NOTICE OF PRIVACY PRACTICES
This Notice describes how medical information about you may be used and disclosed and how you can get access
to this information


I. WHO WE ARE

This Notice describes the private practice of Karl Ahlswede, MD (End of Life Advocacy). We are required by law to maintain the privacy of your health information and to provide you with this Notice.

II. Our Duties to Safeguard Your Protected Health Information (PHI)

Protected Health Information is any information related to your health care that is shared or maintained in any manner.

This Notice applies to all of your medical information generated by Karl Ahlswede, MD (End of Life Advocacy). This Notice will tell you about the ways in which we may use and disclose your medical information. We also describe your rights and certain obligations we have regarding the use and disclosure of your medical information.

We are required by law to: make sure that medical information that identifies you is kept private; give you this Notice of our legal duties and privacy practices related to your medical information; and follow the terms of the Notice that is currently in effect.

III. How Karl Ahlswede, MD
(End of Life Advocacy) may
use and disclose medical
information about You.


Except in emergency or other special situations, we will ask you to sign a general consent, as required by Pennsylvania law, so that we may use and disclose your protected health information for the following purposes:

Treatment. We may use and disclose protected health information about you in connection with medical care. In addition, we may contact you to remind you about appointments, give you instructions, or inform you about treatment alternatives or other health related benefits or services. We may also disclose your medical information to other providers, doctors, nurses, technicians, medical students, hospital personnel or other health care facilities involved in your treatment. We may need to communicate this medical information to other health care providers using phone or two-way radio.

Other Health Care Providers. We may also disclose your PHI to other health care providers when such PHI is required for them to treat you or receive payment for services. For example, we will share your PHI with an ambulance company so the ambulance company can transport you and be reimbursed for transporting you to the hospital.

IV. Other Uses and Disclosures of Your PHI for which authorization is not required.

Disclosure to Relatives and Close Friends.
We may disclose your PHI to a family member, other relative, a close personal friend or any other person if we (1) obtain your agreement; (2) provide you with the opportunity to object to the disclosure; or, (3) we can reasonably infer that you do not object to the disclosure.

If you are not present, or the opportunity to agree or object to a use or disclosure cannot practicably be provided because of your incapacity or an emergency circumstance, we may exercise our professional judgment to determine whether a disclosure is in your best interests. If we disclose information to a family member, other relative or a close personal friend, we would disclose only information that is directly relevant to the person's involvement with your health care.

Public Health Activities.
We may disclose information about you for public health activities including the following: reporting birth or deaths; to prevent or control disease, injury or disability; to report child abuse or neglect; to report reactions to medications or problems with products; to notify individuals who may have been exposed to a disease or may be at risk for contracting a disease or condition; reporting information to your employer as required by laws addressing work¬ related illnesses and injuries or workplace medical surveillance.

Victims of Abuse, Neglect or Domestic Violence. If we reasonably believe you are a victim of abuse, neglect or domestic violence, we may, in accordance with current Pennsylvania law, disclose your PHI to a governmental authority, including a social service or protective services agency, authorized by law to receive reports of such abuse, neglect, or domestic violence.

Legal Proceedings and Law Enforcement.
We may disclose your PHI in response to a court order, subpoena, or other lawful process.

Deceased Persons. We may release medical information to a coroner or medical examiner authorized by law to receive such information.

Organ and Tissue Donation. We may disclose your PHI to organizations that obtain organs or tissues for banking and/or transplantation.

Public Safety. We may use or disclose your PHI to prevent or lessen a serious or imminent threat to the safety of a person or the public.

Research.
We will ask for your permission or authorization before using your PHI for research purposes.

Disaster Relief Efforts.
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.

Military, National Defense and Security.
We may release medical information about you if required for military, national defense and security and other special government functions.

Workers' Compensation.
We may release medical information about you for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illnesses.

As Required by Law. We may use and disclose your PHl when required to do so by any other laws not already referenced above.

V. Uses and Disclosures Requiring Your Specific Authorization

Highly Confidential Information. Federal and State laws require special privacy protections for certain highly confidential information about you. This includes PHI that is: 1) maintained in psychotherapy notes; 2) documentation related to mental health or developmental disabilities services; 3) drug and alcohol abuse, prevention, treatment and referral information; 4) information related to HIV status, testing, treatment as well as any information related to the treatment or diagnosis of sexually transmitted diseases; and 5) PHI related to genetic testing.

Generally, we must obtain your authorization to release this type of information. However, there are limited circumstances under the law when this information may be released without your consent. For example, certain sexually transmitted diseases must be reported to the Department of Health.

VI. Your Rights Regarding Medical Information

About You. You have the following rights regarding medical information we maintain about you:

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 excluding psychotherapy notes. You must submit your request in writing. You may be charged a fee for the costs of copying, mailing or other supplies associated with your request.

We may deny your request to inspect and copy in certain very limited circumstances. You may request that the denial be reviewed. Another licensed health care professional chosen by Karl Ahlswede MD (End of Life Advocacy) will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
Right to Amend. You have the right to request that we amend the PHI we keep about you in your medical and billing records. To request an amendment, your request must be made in writing. We may deny your request if we believe the information you wish to amend is accurate, current and complete.

Right to an Accounting of Disclosures. You have the right to request a record of all disclosures of your PHI. We are not required to give you an accounting of information we have used or disclosed for treatment, payment or health care operations or information you authorized us to disclose.

To request this accounting of disclosures, you must submit your request in writing. Your request may cover any disclosures made in the six years prior to the date of your request.

Right to 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. 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 emergency treatment.

To request restrictions, you must make your request in writing. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply. For example, disclosures to your spouse.

Right to Reguest 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. To request confidential communications, you must make your request in writing. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

Right to Revoke Your Authorization.
You may revoke your authorization for us to use and disclose your PHI at any time by submitting a request in writing to the appropriate department.

VII. Changes to This Notice

We reserve the right to change this notice. Revised Notices will be posted online at www.karlahlswede.com. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future.

VIII. Complaints

If you believe your privacy rights have been violated, you may file a complaint, in writing to: Karl Ahlswede, MD, End of Life Advocacy, POB 136, Wynnewood, PA 19096.

You may also wish to file a complaint with the Director, Office of Civil Rights of the U. S. Department of Health and Human Services. Karl Ahlswede, MD can supply the correct address for the Director.

You will not be penalized for filing a complaint.

IX. 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. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain a record of the care that we provided to you.

This Notice is effective: July 20, 2010.
     
 
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