Notice of Privacy Practices (effective date 4-14-03)

This notice describes how information about you may be used and disclosed and how you can get access to this information.  Please review it carefully.

Understanding your health record:

Each time you have an appointment with a clinic physician, a record of your visit is made.  Typically this record contains your symptoms, demographic information (address, telephone number, etc.), treatment, test results, diagnosis, and plan for future care and treatment.  This information or medical record serves as a:

Basis for planning your care and treatment.

Means of communicating amongst other Clinic physicians that may participate in your care.

Legal document describing the care you receive.

Means by which you or a third-party payer (insurance, Medicare, Medicaid, etc.) can verify that services billed were actually provided.

A tool in educating health professionals (i.e. Student doctors).

A source of data for medical research.

A source of information for public health officials.

A source of data for facility planning and marketing.

A tool with which the Clinic can assess and work to improve the care we render. 

Understanding what is in your record and how your health information is used, helps you understand who may access your health information.

Although your health record is the physical property of the Grand Island Clinic, the information belongs to you.  You have the right to:

Request a restriction on certain uses and disclosures of your protected health information.

Obtain a paper copy of this Notice of Privacy Practices upon request.

Inspect and receive a copy of your health record.

Request an amendment to your health record.

Obtain an accounting of disclosures of your health information.

Request communications of your health information by alternative means or at an alternative location.

Revoke your authorization to use or disclosure of health information, except to the extent that action has already been taken.

Any requests or revocation must be in written form addressed to the Privacy Officer of the Grand Island Clinic at P.O. Box 550, Grand Island, NE 68802

Grand Island Clinic Responsibilities

The Grand Island Clinic is required to maintain the privacy of your health information, provide you with a notice of information practices, abide by the terms of this notice, notify you if we are unable to agree to a requested restriction and accommodate reasonable requests.  The Grand Island Clinic reserves the right to change its practices and to make the new provisions effective for all protected health information we maintain.

Upon your request, we will provide you with the revised notice by sending it to the address you list below.  Your health information will not be disclosed without your authorization, except as described in this notice which is posted in waiting areas and at http://www.grandislandclinic.net.

To Report a Problem or to Seek Additional Information

If you have questions or would like additional information, you may contact the Privacy Officer.  If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer or the Secretary of the Department of Health and Human Services.  There will be no retaliation for filing a complaint.

Examples of Disclosures:

We will use your health information for treatment.  Information obtained by your physician or a clinic staff member will be recorded and used to determine treatment which we believe is best for you.  Referral information provided, observations and actions taken will also be recorded.

We will use your information for payment.  A bill may be sent to you, or your financially responsible party, or a third-party payer.  Information may be shared with third-party payer of health plans to accommodate the process of authorization for payment.  The information on or accompanying the bill may include information that identifies you, dates of service, your diagnosis, medical treatment rendered and supplies used.

We will use your information for health care operations.  Physicians and staff members may use information in your health record to assess the care and outcomes of your care.  This information will be utilized in an effort to improve the quality and effectiveness of the health care and services provided at Grand Island Clinic.

Notification.  We may use or disclose information to notify or assist in notifying a family member or another person indicated by you to be responsible for your care, of your location and general condition.

Communication with Family.  With your permission, physicians may disclose to a family member, close personal friend, or any other person whom you identify, health information that is relevant to your care and/or payment relating to your care.

Marketing.  We may contact you to provide appointment reminders or information about treatment alternatives or other health related benefits and services that may be of interest to you.

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.

Public Health.  As required by State law, we may disclose your health information to Public Health or legal authorities charged with preventing or controlling disease, injury or disability.

Health Care Professional Curriculum.  Through arrangements made with institutions of higher learning, health care students; i.e. Nursing, medical students, residents, may have access to your health information as necessary to provide care and treatment.  Federal law makes provisions for you health information to be released to an appropriate health oversight agency, public health authority, or attorney, provided that a work force member believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public.