(504) 891-1390

NOTICE OF PRIVACY PRACTICES

As Required by the Privacy Regulations Created as a Result of the Health

Insurance 
Portability and Accountability Act of 1996 (HIPAA)

 

Audubon Fertility

 

PLEASE REVIEW THIS NOTICE CAREFULLY.

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU (AS A PATIENT 
OF THIS PRACTICE) MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS 
TO YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION.

 

  1. OUR COMMITMENT TO YOUR PRIVACY

 

Our practice is dedicated to maintaining the privacy of your individually identifiable health 
information (IIHI). In conducting our business, we will create records regarding you and 
the treatment and services we provide to you. We are required by law to maintain the 
confidentiality of health information that identifies you. We also are required by law to 
provide you with this notice of our legal duties and the privacy practices that we maintain 
in our practice concerning your IIHI. By federal and state law, we must follow the terms of 
the notice of privacy practices that we have in effect at the time. We realize that these laws 
are complicated, but we must provide you with the following important information:

 

  • How we may use and disclose your IIHI
  • Your privacy rights in your IIHI
  • Our obligations concerning the use and disclosure of your IIHI

 

The terms of this notice apply to all records containing your IIHI that are created or 
retained by our practice. We reserve the right to revise or amend this Notice of Privacy 
Practices. Any revision or amendment to this notice will be effective for all of your records 
that our practice has created or maintained in the past, and for any of your records that we 
may create or maintain in the future. Our practice will post a copy of our current Notice in 
our office in a visible location at all times, and you may request a copy of our most current 
Notice at any time.

 

  1. IF YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT: 504-

C. WE MAY USE AND DISCLOSE YOUR INDIVIDUALLY IDENTIFIABLE HEALTH 
INFORMATION (IIHI) IN THE FOLLOWING WAYS

 

The following categories describe the different ways in which we may use and disclose 
your IIHI.

  1. Treatment. Our practice may use your IIHI to treat you. For example, we may ask you 
to have laboratory tests (such as blood or urine tests), and we may use the results to help 
us reach a diagnosis. We might use your IIHI in order to write a prescription for you, or we 
might disclose your IIHI to a pharmacy when we order a prescription for you. Many of the 
people who work for our practice, including, but not limited to, our doctors and nurses, 
may use or disclose your IIHI in order to treat you or to assist others in your treatment. 
Additionally, we may disclose your IIHI to others who may assist in your care, such as your 
spouse, children or parents. Finally, we may also disclose your IIHI to other health care 
providers for purposes related to your treatment.
  1. Payment. Our practice may use and disclose your IIHI in order to bill and collect 
payment for the services and items you may receive from us. For example, we may contact 
your health insurer to certify that you are eligible for benefits (and for what range of 
benefits), and we may provide your insurer with details regarding your treatment to 
determine if your insurer will cover, or pay for, your treatment. We also may use and 
disclose your IIHI to obtain payment from third parties that may be responsible for such 
costs, such as family members. Also, we may use your IIHI to bill you directly for services 
and items. We may disclose your IIHI to other health care providers and entities to assist 
in their billing and collection efforts.
  1. Health Care Operations. Our practice may use and disclose your IIHI to operate our 
business. As examples of the ways in which we may use and disclose your information for 
our operations, our practice may use your IIHI to evaluate the quality of care you received 
from us, or to conduct cost management and business planning activities for our practice. 
We may disclose your IIHI to other health care providers and entities to assist in their 
health care operations.

OPTIONAL:

  1. Appointment Reminders. Our practice may use and disclose your llHI to contact you 
and remind you of an appointment.

 

OPTIONAL:

  1. Treatment Options. Our practice may use and disclose your IIHI to inform you of 
potential treatment options or alternatives.

 

OPTIONAL:

  1. Health-Related Benefits and Services. Our practice may use and disclose your IIHI to 
inform you of health-related benefits or services that may be of interest to you.

 

OPTIONAL:

  1. Release of Information to Family Friends. Our practice may release your IIHI to a 
friend or family member that is involved in your care, or who assists in taking care of you. 
For example, a parent or guardian may ask that a babysitter take their child to the 
pediatrician’s office for treatment of a cold. In this example, the babysitter may have access 
to this child’s medical information.
  1. Disclosures Required By Law. Our practice will use and disclose your IIHI when we 
are required to do so by federal, state or local law.

 

  1. USE AND DISCLOSURE OF YOUR IIHI CERTAIN SPECIAL CIRCUMSTANCES

 

The following categories describe unique scenarios in which we may use or disclose your 
identifiable health information:

 

  1. Public Health Risks. Our practice may disclose your IlHI to public health authorities 
that are authorized by law to collect information for the purpose of:
  • Maintaining vital records, such as births and deaths
  • Reporting child abuse or neglect
  • Preventing or controlling disease, injury or disability
  • Notifying a person regarding potential exposure to a communicable disease
  • Notifying a person regarding a potential risk for spreading or contracting a disease or condition.
  • Notifying individuals if a product or device they may be using has been 
recalled
  • Notifying appropriate government agency (ies) and authority (ies) regarding 
the potential abuse or neglect of an adult patient (including domestic 
violence); however, we will only disclose this information if the patient 
agrees or we are required or authorized by law to disclose this information
  • Notifying your employer under limited circumstances related primarily to 
workplace injury or illness or medical surveillance
  • Reporting reactions to drugs or problems with products or devices

 

  1. Health Oversight Activities. Our practice may disclose your IIHI to a health oversight 
agency for activities authorized by law. Oversight activities can include, for example, 
investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, 
administrative, and criminal procedures or actions; or other activities necessary for the 
government to monitor government programs, compliance with civil rights laws and the 
health care system in general.
  1. Lawsuits and Similar Proceedings. Our practice may use and disclose your IIHI in 
response to a court or administrative order, if you are involved in a lawsuit or similar 
proceeding. We also may disclose your IIHI in response to a discovery request, subpoena, 
or other lawful process by another party involved in the dispute, but only if we have made 
an effort to inform you of the request or to obtain an order protecting the information the 
party has requested.
  1. Law Enforcement. We may release IIHI if asked to do so by a law enforcement official:
  • Regarding a crime victim in certain situations, if we are unable to obtain the 
person’s agreement
  • Concerning a death we believe has resulted from criminal conduct
  • Regarding criminal conduct at our offices
  • In response to a warrant, summons, court order, subpoena or similar legal process
  • To identify, locate a suspect, material witness, fugitive or missing person
  • In an emergency, to report a crime (including the location or victim ( s) of the crime, 
or the description, identity or location of the perpetrator)

 

OPTIONAL:

  1. Deceased Patients. Our practice may release IIHI to a medical examiner or coroner to 
identify a deceased individual or to identify the cause of death. If necessary, we also may 
release information in order for funeral directors to perform their jobs.

 

OPTIONAL:

  1. Organ and Tissue Donation. Our practice may release your IIHI to organizations that 
handle organ, eye or tissue procurement or transplantation, including organ donation 
banks, as necessary to facilitate organ or tissue donation and transplantation if you are an 
organ donor.

 

OPTIONAL:

  1. Research. Our practice may use and disclose your IIHI for research purposes in certain 
limited circumstances. We will obtain your written authorization to use your IIHI for 
research purposes except when an Institutional Review Board or Privacy Board has 
determined that the waiver of your authorization satisfies the following: (i) the use or 
disclosure involves no more than a minimal risk to your privacy based on the following: 
(A) an adequate plan to protect the identifiers from improper use and disclosure; (B) an 
adequate plan to destroy the identifiers at the earliest opportunity consistent with the 
research (unless there is a health or research justification for retaining the identifiers or 
such retention is otherwise required by law); and (C) adequate written assurances that the 
IIHI will not be re-used or disclosed to any other person or entity (except as required by 
law) for authorized oversight of the research study, or for other research for which the use 
or disclosure would otherwise be permitted; (ii) the research could not practicably be 
conducted without the waiver; and (iii) the research could not practicably be conducted 
without access to and use of the IIHI.
  1. Serious Threats to Health or Safety. Our practice may use and disclose your IIHI 
when necessary to reduce or prevent a serious threat to your health and safety or the 
health and safety of another individual or the public. Under these circumstances, we will 
only make disclosures to a person or organization able to help prevent the threat
  1. Military. Our practice may disclose your IIHI if you are a member of U.S. or foreign 
military forces (including veterans) and if required by the appropriate authorities.
  1. National Security. Our practice may disclose your IIHl to federal officials for 
intelligence and national security activities authorized by law. We also may disclose your 
IIHI to federal officials in order to protect the President, the officials or foreign heads of 
state, or to conduct investigations.
  1. Inmates. Our practice may disclose your IIHI to correctional institutions or law 
enforcement officials if you are an inmate or under the custody of a law enforcement 
official. Disclosure for these purposes would be necessary: (a) for the institution to provide 
health care services to you, (b) for the safety and security ofthe institution, and/or (c) to 
protect your health and safety or the health and safety of other individuals.
  1. Workers’ Compensation. Our practice may release your IIHI for workers’ 
compensation and similar programs.
  2. YOUR RIGHTS REGARDING YOUR IIUI

 

You have the following rights regarding the IIHI that we maintain about you:

 

  1. Confidential Communications. You have the right to request that our practice 
communicate with you about your health and related issues in a particular manner or at a 
certain location. For instance, you may ask that we contact you at home, rather than work. 
In order to request a type of confidential communication, you must make a written request 
specifying the requested method of contact, or the location where you wish to be contacted. 
Our practice will accommodate reasonable requests. You do not need to give a reason for 
your request.
  1. Requesting Restrictions. You have the right to request a restriction in our use or 
disclosure of your UHI for treatment, payment or health care operations. Additionally, you 
have the right to request that we restrict our disclosure of your IIHI to only certain 
individuals involved in your care or the payment for your care, such as family members and 
friends. We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when 
the information is necessary to treat you. In order to request a restriction in our use or 
disclosure of your IIHI, you must make your request in writing to Audubon Fertility Laboratory. Your request must describe in a clear and concise fashion:

 

(a) The information you wish restricted;

(b) Whether you are requesting to limit our practice’s use, disclosure or both; and

(c) To whom you want the limits to apply.

 

  1. Inspection and Copies. You have the right to inspect and obtain a copy of the IIHI that 
may be used to make decisions about you, including patient medical records and billing 
records, but not including psychotherapy notes. You must submit your request in writing 
to Audubon Fertility Laboratory, in order to inspect and/or obtain a copy 
of your IIHI. We may charge a fee for the costs of copying, mailing, labor and supplies 
associated with your request. Our practice may deny your request to inspect and/or copy 
in certain limited circumstances; however, you may request a review of our denial. Another 
licensed health care professional chosen by us will conduct reviews.
  1. Amendment. You may ask us to amend your health information if you believe it is 
incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our practice. To request an amendment, your request must be made in to 
Audubon Fertility Laboratory. You must provide us with a reason that 
supports your request for amendment. Our practice will deny your request if you fail to 
submit your request (and the reason supporting your request) in to Audubon Fertility Laboratory. Also, we may deny your request if you ask us to amend 
information that is in our opinion: (a) accurate and complete; (b) not part of the IIHI kept 
by or for the practice; (c) not part of the IIHI which you would be permitted to inspect and 
copy; or (d) not created by our practice, unless the individual or entity that created the 
information is not available to amend the information.
  1. Accounting of Disclosures. All of our patients have the right to request an “accounting 
of disclosures. An “accounting of disclosures” is a list of certain non-routine disclosures 
our practice has made of your IIHI for non-treatment, nonpayment or non-operations 
purposes. Use of your UHI as part of the routine patient care in our practice is not required 
to be documented. For example, the doctor sharing information with the nurse; or the 
billing department using your information to file your insurance claim. In order to obtain 
an accounting of disclosures, you must submit your request in writing to Audubon Fertility Laboratory. All requests 
for an “accounting of disclosures” must state a time period, which may not be longer than 
six (6) years from the date of disclosure. The first list you request within a 12-month 
period is free of charge, but our practice may charge you for additional lists within the 
same 12-month period. Our practice will notify you of the costs involved with additional 
requests, and you may withdraw your request before you incur any costs.
  1. Right to a Paper Copy of This Notice. You are entitled to receive a paper copy of our 
notice of privacy practices. You may ask us to give you a copy of this notice at any time.
  1. Right to File a Complaint. If you believe your privacy rights have been violated, you 
may file a complaint with our practice or with the Secretary of the Department of Health 
and Human Services. All complaints must be submitted in writing to Audubon Fertility Laboratory. You will not be penalized for filing a complaint.
  1. Right to Provide an Authorization for Other Uses and Disclosures. Our practice will 
obtain your written authorization for uses and disclosures that are not identified by this 
notice or permitted by applicable law. Any authorization you provide to us regarding the 
use and disclosure of your IIHI may be revoked at any time in writing. After you revoke 
your authorization, we will no longer use or disclose your IIHI for the reasons described in 
the authorization. Please note, we are required to retain records of your care.