Metropolitan Institute of Pain Notice of Privacy Practices

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.

Metropolitan Institute of Pain (hereinafter MIP) acts to maintain the privacy of protected health information, provide individuals with notice of our practice’s legal duties and privacy practices with respect to protected health information as described in the Notice, and abide by the terms of the Notice currently in effect.

Metropolitan Institute of Pain acts to maintain the privacy of protected health information, provide individuals with notice of our practice’s legal duties and privacy practices with respect to protected health information as described in the Notice, and abide by the terms of the Notice currently in effect. SMS consent will not be shared or sold with any third-party businesses.

Provision of Notice: MIP provides its Notice of Privacy Practices to every patient with whom it has a direct treatment relationship. The Notice is provided no later than the date of the first treatment to the patient after April 13, 2003.

MIP makes its Notice available to any member of the public to enable each prospective patient to evaluate our practice’s privacy practices when making his or her decision regarding whether to seek treatment from our practice MIP provides its Notice via e-mail to any patient or other individual who so requests the Notice.

Documentation of Provision of Notice: When a direct treatment patient receives the Notice from MIP, the patient will be asked to sign its “Receipt of Notice of Privacy Practices” form. The form is filed with the patient’s medical record. If the patient refuses to sign the form, it is noted in the medical record that the patient was given the Notice and refused to sign the form.

Effective Date and Changes to Notice: This Notice is effective April 14, 2003. MIP reserves the right to revise this Notice whenever there is a material change to the uses or disclosures, the individual’s rights, the covered entity’s legal duties, or other privacy practices stated in the Notice. Except when required by law, a material change to any term of the Notice will not be implemented prior to the effective date of the Notice in which such material change is reflected.

 If the Notice is revised, MIP makes the revised Notice available upon request beginning on the revision’s effective date. The revised Notice is posted in the practice’s reception area and made available to all patients, including those who have received a previous Notice. Upon receipt of a revised Notice, a patient is asked to acknowledge receipt of the Notice.

Complaints: MIP PSGC, S.C. allows all patients and their agents to file complaints with the practice and with the secretary of the federal Department of Health and Human Services (DHHS). A patient or his or her agent may file a complaint with the practice whenever he or she believes that the practice has violated the patient’s rights.

Complaints to the practice must be in writing, must describe the acts or omissions that are the subject of the complaint, and must be filed within 180 days of the time the patient became aware or should have become aware of the violation. Complaints must be addressed to the attention of MIP ’s privacy officer at the practice’s address. The practice investigates each complaint and may, at its discretion, reply to the patient or to the patient’s agent.

Complaints to the Secretary of the Department of Health and Human Services must be in writing, must name the practice, must describe the acts or omissions that are the subject of the complaint, and must be filed within 180 days of the time the patient became aware or should have become aware of the violation. Complaints must be addressed to: Office for Civil Rights, U.S. Department of Health and Human Services, 233 N. Michigan Ave., Suite 240, Chicago, IL 60601. Voice phone 312-886-2359, fax 312-886- 1807, TDD 312-353-5693.

 MIP does not take any adverse action against any patient who files a complaint (either directly or through an agent) against the practice. Contact Person: MIP has a Privacy Officer that serves as the contact person for all issues related to the Privacy Rule. The Privacy Officers are Monica Hernandez and Evans Castor. If you have any questions about this Notice, please contact either of the above individuals at 312- 757-4647 or at 312 N. May St. Suite 110, Chicago, Il 60607

 Uses and Disclosures of Protected Health Information

MIP reasonably ensures that the protected health information (PHI) it requests, uses, and discloses for any purpose is the minimum amount of HGI necessary for that purpose.

MIP treats all qualified individuals as personal representatives of patients. MIP generally allows individuals to act as personal representatives of patients. The two general exceptions to allowing individuals to act as personal representatives relate to unemancipated minors and situations of abuse, neglect, or endangerment.

MIP makes reasonable efforts to ensure that protected health information is used only by and disclosed only to individuals who have a right to the protected health information. Toward that end, the practice makes reasonable efforts to verify the identity of those using or receiving protected health information.

Uses and Disclosures –Treatment, Payment and Health Care Operations MIP uses and discloses protected health information for payment, treatment, and health care operations. Treatment includes those activities related to providing services to the patient, including releasing information to other health care providers involved in the patient’s care. Payment relates to all activities associated with getting reimbursed for services provided, including submission of claims to insurance companies and any additional information requested by the insurance company so they can determine if they should pay the claim. Health care operations include a number of areas, including quality assurance and peer review activities.

Uses and Disclosures – Not Requiring Authorization Disclosure to Those Involved in Individual’s Care: MIP discloses protected health information to those involved in a patient’s care when the patient approves or, when the patient is not present or not able to approve, when such disclosure is deemed appropriate in the professional judgment of the practice.

When the patient is not present, MIP determines whether the disclosure of the patient’s protected health information is authorized by law and if so, discloses only the information directly relevant to the person’s involvement with the patient’s health care. MIP does not disclose protected health information to a suspected abuser, if, in its professional judgment, there is reason to believe that such a disclosure could cause the patient serious harm. Further, MIP uses and discloses information as required by law.

Uses and Disclosures Required by Law:  MIP uses and discloses protected health information to appropriate individuals as required by law. As required by law discloses protected health information to public health officials. This includes reporting of communicable diseases and other conditions, sexually transmitted diseases, lead poisoning, Reyes syndrome, and mandated reports of injury, medical conditions or procedures, or foodborne illness including but not limited to adverse reactions to immunizations, cancer, adverse pregnancy outcomes, death, birth.

 MIP discloses protected health information regarding victims of abuse, neglect, or domestic violence. MIP discloses information about a minor child, disabled adult, nursing home resident, or person over 60 years of age whom the practice reasonably believes to be a victim of abuse or neglect to the appropriate authorities as required by law or, if not required by law, if the individual agrees to the disclosure. This includes child abuse and neglect, elder abuse and exploitation, abused and neglected nursing home residents, or abuse of disabled adults.

MIP  informs the individual of the reporting unless the practice, in the exercise of professional judgment, believes informing the individual would place the individual at risk of serious harm, or unless the practice would be informing a personal representative, and the practice believes the personal representative is responsible for the abuse, neglect, or other injury, and that informing such person would not be in the best interests of the individual as determined by the professional judgment of the practice.

Uses and Disclosures for Health Oversight Activities: MIP uses and discloses PHI as required by law for health oversight activities. The information may be used and released for audits, investigations, licensure issues, and other health oversight activities, including, but not limited to hospital peer review, managed care peer review, or Medicaid or Medicare peer review.

Disclosures for Judicial and Administrative Proceedings: In general, MIP  discloses information for judicial and administrative proceedings in response to an order of a court or an administrative tribunal; or a subpoena, discovery request or other lawful process, not accompanied by a court order or an ordered administrative tribunal.

Disclosures for Law Enforcement Purposes MIP discloses PHI for law enforcement purposes to law enforcement officials.

Uses and Disclosures Related to Decedents: MIP uses and discloses PHI as required to a coroner or medical examiner and funeral directors as required by law. The attending physician is required to sign the death certificate and provide the coroner with a copy of the decedent’s protected health information.

Uses and Disclosures Related to Cadaveric Organ, Eye or Tissue Donations: MIP uses and discloses protected health information to facilitate organ, eye, or tissue donations.

Uses and Disclosures to Avert a Serious Threat to Health or Safety: MIP uses and discloses protected health information to public health and other authorities as required by law to avert a serious threat to health and safety.

Uses and Disclosures for Specialized Government Functions: MIP uses and discloses protected health information for military and veterans’ activities, national security and intelligence activities, and other activities as required by law.

Uses and Disclosures in Emergency Situations: MIP uses and discloses protected health information as appropriate to provide treatment in emergency situations. In those instances where MIP has not previously provided its Notice of Privacy Practices to a patient who receives direct treatment in an emergency situation, the practice provides the Notice to the individual as soon as practicable following the provision of the emergency treatment. Marketing Purposes: MIP does not use or disclose any protected health information for marketing purposes. MIP does engage in communications about products and services that encourages recipients of the communication to purchase or use the product or service for treatment, to direct or recommend alternative treatments, therapies, health care providers, or settings of care to the individual. These activities are not considered marketing.

In addition, MIP will contact the individual with appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to the individual.

Uses and Disclosures – Do Not Apply to Practice

Research: MIP does not engage in any research activities that require it to use or disclose protected health information.

Other Uses and Disclosures: MIP does not use or disclose protected health information to an employer or health plan sponsor, for underwriting and related purposes, for facility directories, to brokers and agents, or for fundraising.

 If an individual wants MIP to release his or her protected health information to employers or health plan sponsors, for underwriting and related purposes, for facility directories, or to brokers and agents, then he or she can contact MIP and complete an appropriate written authorization.

Individual Rights Individual Rights – Accounting for Disclosures of Protected Health Information

 MIP tracks all disclosures of a patient’s protected health information that occur for other than the purposes of treatment, payment, and health care operations, that are not made to the individual or to a person involved in the patient’s care, that are not made as a result of a patient authorization, and that are not made for national security or intelligence purposes or to correctional institutions or law enforcement officials. 

MIP charges a reasonable fee for more frequent accounting requests. The charge will be $25.00. An individual can request an accounting of disclosures for a period of up to six years prior to the date of the request. Requests for shorter accounting periods will be accepted. However, patients may only request an accounting of disclosures made on or after April 14, 2003.

MIP responds to all requests for an accounting of disclosures within 60 days of receipt of the request. If the practice intends to provide the accounting for disclosures and cannot do so within 60 days, the practice informs the requestor of such and provides a reason for the delay and the date the request is expected to be fulfilled. Only on 30-day extension is permitted. A request for an accounting for disclosures must be made in writing and mailed or sent to MIP. It should be marked “Attention: Privacy Officer.”

Individual Rights – Inspect and Copy Protected Health Information MIP allows individuals to inspect and copy their protected health information, documents all requests, responds to those requests in a timely fashion, informs individuals of their appeal rights when a request is rejected in whole or in part, and charges a reasonable fee for the copying of records.

MIP reviews the request in a timely fashion and acts on a request for access generally within 30 days. MIP may have a single extension of 30 days, if needed, to act on the request. Each request will be accepted or denied and the requestor notified in writing. If a request is denied, the requestor is informed as to whether or not the denial is reviewable. The requestor has the right to have any denial reviewed by a licensed health care professional who is designated by the practice as a reviewing official and who did not participate in the original decision to deny. The practice informs the requestor of the decision of the reviewing official and adheres to the decision.