We understand that medical information about you is personal. We are committed to protecting this information.

We create a record of the care and services you receive to provide quality care and to comply with legal requirements. This notice applies to all of the records of your care that we maintain, whether created by facility staff or your personal doctor.

We are required by law to:

• Maintain the privacy of your medical information.
• Give you this notice of our legal duties and privacy notices with respect to medical information about you.
• Follow the terms of the notice that is currently in

This notice of privacy practices describes how we may use and disclose your protected health information to carry out treatment, payment or healthcare operations and for other purposes that are permitted or required by law. 

It also describes your rights to access and control your protected health information. “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related healthcare services.

It is not the intent of the law or our policies to impede medical care. We may use and disclose your protected health information in any circumstances that we determine to be urgent or emergent in nature. For example, we may notify you at the contact numbers provided by you. We may leave a message with pertinent information.

Your protected health information may be used and disclosed by your provider, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing healthcare services to you. Your protected health information may also be used and disclosed to pay your healthcare bills and to support the operation of the provider’s practice.

Following are examples of the types of uses and disclosures of your protected healthcare information that the provider’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.

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Your protected health information may be used, as needed, to obtain payment for your healthcare services. This may include certain activities that your health insurance plan may require of us before it approves or pays for the healthcare 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.
• Undertaking utilization review activities. For example, obtaining approval for a procedure or a medication may require that your relevant protected health be disclosed to the health plan to obtain approval.

 In addition, we may release your medical information to other entities covered by privacy laws for payment purposes relative to this organization. 

We may use or disclose, as needed, your protected health information in order to support the business activities of your provider’s practice. These activities include but are not limited to quality assessment activities, employee review activities, training of medical students or residents, licensing, and conducting or arranging other business activities. 

For example, we may disclose your protected health information to medical school students or residents that see patients at our office. In addition, we may use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your provider. We may also call you by name in the waiting room when your provider is ready to see you. 

We will share your protected health information with third-party business associates that perform various activities for the practice. Whenever an arrangement between our office and a business associate involves the use or disclosure of your protected health information, we will have a written contract that contains terms that will protect the privacy of your protected health information.

We may communicate to you via postal mail and our secure Patient Portal regarding scheduled appointments, test results, preparation for tests, treatment options, insurance questions and payments.

We may disclose your medical information to other entities covered by privacy laws for its operations if it already has a relationship with you and the operations pertain to activities such as quality assurance, training, or fraud and abuse detection.

Unless you object, we will use and disclose the location at which you are receiving care and your condition (in general terms). All of this information will be disclosed to people that ask for you by name.

Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify your protected health information that directly relates to that person’s involvement in your healthcare or payment for your care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. 

We may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death. Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosure to family or to other individuals involved in your healthcare.

We may occasionally inadvertently use or disclose your medical information when such use or disclosure is incident to another use or disclosure that is permitted or required by law. For example, while we have safeguards in place to protect against others overhearing our conversations that take place between doctors, nurses or other personnel, there may be times that such conversations are in fact overheard. Please be assured, however, that we have appropriate safeguards in place to avoid such situations, and others, as much as possible.

Upon a request by you, we may use or disclose your medical information in accordance with your request.

We may use or disclose certain parts of your medical information, called a “limited data set,” for purposes of research, public health reasons or for our healthcare operations. We would disclose a limited data set only to third parties that have provided us with satisfactory assurances that they will use or disclose your medical information only for limited purposes.

We might be required by law to disclose your medical information to the secretary of the Department of Health and Human Services or their designee in the case of a compliance review to determine whether we are complying with privacy laws.

We may use your medical information or disclose it to a third party whom we have hired to create information that does not identify you in any way. Once we have de-identified your information, it can be used or disclosed in any way according to law.

Members of our workforce, including employees, volunteers, trainees or independent contractors, may disclose your medical information to a healthcare oversight agency, public health authority, healthcare accreditation organization or attorney hired by the workforce member to report the workforce member’s belief that we have engaged in unlawful conduct or that our care or services could endanger a patient, workers or the public.

In addition, if a workforce member is a crime victim, the member may disclose your medical information to a law enforcement official.

Under Indiana law, we cannot disclose the medical information of minors to non-custodial parents if a court order or decree is in place that prohibits the non-custodial parent from receiving such information. However, we must have documentation of the court order prior to denying the non-custodial parent such access.

Under Indiana law, we cannot disclose the medical information of minors to non-custodial parents if a court order or decree is in place that prohibits the non-custodial parent from receiving such information. However, we must have documentation of the court order prior to denying the non-custodial parent such access.

Under Indiana law, we cannot disclose the medical information of minors to non-custodial parents if a court order or decree is in place that prohibits the non-custodial parent from receiving such information. However, we must have documentation of the court order prior to denying the non-custodial parent such access.

Because of federal law, we will not release your medical information if it contains information about drug or alcohol abuse without your written permission except in very limited situations.

If your records contain information regarding your mental health, we are restricted in the ways that we can use and disclose them. We can disclose such records without written permission only in the following situations:

• If the disclosure is made to you (unless it is determined by a physician that the release would be detrimental to your health)
• Disclosures to our employees in certain circumstances
• For payment purposes
• For data collection, research and monitoring managed care providers if the disclosure is made to the division of mental health
• For law enforcement purposes or to avert a serious threat to the health and safety of you or others
• To a coroner or medical examiner
• To satisfy reporting requirements
• To satisfy release of information requirements that are required by law
• To another provider in an emergency
• For legitimate business purposes
• Under a court order
• To the Secret Service if necessary to protect a person under Secret Service protection
• To the statewide waiver ombudsman

We may use or disclose your protected health information in the following situations without your consent or authorization. These situations include:

Public Health Purposes

We may disclose your protected health information for public health activities. These generally include the following:

• To prevent or control disease, injury or disability
• To report deaths
• To report abuse or neglect
• To report reactions to medications or problems with products
• To notify people of recalls of products they may be using
• To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease of condition
• To notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence (we will only make this disclosure when required or authorized by law)

Health Oversights Activities

We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations and inspections. These activities are necessary for the government to monitor the healthcare system, government programs and compliance with civil rights laws.

Research

We may disclose your protected health information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information.

 Coroners, Funeral Directors and Organ Donation

We may release medical 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 medical information about patients to a funeral director, as necessary and authorized by law, in order to permit the funeral director to carry out their duties.

Protected health information may be used and disclosed for cadaveric organ, eye or tissue donation purposes.

Workers’ Compensation

We may release medical information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.

Custodial Situations

If you are an inmate in a correctional institution and if the correctional institution or law enforcement authority makes certain representations to us, we may disclose your health information to a correctional institution or law enforcement official. Except for disclosures to another provider for your treatment, the information disclosed will be limited to your contact information or physical characteristics.

To Avert a Serious Threat to Health or Safety or in Disaster Situations

We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public, another person or in the event of a disaster. Any disclosure, however, would only be to someone able to help prevent the threat or to assist in the disaster relief efforts.

 Military Activity and National Security

When the appropriate conditions apply, we may use or disclose protected health information of individuals who are U.S. Armed Forces personnel for activities deemed necessary by appropriate military command authorities; for the purpose of a determination by the Department of Veteran Affairs of your eligibility for benefits, or to foreign military authority if you are a member of that foreign military services.

We may also disclose your protected health information to authorized federal officials for conducting national security and intelligence activities, including for the provision of protective services to the president or others legally authorized.

Lawsuits and Disputes

If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request or other lawful process by someone else involved in the dispute.

Law Enforcement

We may release medical information if asked to do so by a law enforcement official:

• In response to a court order, subpoena, warrant, summons or similar process
• To identify or locate a suspect, fugitive, material witness or missing person
• About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement
• About criminal conduct on our premises
• In emergency circumstances to report a crime, the location of the crime or victims, or the identity, description or location of the person who committed the crime

 In these cases, information that is disclosed will be limited to demographic information or information regarding physical characteristics.

Other uses and disclosures of your protected health information will be made only with your written authorization unless otherwise permitted or required by law as describe above. You may revoke this authorization at any time, in writing, except to the extent that your physician or the physician’s practice has taken an action in reliance on the use or disclosure indicated in the authorization.

We may change our policies at any time. Changes will apply to medical information we already hold as well as new information after the changes occur. Before we make a significant change in our policies, we will change our notice and post the new notice in waiting areas, exam rooms and on our website. A current copy of the notice may be obtained at any time upon request. The effective date is listed just below the title of this notice. You will also be asked to acknowledge in writing your receipt of this notice.

If you are concerned that your privacy rights may have been violated or you disagree with a decision we have made about access to or amendments to your records, you may contact our privacy officer at (765) 289-1011. You may also send a written complaint to the U.S. Department of Health and Human Services Office of Civil Rights. Under no circumstances will you be penalized or retaliated against for filing a complaint.