Byers Peak Family Medicine
Notice of Privacy Practices for Protected Health Information
 
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please read this carefully.
 
This office is permitted by federal privacy laws to make uses and disclosers of your health information for purposes of treatment, payment and health care
operations. Protected information is the information we create and obtain in providing services to you. Such information may include documenting your symptoms,
examinations, and test results, diagnoses, treatment and aplying for future care or treatment. It also includes billing documentation of those services.
 
Examples of Uses of Your Health Information for Treatment Purposes are:
A nurse obtains treatment information about you and records it in a health record
A consultation is needed and the information from your visit will be sent to the consultant
To remind you of your appointments
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Examples of Use of Your Health Information for Payment Purposes:
 
We submit requests for payment to your health insurance company. The insurance company (or other business associate helping us obtain payment) requests information from us regarding medical care given. We will provide information to them about you and the care given.
 
Examples of Use of Your Information for Health Care Operations:
 
We obtain services from our insurers or other business associates such as quality assessment, quality improvement, outcome evaluation, protocol and clinical guideline development, training programs, credentialing, medical review, legal services and insurance. We will share information about you with such insurers or other associates as necessary to obtain these services. 
 
 
Your Health Information Rights
 
The health and billing records we maintain are the physical property of the office. The information in it, however, belongs to you. You have the right to:
 
                                                            
Request a restriction on certain uses and disclosures of your health information by delivering the request to the office—we are not required to grant the request, but we will comply with any request granted;
 
Obtain a paper copy of the current Notice of Privacy Practices for Protected Health Information by making a request at the office;
 
 
Request that you be allowed to inspect and copy your health record and billing record-you may exercise this right by delivering the request to the office;
 
Appeal a denial of access to your protected health information, except in certain circumstances;
 
Request that your health care record be amended to correct incomplete or incorrect information by delivering a request to the office. We may deny your request if you ask us to amend information that:
 
Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
Is not part of the health information kept by or for the office;
Is not part of the information you would be permitted to inspect and copy; or,
Is accurate and complete.
If your request is denied, you will be informed of the reason for the denial and will have an opportunity to submit a statement of disagreement to be maintained with your records.
 
Request that communication of your health information be made by alternative means or at an alternative location by delivering the request in writing to our office.
 
Obtain an accounting of disclosures of your health information as required to be maintained by law by delivering a request to the office. An accounting will not include uses and disclosures of information for treatment, payment, or operations; disclosures or uses made to you or made at your request; uses or disclosures made pursuant to an authorization signed by you; uses or disclosures made in a facility directory or to family members or friends relevant to that person’s involvement in your care or in payment for such care; or, uses or disclosures to notify family or others responsible for your care of your location, condition or your death.
 
Revoke authorizations that you made previously to use or disclose information by delivering a written revocation to the office, except to the extent information or action has already been taken.
 
 
If you want to exercise any of the above rights, please contact James G. Kennedy, MD, Byers Peak Family Medicine, LLC, P O Box 1312, 78878 US Highway 40 (Main Street), Winter Park, Colorado, 80482, in person or in writing during regular business hours. He will inform you of the steps that need to be taken to exercise your rights.
 
Our Responsibilities
 
The office is required to:
Maintain the privacy of your health information as required by law;
 
Provide you with a notice as to our duties and privacy practices as to the information we collect and maintain for you;
 
Abide by the terms of this Notice
 
Accommodate your reasonable requests regarding methods to communicate health information with you.
 
We reserve the right to amend, change, or eliminate provisions in our privacy practices and access practices and to enact new provisions regarding the protected health information we maintain. If our information practices change, we will amend our Notice. You are entitled to receive a revised copy of the Notice by calling and request a copy or our Notice or by visiting the office and picking up a copy.
 
To Request Information or File a Complaint
 
If you have questions, would like additional information, or want to report a problem regarding the handling of your information, you may contact James G. Kennedy, MD, Byers Peak Family Medicine, LLC, P O Box 1312, 78878 US Highway 40 (Main Street), Winter Park, Colorado, 80482, 970-722-0300.
 
Additionally, if you believe your privacy rights have been violated, you may file a written complaint at our office by delivering the written complaint to James G. Kennedy, MD, Byers Peak Family Medicine, LLC. You may also file a complaint by mailing it or e-mailing it to the Secretary of Health and Human Services, whose street address is: Office of Civil Rights – US Dept. of Health and Human Service- 200 Independence Avenue S. W.- Room 509F, HHH Building- Washington, D.C. 20201.
 
We cannot, and will not, require you to waive the right to file a complaint with the Secretary of Health and Human Services as a condition of receiving treatment from the office
We cannot, and will not, retaliate against you for filing a complaint with the Secretary of Health and Human Services
 
Other Disclosures and Uses
 
Communication with Family
 
Using our best judgment, we may disclose to a family member, other relative, close personal friend, or any other person you identify, health information relevant to that person’s involvement in your care or in payment for such care if you do not object in an emergency.
 
Notification
 
Unless you object, we may use or disclose your protected health information to notify, or assist in notifying a family member, personal representative, or other person responsible for your care, about your location, and about your general condition, or your death.
 
Research
 
We may disclose information to researchers when an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information has approved their research.
Disaster Relief
 
We may use and disclose your protected health information to assist in disaster relief efforts.
 
Organ Procurement Organizations
 
Consistent with applicable law, we may disclose your protected health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.
 
Food and Drug Administration (FDA)
 
We may disclose to the FDA your protected health information relating to adverse events with respect to food, supplements, products and product defects, or post-marketing surveillance information to enable product recalls, repairs, or replacements.
Workers Compensation
 
If you are seeking compensation through Workers Compensation, we may disclose your protected health information to the extent necessary to comply with laws relating to Workers Compensation
Public Health
 
As authorized by law, we may disclose your protected health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability; to report reactions to medication or problems with products; to notify people of recalls; to notify a person who may have been expose to a disease or who is at risk for contracting or spreading a disease or condition.
Abuse and Neglect
 
We may disclose your protected health information to public authorities as allowed by law to report abuse or neglect.
 
Employers
 
We may release your protected health information to your employer if e provide health care services to you at the request of your employer; and the health care services re provided either to conduct an evaluation relating to medical surveillance of the workplace or to evaluate whether you a work-related illness or injury. In such circumstance, we will give written notice of such release of information to your employer. Any other disclosers to your employer will be made only if you execute a specific authorization for release of that information to your employer.
 
Correctional Institutions
 
If you are an inmate of a correctional institution, we may disclose to the institution or its agents the your protected health information necessary for your health and the health and safety of other individuals.
 
Law Enforcement
 
We may disclose your protected health information for law enforcement purposes as required by law, such as when required by a court order, or in cases involving felony prosecution, or to the extent an individual is in the custody of law enforcement.
 
Health Oversight
 
Federal law allow us to release your protected health information to appropriate health oversight agencies or for health oversight activities.
 
Judicial/Administrative Proceedings
 
We may disclose your protected health information in the course of any judicial or administrative proceeding as allowed or required by law, with your authorization, or as directed by a proper court order.
 
 
Serious Threat
 
To avert a serious threat to health or safety, we may disclose your protected health information consistent with applicable law to prevent or lessen a serious, imminent threat to the health or safety of a person or the public.
For Specialized Governmental Functions
 
We may disclose your protected health information for specialized governmental functions as authorized by law such as to the armed forces personnel, for national security, or to public assistance program personnel.
 
Coroners, Medical Examiners, and Funeral Directors
 
We may release your protected health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release your protected health information about patients to funeral directors as necessary for them to carry out their duties.
Other Uses
 
Other uses and disclosures, besides those identified in the Notice, will be made only as otherwise required by law or with your written consent and you may revoke the consent as previously provided in the Notice under “Your Health Information Rights.”
 
Website
 
If we maintain a website that provides information about our practice, this Notice will be on the website.
 
 
To my patients: although all email communication is conducted through a secure email account, there can never be a full guarantee that emailis secure. If you require total security, please call or visit the office. 
Email should never be used for emergency communication. Although, we check the email frequently, there could be a delay that would effect your health. Please use the email access for nonurgent matters only.