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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.

Your health information is personal and we are committed to protecting it. Your health information is also very important to our ability to provide you with quality care, and to comply with certain laws. This Notice applies to all records about your care that are kept at our facility, whether the records are made by us or other healthcare providers.

I. We Are Legally Required to Safeguard Your Protected Health Information.
We are required by law to:

  • A. Maintain the privacy of your health information, also known as “protected health information”
    or “PHI;”
  • B. Provide you with this Notice, and
  • C. Comply with this Notice


II. Future Changes to Our Practices and this Notice
We reserve the right to change our privacy practices and to make any such change applicable to the PHI we obtained about you before the change. If a change in our practices is material, we will revise this Notice to reflect the change. You may obtain a copy of any revised Notice by contacting the Privacy Officer at (970) 298-2482. We will also make any revised Notice available at our check-in counter.


III. How We May Use and Disclose Your Protected Health Information
The law requires us to have your written authorization for some uses and disclosures. In other circumstances, the law allows us to use or disclose PHI without your written authorization. Section III gives examples of each of these circumstances.

A. Uses and Disclosures for Treatment, Payment and Health Care Operations
We may use or disclose your PHI to provide treatment to you. For example, we may disclose your PHI to physicians, nurses, and other health care personnel who are involved in your care. We may also use and disclose your PHI to contact you as a reminder that you have an appointment for treatment at our facility, to tell you about or recommend possible treatment options or alternatives, or about health-related benefits or services that may interest you.

We may also use or disclose your PHI to your insurance carrier in order to get paid for the treatment provided to you. For example, we may use your PHI to create the bills that we submit to the insurance company, or we may disclose certain portions of your PHI to our business associates who perform billing and claims processing services to us.

We may also use or disclose your PHI in order to operate this facility. For example, we may use your PHI to evaluate the quality of care you received from us, or to evaluate the performance of those involved with your care. We may also provide your PHI to our attorneys, accountants and other consultants to make sure we are complying with the laws that affect us.

Western Slope Cardiology, PC
Effective September 2013


B. Uses and Disclosures That Require Us to Give You the Opportunity to Object

If you do not object, we may include your name, location in our facility, and general condition when responding to requests by those who ask for you by name. Unless you object we may provide relevant portions of your PHI to a family member, friend, or other person you indicate that is involved in your health care or in helping you get payment for your health care. In an emergency or when you are not capable of agreeing or objecting to these disclosures, we will disclose PHI as we determine is in your best interest, but will tell you about it later, after the emergency, and give you the opportunity to object to future disclosures to family and friends. Unless you object, we may also disclose your PHI to persons performing disaster relief notification activities.

  • Disclosures and uses of patient information that do require authorization from patients are:
    • (a) Psychotherapy notes: These are notes of a mental health professional that are kept separate from the record itself
    • (b) Protected information that the office uses for marketing or fundraising
    • (c) Any disclosure the office makes that constitutes a sale of protected information

C. Certain Uses and Disclosures Do Not Require Your Written Authorization Other than Treatment, Payment, and Health Care Operations
The law allows us to disclose PHI without your written authorization in the following circumstance.

  • (1) When Required by Law. We disclose PHI when we are required to so by federal, state or local
    law
  • (2) For Public Health Activities. For example, we disclose PHI when we report suspected child
    abuse, the occurrence of certain diseases, or adverse reactions to a drug or medical device
  • (3) For Reports about Victims of Abuse, Neglect, or Domestic Violence. We will disclose your
    PHI in these reports only if we are required or authorized by law to do so, or if you otherwise agree
  • (4) To Health Oversight Agencies. We will provide PHI as requested to government agencies
    who have authority to audit or investigate our operations
  • (5) For Lawsuits and Disputes. If you are involved in a lawsuit or dispute, we may disclose
    your PHI in response to a subpoena or other lawful request, but only if efforts have been
    made to tell you about the request or to obtain a court order that will protect the PHI
    requested
  • (6) To Law Enforcement. We may release PHI if asked to do so by a law enforcement official
    in the following circumstances:

    • (a) in response to a court order, subpoena, warrant, summons, or similar process;
    • (b) to identify or locate a suspect, fugitive, material witness, or missing Person;
    • (c) about the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement;
    • (d) about a death we believe may be due to criminal conduct;
    • (e) about criminal conduct at our facility; and
    • (f) in emergency circumstances, to report a crime, its location or victims, or the identity, description, or location of the person who committed the crime
  • (7) To Coroners, Medical Examiners, and Funeral Directors. We may disclose PHI to facilitate
    the duties of these individuals
  • (8) To Avert a Serious Threat to Health and Safety. We may disclose your PHI to someone who
    can help prevent a serious threat to your health and safety or the health and safety of another person or the public
  • (9) For Specialized Government Functions. For example, we may disclose your PHI to
    authorized federal officials for intelligence and national security activities that are authorized by law, or so that they may provide protective services to the President or foreign heads of state or conduct special investigations authorized by law
  • (10) To Workers’ Compensation or similar programs. We may provide your PHI to these
    programs in order for you to obtain benefits for work-related injuries or illness

For some types of PHI, there may be stricter restrictions on our use or disclosure of PHI. For example, drug and alcohol abuse patient treatment information, HIV test results, mental health information, and genetic testing results may be subject to greater protection of your privacy.

In general, we may disclose a minor patient’s PHI to a parent or guardian, but we may deny the parent’s access to the minor patient’s PHI in some situations.


IV. Other Uses and Disclosures of Your Protected Health Information
Other uses and disclosures of your PHI that are not covered by this Notice or the laws that apply to us will be made only with your written authorization. If you give us written authorization for a use or disclosure of your PHI, you may revoke that authorization, in writing, at any time. If you revoke your authorization we will no longer use or disclose your PHI for the purposes specified in the written authorization, except that we are unable to take back any disclosures we have already made with your permission, and are required to retain certain records of the uses and disclosures made when the authorization was in effect.


V. Your Rights Related to Your Protected Health Information
You have the following rights:

A. The Right to Request Limits on Uses and Disclosures of Your PHI
You have the right to ask us to limit how we use and disclose your PHI, as long as you are not asking us to limit uses and disclosures that we are required or authorized to make to the Secretary of the Federal Department of Health Services or any of the disclosures described in Section III above. Any such request must be submitted in writing to our Medical Records Department. We are not required to agree to your request. If we do agree, we will put it in writing and will abide by the agreement except when you require emergency treatment.

B. The Right to Choose How We Communicate With You
You have the right to ask that we send information to you at a specific address (for example, at work rather than at home) or in a specific manner (for example, never by telephone or if you would like it in an electronic format). You must make the request in writing and addressed to our Medical Records Department.

C. Except for Limited Circumstances, You May Look at and Copy Your PHI if You Ask in Writing to Do So
Any such request must be addressed to our Medical Records Department, which will respond to your request within 30 days. In certain situations, we may deny your request, but if we do, we will tell you in writing of the reasons for the denial and explain your right to have the denial reviewed.

D. The Right to See and Copy Your PHI

If you believe that the PHI we have about you is incomplete or incorrect, you may ask us to amend it. Any such request must be made in writing and must be addressed to our Medical Records Department and you must tell us why you think the amendment is appropriate. We will not process your request if it is not in writing or does not tell us why you think the amendment is appropriate. We will act on your request within 30 days.

E. Restricting Information Releases
A patient that pays for a service in full and out of pocket may request that the office not disclose any information about that service to an insurance company. This request must be in writing and has to identify what information is restricted and what the insurance company is not to receive.

We may deny your request if you ask us to amend information that:

  • Was not created by us, unless the person who created the information is no longer available to make the amendment
  • Is not part of the PHI we keep about you
  • Is not part of the PHI you would be allowed to see or copy
  • Is determined by us to be accurate and complete.

If we deny the requested amendment, we will tell you in writing how to submit a statement of disagreement or complaint or to request inclusion of your original amendment request in your PHI.

E. The Right to Get a List of the Disclosures We Have Made
You have the right to get a list of instances in which we have disclosed your PHI. The list will not include disclosures we have made for our treatment, payment, and health care operations purposes, those made directly to you or your family or friends or for disaster notification purposes. Neither will the list include disclosures we have made with your written authorization, for national security purposes or to law enforcement personnel, disclosures of limited data set, or disclosures made before April 14, 2003

Your request for a list of disclosures must be made in writing and be addressed to our Medical Records Department. We will respond to your request within 60 days (or 90 days if the extra time is needed). The list we provide will include disclosures made within the last six years unless you specify a shorter period. The first list you request within a 12 month period will be free. You will be charged our costs for providing any additional lists within the 12 month period.

F. The Right to Get a Paper Copy of This Notice
You may obtain a paper copy of this notice by asking for one at the front desk

G. Breach Notification
Patients will be notified in writing within 60 days when a breach in their protected information occurs. Any loss or inappropriate disclosure of data is presumed to be a breach unless the office can show there’s only minimal probability the data was used improperly.


VI. Complaints

If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Federal department of Health and Human Services. To file a complaint with us, put your complaint in writing and address it to our Privacy Officer at 2643 Patterson Road, Suite 605, Grand Junction, CO 81506. We will not retaliate against you for filing a complaint. You may a