.
· You have a right to receive an accounting of certain disclosures: You have the right to receive an accounting of disclosures of your Protected Health Information. An “accounting” being a list of the disclosures that have been made of your information. The request can be made for paper and/or electronic disclosures and will not include disclosures made for the purposes of: treatment; payment; health care operations; notification and communication with family and/or friends; and those required by law.
· You have the right to request restrictions of your Protected Health Information: You have a right to restrict and/or limit the information I disclose to others, such as family members, friends, and individuals involved in your care or payment for your care. You also have the right to limit or restrict the information used or disclosed for treatment, payment, and/or health care operations. Your request must be submitted in writing and include the specific restriction requested, whom you want the restriction to apply, and why you would like to impose the restriction. Please note that David Crabtree, MD is not required to agree to your request for restriction except for a restriction requested to not disclose information to your health plan for care and services in which you have paid in full out-of-pocket.
· You have a right to request to receive confidential communications: You have a right to request confidential communications from me by alternative means or at an alternative location. For example, you may designate I send mail only to an address specified by you which may or may not be your home address. You may indicate I should only call you on your work phone or specify which telephone numbers I am allowed or not allowed to leave messages on. You do not have to disclose the reason for your request; however, you must submit a request with specific instructions in writing.
· You have a right to receive a paper copy of this notice:Even if you have agreed to receive an electronic copy of this Privacy Notice, you have the right to request we provide it in paper form. You may make such a request at any time.
CHANGES TO THIS NOTICE
David Crabtree, MD reserves the right to change the terms of this notice and will notify you of such changes. Copies will be made available of a new notice if you wish to obtain one. We will not retaliate against you for filing a complaint.
COMPLAINTS
If at any time you believe your privacy rights have been violated and you would like to register a complaint, you may do so with David Crabtree, MD or with the Secretary of the United States Department of Health and Human Services.
If you wish to file a complaint with David Crabtree, MD, please submit it in writing to the office.
If you wish to file a complaint with the Secretary of the United States Department of Health and Human Services, please go to the website of the Office for Civil Rights (www.hhs.gov/ocr/hipaa/), call 202-619-0257 (toll free 877-696-6775), or mail to:
Secretary of the US – Department of Health and Human Services, 200 Independence Ave S.W., Washington, D.C. 20201.
Medical Board of California
Notice: Medical doctors are licensed and regulated by the Medical Board of California. To check up on a license or to file a complaint go to: www.mbc.ca.gov, email licensecheck@mbc.ca.gov, or call (800) 633-2322.