Semmes Murphey Clinic Notice of Privacy Practices

Each time you visit a hospital, physician, or other health care provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information is often referred to as your “medical record.” This information and other information relating to your care is referred to in this notice as “Health Information.” The doctors and staff of Semmes Murphey Clinic (“Semmes Murphey”) maintain Health Information relating to the care you receive from us.

The Health Information contained in your record is useful for a number of reasons. For example, this information:

• Serves as a basis for planning your care and treatment
• Provides a means of communication among the many health professionals who contribute to your care
• Describes the care you received
• Allows you, your insurance company or other third-party payer to verify that services are accurately billed
• Allows health care professionals and organizations involved in your care to conduct treatment, payment, and operational activities
• Contains information we will need to contact you about appointment reminders, treatment alternatives, or other health-related benefits

Understanding what is in your record and how your Health Information is used helps you to ensure its accuracy and to better understand who, what, when, where, and why others may access your Health Information. This, in turn, allows you to make more informed decisions about its use and disclosure.

Although your Health Information at our offices is the physical property of Semmes Murphey, you have

certain rights relating to this information. As a patient, you are generally entitled to:

• Obtain a copy or summary of your Health Information or to inspect such information (a reasonable fee may be charged). We will provide an electronic copy of your Health Information upon request
• Request an amendment to your Health Information where you feel there is an error
• Request a restriction on certain uses and disclosures of your Health Information. We will consider reasonable, appropriate requests, but are not obligated to agree to them, unless you request a restriction on disclosure of information to your health insurance company based on services for which you paid in full, out-of-pocket
• Obtain an accounting of certain disclosures of your Health Information (a reasonable fee may be charged to fulfill repeated requests for accountings)
• Request that communication of your Health Information made to you be made by alternative means or at alternative locations (for example, a certain postal address or phone number).
• Please be aware that it is our standard practice to use any or all of the information you have provided to us in order to contact you for purposes of treatment (for example, conveying test results), payment, and business operations (for example, scheduling appointments, providing appointment reminders). We may use mailings and may leave messages on your answering machine, voice mail, or with others who may answer your phone for such purposes. Also, if contact information we have for you is no longer valid, we may contact other persons identified in your record (for example, family members, persons identified as an emergency contact) to obtain updated contact information on you. If you wish to limit or specify the means by which we contact you, you may request our Patient Request Form and return it to the Semmes Murphey Privacy Officer as provided below. You do not need to give a reason for your request. Semmes Murphey will accommodate requests we determine to be reasonable
• Obtain a paper copy of Semmes Murphey’s notice of privacy practices (if you have received this electronically)
• Revoke a previous authorization to certain uses and disclosures of your Health Information by Semmes Murphey (that you may have provided under a written authorization), except where actions have already been taken relating to that authorization
• Receive notice when your unsecured Health Information has been breached
  
  With the exception of obtaining a copy of our current notice, to exercise any of these rights, you must do so in writing. Please contact our Privacy Officer to obtain written request forms or to ask any questions you have regarding these rights. You can contact our Privacy Officer at 901.522.7700. Communications may also be sent by mail to:

Privacy Officer, Semmes Murphey, P.C., 6325 Humphreys Boulevard, Memphis, TN 38120.

Semmes Murphey is required by law to take measures designed to protect the privacy of your Health Information, to provide you with this notice describing our privacy practices and legal duties and to notify you following a breach of your unsecured Health Information. We are also required to abide by the terms of our current notice. We reserve the right to change our notice and privacy practices, and to make the new provisions effective for all protected health information we maintain, including your Health Information. Should our privacy practices change, we will post our revised notice at our offices and on our website at www.semmes-murphey.com. An updated version may also be provided to you following any substantial changes to the notice upon your written request to our Privacy Officer or upon you request during a return visit to Semmes Murphey.

Except as consistent with this notice or as otherwise required or permitted by law (for example, in emergency treatment situations), we will not use or disclose your Health Information without obtaining your written authorization. For example, we will obtain your authorization before most uses and disclosures of psychotherapy notes; for marketing purposes; and for disclosures that would constitute a sale of your Health Information (508(a)(2)-(a)(4)). When feasible, we will accommodate reasonable requests from you to communicate Health Information by alternative means or to alternative locations.

Although other health care providers may provide treatment to you (for example, hospitals or other physician groups), we are not jointly managed with or owned by such providers. They will have their own policies and procedures for handling your health information.

If have questions and would like additional information, you may contact Semmes Murphey’s Privacy Officer at 901.522.7700. Communications may also be sent by mail addressed to:

Privacy Officer, Semmes Murphey, P.C., 6325 Humphreys Boulevard, Memphis, TN 38120.

If you believe your privacy rights have been violated, please file a complaint with the Privacy Officer, as listed above, or with the Secretary of the U.S. Department of Health and Human Services. There will be no retaliation for filing a complaint.

We will use your Health Information for treatment. For example: Information obtained by a nurse, physician, or other member of your health care team will be recorded in your record and used to determine your course of treatment. Members of your health care team will then record the actions they took and their observations. Semmes Murphey may also provide copies of your Health Information to other health care providers who take care of you.

We will use your Health Information for payment. For example: A bill may be sent to you or your insurance company or other third-party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used. Semmes Murphey may also provide other health care providers involved in your care with information to assist in their billing and payment activities.

We will use your Health Information for our business operations. For example: Semmes Murphey doctors and staff may use information in your health record to assess the care and outcomes in your case and others like it or to train students or other health professionals. This information will then be used in an effort to continually improve the quality and effectiveness of the health care and services we provide.

Vendors: There are some services provided in our organization through contracts with outside vendors. For example, we might use a copy service to make copies of patient records for us. When such services are contracted, we may disclose your Health Information to our vendors so that they can perform the job we’ve asked them to do. To help protect your Health Information, we require vendors to agree in writing to safeguard Health Information, consistent with the same standards that we are required to observe.

Notification: We may use or disclose your Health Information to notify or assist in notifying a family member, personal representative, or other person responsible for your care, of your location and general condition in the event you are unable to care for yourself.

Communication with family: We may disclose to a family member, other relative, close personal friend, or other person you identify, Health Information that is in our judgment relevant to that person’s involvement in your care or payment for your care.

Note to persons under the age of 18: Good medical practice, payment requirements, or state law may make it necessary to tell your parent or guardian about your visit or provide them with all or part of your Health Information. If this is a concern to you, please discuss your concern with your doctor or Semmes Murphey’s Privacy Officer before you receive services.

Limited data sets and de-identified information: In many instances where we use or disclose information for purposes of research, public health, or health care operations, certain information (names, social security numbers, etc.) will be removed to help protect the identity of the patient.

Research: We may use and disclose information for research activities when you have provided written authorization and/or protocols designed to ensure the privacy of your Health Information are in place.

Decedents: We may disclose Health Information to medical examiners or funeral directors to permit them to carry out their duties.

Organ procurement organizations: Consistent with applicable law, we may disclose 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.

Marketing: We, or persons working with us, may contact you to provide information about health-related products or services that may be of interest to you. Your Health Information may also be a source of data for Semmes Murphey’s planning and marketing activities. If we desire to provide Health Information to third parties for their marketing activities, or if we receive remuneration for our marketing activities, we will ask for your authorization in writing before doing so.

Fundraising: We, or someone working with us, may contact you as part of a fund-raising effort on our behalf. You have the right to opt-out of fundraising communications. To do so, please contact the Semmes Murphey Privacy Officer at 901.522.7700. Food and Drug Administration (FDA): We may disclose to the FDA Health Information relative to adverse events with respect to food, supplements, products and product defects, or post-marketing surveillance information to enable product recall, repair, or replacement.

Workers compensation: We may disclose Health Information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.

Public health: We may disclose your Health Information to public health or legal authorities charged with improving health (for example, by preventing or controlling disease, injury, or disability) when and to the extent required or permitted by law.

National security/military service: We may disclose Health Information for national security purposes. We may also disclose Health Information about Armed Forces personnel to appropriate military authorities in certain circumstances.

Correctional institution: If you are an inmate of a correctional institution, we may disclose to the institution or agents of this institution Health Information necessary for your health and the health and safety of others.

Law enforcement/Prevention of harm/Required by law: We may disclose Health Information for law enforcement purposes as required by law or in response to a valid subpoena or court order; or where, in our judgment, we believe there may be a threat of serious bodily harm to a patient or other person. Also, Federal or state law may require that your Health Information be released to an app

THE POLICIES IN THIS NOTICE BECAME EFFECTIVE ON: March 1, 2013.