Common use of Uses and Disclosures of Protected Health Information Clause in Contracts

Uses and Disclosures of Protected Health Information. Your protected health information may be used and disclosed by your physician, our office staff and others outside of our office who are involved in your care and treatment for the purpose of providing health care services to you. Your protected health information may also be used and disclosed to pay your health care bills and to support the operation of your physician’s practice. Following are examples of the types of uses and disclosures of your protected health information that your physician’s office is permitted to make. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by our office. Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with another provider. For example, we would disclose your protected health information, as necessary, to a home health agency that provides care to you. We will also disclose protected health information to other physicians who may be treating you. For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you. In addition, we may disclose your protected health information from time-to-time to another physician or health care provider (e.g., a specialist or laboratory) who, at the request of your physician, becomes involved in your care by providing assistance with your health care diagnosis or treatment to your physician. Payment: Your protected health information will be used and disclosed, as needed, to obtain payment for your health care services provided by us or by another provider. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we recommend for you such as: making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example, obtaining approval for an office visit may require that your relevant protected health information be disclosed to the health plan. You will however be able to restrict disclosures to your insurance carrier for services for which you wish to pay “out of pocket” under the new Omnibus Rule.

Uses and Disclosures of Protected Health Information. Permissible Uses and Disclosures Not Requiring Your protected Written Authorization Your mental health information may be used and disclosed by your physician, our office staff and others outside of our office who are involved in your care and treatment for the purpose of providing health care services to youfollowing ways. • Treatment: Your protected mental health information may also be used and disclosed to pay your health care bills in the provision and to support the operation coordination of your physician’s practicehealthcare. Following are examples of the types of uses For example, this may include coordinating and disclosures of your protected health information that your physician’s office is permitted to make. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by our office. Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of managing your health care with another providerother health care professionals. For example, we would disclose your protected health information, as necessary, to a home health agency that provides care to you. We will also disclose protected health information to other physicians who may be treating you. For example, your protected Your mental health information may be provided to a physician to whom used and disclosed when I consult with another professional colleague, or if you have been are referred to ensure that the physician has the necessary information to diagnose for medication, or treat youfor coverage arrangements during my absence. In addition, we may disclose your protected health any of these instances only information from time-to-time necessary to another physician or health care provider (e.g., a specialist or laboratory) who, at complete the request of your physician, becomes involved in your care by providing assistance with your health care diagnosis or treatment to your physiciantask will be provided. • Payment: Your protected mental health care information will be used to develop accounts receivable information, to bill you, and disclosedwith your consent to provide information to your insurance company or other third party payer for services provided. The information provided to insurers and other third party payers may include information that identifies you, as neededwell as your diagnosis, dates and type of service, and other information about your condition and treatment, but will be limited to obtain payment the least amount necessary for your the purposes of the disclosure. • Health Care Operations: Your mental health information may be used and disclosed in connection with our health care services provided operations, including quality improvement activities, training programs and obtaining legal services. Only necessary information will be used or disclosed. • Required or Permitted by us Law: Your mental health care information may be used or disclosed when I am required or permitted to do so by another providerlaw or for health care oversight. This may include certain includes, but is not limited to: (a) reporting child abuse or neglect; (b) when court ordered to release information; (c) when there is a legal duty to warn or to take action regarding imminent danger to others; (d) when the client is a danger to self or others or gravely disabled; (e) when a coroner is investigating the client’s death; or (f) to health oversight agencies for oversight activities that your health insurance plan may undertake before it approves or pays authorized by law and necessary for the oversight of the health care system, government health care benefit programs, or regulatory compliance. • Contacting the Client: You may be contacted to remind you of appointments and to tell you about treatments or other services we recommend for you such asthat might be of benefit to you. • Crimes on the premises or observed by the provider: making a determination of eligibility Crimes that are observed by the therapist or coverage for insurance benefitsthe therapist’s staff, reviewing services provided crimes that are directed toward the therapist or the therapist’s staff, or crimes that occur on the premises will be reported to you for medical necessity, and undertaking utilization review activities. For example, obtaining approval for an office visit may require that your relevant protected health information be disclosed to the health plan. You will however be able to restrict disclosures to your insurance carrier for services for which you wish to pay “out of pocket” under the new Omnibus Rulelaw enforcement.

Uses and Disclosures of Protected Health Information. Your protected health information I may be used use and disclosed by disclose PHI without your physicianwritten authorization, our office staff and others outside of our office who are involved for certain purposes as described below. The examples provided in your care and treatment for the purpose of providing health care services to you. Your protected health information may also be used and disclosed to pay your health care bills and to support the operation of your physician’s practice. Following are examples of the types of uses and disclosures of your protected health information that your physician’s office is permitted to make. These examples each category are not meant to be exhaustive, but are meant to describe the types of uses and disclosures that may be made by our officepermissible under federal and state law. Permissible Uses and Disclosures That Do Not Require Written Consent:  Treatment: We will I may disclose your PHI to physicians, psychiatrists, psychologists, and other licensed health care providers who provide you with health care services or are otherwise involved in your care.  Health care operations: I may use and disclose your protected health information PHI to providefacilitate the efficient and correct operation of my practice, coordinate, including phone messages to you concerning scheduling appointments or manage routine follow-up.  To authorize or obtain payment for treatment: I may use and disclose your PHI to your health care plan to authorize services, submit claims, and any related servicescollect payment for the treatment and services I provide you. This includes the coordination or management of I disclose your PHI to a billing service who processes health care claims, obtains authorizations, verifies benefits, and provides account statements to you as required.  Emergency treatment: Your consent isn't required if you need emergency treatment provided that I attempt to get your consent after treatment is rendered. In the event that I try to get your consent but you are unable to communicate with another providerme (for example, if you are unconscious or in severe pain) but I think that you would consent to such treatment if you could, I may disclose your PHI.  When required or permitted by law: I may use or disclose PHI when I am required or permitted to do so by law. For example, we would I may disclose PHI to appropriate authorities if I reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of crimes. In addition I may disclose PHI to the extent necessary to avert a serious threat to your protected health information, as necessary, or safety or the health or safety of others. Other disclosures permitted or required by law include the following: disclosures to state and federal agencies authorized to access PHI. These include disclosures for public health activities; and health oversight activities; disclosures to judicial and law enforcement officials in response to a home health agency that provides care court order or other lawful process; and disclosures to you. We will also disclose protected health information to other physicians who may be treating you. For examplemilitary and national security agencies, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you. In additioncoroners, we may disclose your protected health information from time-to-time to another physician or health care provider (e.g., a specialist or laboratory) who, at the request of your physician, becomes involved in your care by providing assistance with your health care diagnosis or treatment to your physician. Payment: Your protected health information will be used and disclosed, as needed, to obtain payment for your health care services provided by us or by another provider. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we recommend for you such as: making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessityexaminers, and undertaking utilization review activities. For example, obtaining approval for an office visit may require that your relevant protected health information be disclosed to the health plan. You will however be able to restrict disclosures to your insurance carrier for services for which you wish to pay “out of pocket” under the new Omnibus Rulecorrectional institutions or otherwise as authorized by law.

Uses and Disclosures of Protected Health Information. Your protected health information I may be used use and disclosed by disclose PHI without your physicianwritten authorization, our office staff and others outside of our office who are involved for certain purposes as described below. The examples provided in your care and treatment for the purpose of providing health care services to you. Your protected health information may also be used and disclosed to pay your health care bills and to support the operation of your physician’s practice. Following are examples of the types of uses and disclosures of your protected health information that your physician’s office is permitted to make. These examples each category are not meant to be exhaustive, but are meant to describe the types of uses and disclosures that may be made by our officepermissible under federal and state law. PERMISSIBLE USES AND DISCLOSURES THAT DO NOT REQUIRE WRITTEN CONSENT: • Treatment: We will I may disclose your PHI to physicians, psychiatrists, psychologists, and other licensed health care providers who provide you with health care services or are otherwise involved in your care. • Health care operations: I may use and disclose your protected health information PHI to providefacilitate the efficient and correct operation of my practice, coordinate, including phone messages to you concerning scheduling appointments or manage routine follow-up. • To authorize or obtain payment for treatment: I may use and disclose your PHI to your health care plan to authorize services, submit claims, and any related servicescollect payment for the treatment and services I provide you. This includes the coordination or management of I disclose your PHI to a billing service who processes health care claims, obtains authorizations, verifies benefits, and provides account statements to you as required. • Emergency treatment: Your consent isn't required if you need emergency treatment provided that I attempt to get your consent after treatment is rendered. In the event that I try to get your consent but you are unable to communicate with another providerme (for example, if you are unconscious or in severe pain) but I think that you would consent to such treatment if you could, I may disclose your PHI. • When required or permitted by law: I may use or disclose PHI when I am required or permitted to do so by law. For example, we would I may disclose PHI to appropriate authorities if I reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of crimes. In addition I may disclose PHI to the extent necessary to avert a serious threat to your protected health information, as necessary, or safety or the health or safety of others. Other disclosures permitted or required by law include the following: disclosures to state and federal agencies authorized to access PHI. These include disclosures for public health activities; and health oversight activities; disclosures to judicial and law enforcement officials in response to a home health agency that provides care court order or other lawful process; and disclosures to you. We will also disclose protected health information to other physicians who may be treating you. For examplemilitary and national security agencies, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you. In additioncoroners, we may disclose your protected health information from time-to-time to another physician or health care provider (e.g., a specialist or laboratory) who, at the request of your physician, becomes involved in your care by providing assistance with your health care diagnosis or treatment to your physician. Payment: Your protected health information will be used and disclosed, as needed, to obtain payment for your health care services provided by us or by another provider. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we recommend for you such as: making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessityexaminers, and undertaking utilization review activities. For example, obtaining approval for an office visit may require that your relevant protected health information be disclosed to the health plan. You will however be able to restrict disclosures to your insurance carrier for services for which you wish to pay “out of pocket” under the new Omnibus Rulecorrectional institutions or otherwise as authorized by law.