Gateway Gastroenterology

Privacy Policy

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OUR COMMITMENT TO YOUR PRIVACY

Our practice is dedicated to maintaining the privacy of your health information. In conducting our business, we will create records regarding you and the treatment and services we provide to you. We are required by law to maintain the confidentiality of health information that identifies you. We also are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your health information. By federal and state law, we must follow the terms of the notice of privacy practices that we have in effect at the time.

We realize that these laws are complicated, but we must provide you with the following important information:

• How we may use and disclose your health information.
• Your privacy rights in your health information.
• Our obligations concerning the use and disclosure of your health information.

WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION IN THE FOLLOWING WAYS:

Below, we have listed some of the reasons why we might use or disclose your health information with some examples. Not every use or disclosure is discussed, but all of the ways that we are allowed to use and disclose information falls into one of these categories.

For Treatment: Our practice may use your health information to treat you. For example, we may ask you to have laboratory tests (such as blood or urine tests), and we may use the results to help us reach a diagnosis. Many of the people who work for our practice − including, but not limited to, our doctors and nurses − may use or disclose your health information in order to treat you or to assist others in your treatment. Additionally, we may disclose your health information to others who may assist in your care, such as your spouse, children, or parents. Finally, we may also disclose your health information to other health care providers for purposes related to your treatment.

For Payment: Our practice may use and disclose your health information in order to bill and collect payment for the services and items you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment so that your insurer will cover, or pay for, your treatment.

For Health Care Operations: Our practice may use and disclose your information for our practice operations to evaluate the quality of care you received from us.

Uses and Disclosures of Medical Information that Do Not Require Your Authorization: We can use or disclose health information about you without your authorization when there is an emergency, when we are required by law to treat you, or when we are required by law to use or disclose certain information. We may use or disclose your health information without your authorization in any of the following circumstances:

• When it is required by federal, state or other law;
• When it is needed for public health activities;
• When reporting information about victims of abuse, neglect or domestic violence;
• When disclosing information for judicial and administrative proceedings;
• When disclosing information for law enforcement purposes;
• When disclosing information about deceased persons to medical examiners, coroners and funeral directors;
• When disclosing or using information for organ and tissue donation purposes;
• When disclosing information for research purposes;
• When we believe in good faith that the disclosure is necessary to avert a serious health or safety threat;
• When disclosure is necessary for specialized government functions;
• When disclosure is necessary to comply with worker’s compensation laws or purposes.

Planned Uses or Disclosures to Which You May Object: We may use or disclose your health information for any of the purposes described in this section unless you affirmatively object to or otherwise restrict a particular release. You may direct your objections or restrictions in writing to your caregiver or to the Privacy Officer listed in this Notice.

• We may use or disclose your health information to contact you and remind that you have an appointment for treatment or medical care.
• We may use or disclose your health information to provide you with information about or recommendations of possible treatment options or alternatives that may interest you.
• We may use and disclose your health information to a group health plan, health insurance issuer, HMO or plan sponsor.
• We may release health information about you to a friend and/or family member who is involved in your care.
• We can disclose health information about you to a public or private entity that is authorized by law or its charter to assist in disaster relief efforts (e.g., the American Red Cross).

Your Rights Regarding Your Health Information:
You have the following rights regarding the health information that we maintain about you:

1. Confidential Communications. You have the right to request that our practice communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home, rather than work. In order to request a type of confidential communication, you must make a written request to Gateway Gastroenterology specifying the requested method of contact, or the location where you wish to be contacted. Our practice will accommodate reasonable requests. You do not need to give a reason for your request.
2. Requesting Restrictions. You have the right to request a restriction in our use or disclosure of your health information for treatment, payment or health care operations. Additionally, you have the right to request that we restrict our disclosure of your health information to only certain individuals involved in your care of the payment for your care, such as family members and friends. We are not required to agree to your request; however if we do not agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you. In order to request a restriction in our use or disclosure of your health information, you must make your request in writing to Gateway Gastroenterology. Your request must describe in a clear and concise fashion:
   1. the information you wish restricted;
   2. whether you are requesting to limit our practice’s use, disclosure or both; and
   3. to whom you want the limits to apply.
3. Inspection and Copies. You have the right to inspect and obtain a copy of your health information that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes. You must submit your request in writing to Gateway Gastroenterology in order to inspect and/or obtain a copy of your health information. Our practice may charge a fee for the costs of copying, mailing, labor and supplies associated with your request. Our practice may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial. Another licensed health care professional chosen by us will conduct reviews.
4. Amendment. You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our practice. To request an amendment, your request must be made in writing to:Gateway Gastroenterology
   621 S. New Ballas Rd., Suite 228A
   St. Louis, MO 63141
   (314) 569-6973.
   
   You must provide us with a reason that supports your request for amendment. Our practice will deny your request if you fail to submit your request (and the reason supporting your request) in writing. Also, we may deny your request if you ask us to amend information that is in our opinion:
   1. accurate and complete;
   2. not part of the health information kept by or for the practice;
   3. not part of the health information which you would be permitted to inspect and copy; or
   4. not created by our practice, unless the individual or entity that created the information is not available to amend the information.
5. Accounting of Disclosures. All of our patients have the right to request an “accounting of disclosures.” An “accounting of disclosures” is a list of certain non-routine disclosures our practice has made of your health information for non-treatment, non-payment, or non-operations purposes. Use of your health information as part of the routine patient care in our practice is not required to be documented. For example, the doctor sharing information with the nurse; or the billing department using your information to file your insurance claim. In order to obtain an accounting of disclosures, you must submit your request in writing to:Gateway Gastroenterology
   621 S. New Ballas Rd., Suite 228A
   St. Louis, MO 63141
   (314) 569-6973.
   
   All requests for an “accounting of disclosures” must state a time period, which may not be longer then six (6) years from the date of disclosure and may not include dates before April 14, 2003.The first list you request within a 12-month period is free of charge, but our practice may charge you for additional lists within the same 12-month period. Our practice will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs.
6. Right to a Paper Copy of This Notice. You are entitled to receive a paper copy of our notice of privacy practices. You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this notice, contact Gateway Gastroenterology at (314) 569-6973.
7. Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services. To file a complaint with our practice, contact the Privacy officer as listed below. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
8. Right to Provide an Authorization for Other Uses and Disclosures. Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your health information may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your health information for the purposes described in the authorization. Please note, we are required to retain records of your care. Again, if you have questions regarding this notice or our health information privacy policies, please contact our Privacy Officer at:Privacy Officer
   Gateway Gastroenterology
   621 S. New Ballas Rd., Suite 228A
   St. Louis, MO 63141
   (314) 569-6973.
   
   Changes to This Notice. We reserve the right to change or modify the information contained in this Notice. Any changes that we make will comply with appropriate federal, state, or other laws. At each first delivery of service, we will provide the most recent copy of this Notice and post this version at our office. Also, you can call or write our office to obtain the most recent version of this Notice.

Effective 4/2003

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.

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