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.
If you have any questions about this Notice, please
contact our Privacy Officer at the number listed at the end of
this Notice.
Each time you visit a healthcare provider, a record of your
visit is made. Typically, this record contains your symptoms,
examination and test results, diagnoses, treatment, a plan for
future care or treatment, and billing-related information. This
Notice applies to all of the records of your care generated by
your health care provider.
Our Responsibilities
Aventiv Research, Inc. is required by law to
maintain the privacy of your health information and to provide
you with a description of our legal duties and privacy practices
regarding your health information. The current Notice will be
posted in the waiting room. The notice will include the
effective date. In addition, we will make our best effort to
provide you with a copy of this notice that we request you
acknowledge with your signature.
We are required by law to abide by the terms of this Notice
and notify you if we make changes to this Notice, which may be
at any time. Changes to the Notice will apply to your medical
information that we already maintain as well as new information
received after the change occurs. If we change our Notice, it
will be posted in the waiting room. You may also request that a
revised Notice be sent to you in the mail or you may ask for one
at your next appointment or appropriate visit. This Notice will
also serve to advise you as to your rights with regard to your
medical information.
How We May Use and Disclose Medical
Information About You.
The following categories describe examples of the way we use
and disclose medical information:
- For Treatment: We may use medical information
about you to provide, coordinate and manage your treatment
or services. We may disclose medical information about you
to other doctors, nurses, technicians (e.g. clinical
laboratories or imaging companies), medical students, or
other personnel who are involved in your care. We may
communicate your information either orally or in writing by
mail or facsimile.
We may also provide a subsequent
healthcare provider with copies of various reports that
should assist him or her in treating you. For example, your
medical information may be provided to a physician to whom
you have been referred so as to ensure that the physician
has appropriate information regarding your previous
treatment and diagnosis.
- For Payment: We may use and disclose medical
information about your treatment and services to bill and
collect payment from you, your insurance company or a third
party payer. For example, we may need to give your insurance
company information before it approves or pays for the
health care services we recommend for you.
- For Health Care Operations: We may use or
disclose, as needed, your health information in order to
support our business activities. These activities may
include, but are not limited to quality assessment
activities, employee review activities, licensing, legal
advice, accounting support, information systems support and
conducting or arranging for other business activities. In
addition, we may also call you by name in the waiting room
when your physician is ready to see you. We may use or
disclose your protected health information, as necessary, to
contact you to remind you of your appointment by telephone
or reminder card.
- Business Associates: There are some services
provided in our organization through contracts with business
associates. Examples include quality assurance,
software/hardware support, and accreditation. If these
services are contracted, we may disclose your health
information to our business associate so that they can
perform the job that we have asked them to do and bill you
or your third-party payer for services rendered. To protect
your health information, however, we require the business
associate to appropriately safeguard your information
through a written contract.
Other Permitted and Required Uses and
Disclosures That May Be Made With Your Consent, Authorization or
Opportunity to Object
We also may use and disclose your health information as set
forth below. You have the opportunity to agree or object to the
use or disclosure of all or part of your health information in
these instances. If you are not present or able to agree or
object to the use or disclosure of the health information (such
as in an emergency situation), then your clinician may, using
professional judgment, determine whether the disclosure is in
your best interest. In this case, only the information that is
relevant to your health care will be disclosed.
- Individuals Involved in Your Care or Payment for Your
Care: Unless you object, we may release medical information
about you to a friend or family member who is involved in
your medical care or who helps to pay for your care. In
addition, we may disclose medical information about you to
an entity assisting in a disaster relief effort so that your
family can be notified about your condition, status and
location.
- Future Communications: We may communicate to you via
newsletters, mailings or other means regarding treatment
options, information on health-related benefits or services;
to remind you that you have an appointment for medical care;
or other community based initiatives or activities in which
our facility is participating. If you are not interested in
receiving these materials, please contact our Privacy
Officer.
Other Permitted and Required Uses and
Disclosures That May Be Made Without Your Authorization or
Opportunity to Object
We may use or disclose your health information in the
following situations without your authorization or without
providing you with an opportunity to object. These situations
include:
- As required by law. We may use and disclose
health information to the following types of entities,
including but not limited to:
- Food and Drug Administration
- Public Health or Legal Authorities charged with
preventing or controlling disease, injury or disability
- Correctional Institutions
- Workers Compensation Agents
- Organ and Tissue Donation Organizations
- Military Command Authorities
- Health Oversight Agencies
- Funeral Directors, Coroners and Medical Directors
- National Security and Intelligence Agencies
- Protective Services for the President and Others
- Authority that receives reports on abuse and neglect
- Law Enforcement/Legal Proceedings: We may
disclose health information for law enforcement purposes as
required by law or in response to a valid subpoena.
- State-Specific Requirements: Many states have
requirements for reporting, including population-based
activities relating to improving health or reducing health
care costs.
Your Health Information Rights
Although your health record is the physical property of the
Aventiv Research, Inc. that compiled it, you have the
right to:
- Inspect and Copy: You have the right to inspect
and copy medical information that may be used to make
decisions about your care. We ask that you submit these
requests in writing. Usually, this includes medical and
billing records, but does not include psychotherapy notes or
information compiled in reasonable anticipation of, or for
use in, a civil, criminal, or administrative action or
proceeding. We may deny your request to inspect and copy in
certain very limited circumstances. If you are denied access
to medical information, you may request that the denial be
reviewed. The person conducting the review will not be the
person who denied your request. We will comply with the
outcome of the review. Requests for access to and copies of
your medical information must be submitted to Columbus
Clinical Research, Inc. in writing. There is no charge for
copying releases of PHI.
- Amend: If you feel that medical information we
have about you is incorrect or incomplete, you may ask us to
amend the information by submitting a request in writing.
You have the right to request an amendment for as long as we
keep the information. We may deny your request for an
amendment and if this occurs, you will be notified of the
reason for the denial.
- An Accounting of Disclosures: You have the right
to request an accounting of our disclosures of medical
information about you except for certain circumstances,
including disclosures for treatment, payment, health care
operations or where you specifically authorized a
disclosure. Aventiv Research, Inc. will provide
the first accounting to you in any 12-month period without
charge. The cost for subsequent requests for an accounting
within the 12-month period will be no charge. We ask that
you submit these requests in writing.
- Request Restrictions: You have the right to
request a restriction or limitation on the medical
information we use or disclose about you for treatment,
payment or health care operations. You also have the right
to request a limit on the medical information we disclose
about you to someone who is involved in your care or the
payment for your care, like a family member or friend. For
example, you could ask that we not use or disclose
information about a procedure that you had. We ask that you
submit these requests in writing.
We are not required to agree to your
request. If we do agree, we will comply with your
request unless the information is needed to provide you with
emergency treatment.
- Request Confidential Communications: You have the
right to request that we communicate with you about medical
matters in a certain way or at a certain location. We will
agree to the request to the extent that it is reasonable for
us to do so. For example, you can ask that we use an
alternative address for billing purposes. We ask that you
submit these requests in writing.
- A Paper Copy of This Notice: You have the right
to a paper copy of this notice. You may ask us to give you a
copy of this notice at any time. Even if you have agreed to
receive this notice electronically, you are still entitled
to a paper copy of this notice.
To exercise any of your rights, please obtain the required
forms from the Privacy Officer and submit your request in
writing.
Complaints
If you believe your privacy rights have been violated, you
may file a complaint with us by calling (614) 501-6164 and
asking for the Privacy Officer or by contacting the Secretary of
the Federal Department of Health and Human Services. All
complaints must be also submitted in writing. You will not be
penalized for filing a complaint.
Other Uses of Medical Information
Other uses and disclosures of medical information not covered
by this Notice or the laws that apply to us will be made only
with your written permission. If you provide us permission to
use or disclose medical information about you, you may revoke
that permission, in writing, at any time. If you revoke your
permission, we will no longer use or disclose medical
information about you for the reasons covered by your written
authorization. However, we are unable to take back any
disclosures we have already made with your permission and we are
required to retain our records of the care that we provided to
you.
Privacy Officer:Dr. Samir Arora
Telephone Number: (614) 501-6164