Frequently Asked Questions

Affordable Quality Care

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.

This Notice of Privacy Practices is provided to you as a requirement of the Health Insurance Portability and Accountability Act (HIPAA).
We are strongly committed to protecting your medical information, also referred to as Protected Health Information. We create a medical record about your care because we need the record to provide you with appropriate treatment and to comply with various legal requirements. We transmit some medical information about your care in order to obtain payment for the services you receive, and we use certain information in our day-to-day operations. This Notice will let you know about the various ways we use and disclose your Protected Health Information. This Notice describes your rights and our obligations with respect to the use or disclosure of your Protected Health Information.

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 often referred to as your health or medical records, serves as a:

• Basis for planning your care and treatment
• Means of communication among the many health professionals who contribute to your care
• Legal document describing the care you received means by which you or a third-party payer can verify that services billed were actually provided
• Means by which you or a third-party payer can verify that services billed were actually provided
• Tool in educating health professionals
• Source of data for medical research
• Source of information for public health officials charged with improving the health of the nation
• Source of data for facility planning and marketing tool with which we can assess and continually work to improve the care we render and the outcomes we achieve

Understanding what is in your record and how your health information is used helps you to:

• Ensure its accuracy
• Better understand who, what, when, where, and why others may access your health information
• Make more informed decisions when authorizing disclosure to others

Protected Health Information is individually identifiable health information. This information relates to your past, present, or future physical or mental health or condition and related health care services; to the past, present, or future payment for such health care services; and includes demographic information such as your age, address, or email address. Affordable Quality Care is required by law to do the following:

• Make sure that your Protected Health Information is kept private
• Give you this Notice of our legal duties and privacy practices related to the use and disclosure of your Protected Health Information
• Follow the terms of the Notice currently in effect
• Describe how we will communicate any changes in this Notice to you

We reserve the right to change this Notice. We reserve the right to make the revised Notice effective for Protected Health Information we already have about you, as well as any Protected Health Information we create or receive in the future. You may obtain another Notice of Privacy Practices by asking your practitioner for a copy at your next appointment or by sending a written request for a copy to the Affordable Quality Care Privacy Officer at the address listed below.

The following categories describe the ways that we may use and disclose your medical information, including sensitive information such as mental health, communicable disease, and drug and alcohol abuse information. In order to assure compliance with Oklahoma law, we will obtain your general consent to use and disclose your medical information. Not every use or disclosure in a category will be listed.

If you are concerned about a possible use or disclosure of any part of your medical information, you may request a restriction. Your right to request a restriction is described in the section below regarding patient rights.

Oklahoma law only permits disclosure of communicable disease information, (such as HIV, AIDS, Hepatitis, etc.) under the following circumstances:

1. With the patient's written consent
2. If release is ordered by a court
3. If release is required by the State Department of Health to protect the public
4. If release is made to a person exposed to such diseases
5. If release is required to health professionals, appropriate state agencies or a court to enforce Oklahoma law
6. If release is required for statistical purposes without patient identity, or
7. If release is necessary to health care providers and related parties for diagnosis and treatment purposes

Treatment. We will use your health information for treatment

For example: Information obtained by a nurse, physician, or other member of your healthcare team will be recorded in your record and used to determine the course of treatment that should work best for you. Your physician will document in your record his or her plan for your care. Members of your health care team will then record the actions they took and their observations. In that way, the physician will know how you are responding to treatment.

We also will provide a physician or a subsequent health care provider with copies of various reports that should assist him or her in treating you outside of this practice. For example: A physician we would refer you to for specialized care.

Payment. We will use your health information to obtain payment for the services we provide to you

We may use and disclose your Protected Health Information in order to bill and obtain payment for health care services provided to you. For example, a bill may be sent to you or a third-party, including Medicare, Medicaid, and private insurance companies. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used. We may disclose medical information about you to another health care entity or provider so that it may obtain payment for services provided.

Health Care Operations. We will use your health information for our business operations

We may use or disclose your Protected Health Information in connection with our business operations. These operations include, but are not limited to, quality assessment activities, development of clinical guidelines, reviewing the qualifications and performance of practitioners and other health care professionals, training activities, legal services, and auditing functions, business planning, and development and business management and general administrative operations of our facilities. We may share your Protected Health Information with third-party business associates that perform various activities (e.g., collections, transcription services) for our facilities. Whenever an arrangement between our facility and our business associate involves the use or disclosure of your Protected Health Information, we will have a written contract that contains terms that will protect the privacy of your Protected Health Information.

Business Associates

We may disclose your medical information to other entities that provide services to or for Affordable Quality Care that require the release of patient medical information. However, we will make these disclosures only if we have received satisfactory assurance that the other entity will properly safeguard your medical information. For example: We may contract with another entity to provide billing services.

Treatment Alternatives

We may use or disclose your Protected Health Information to provide you with information about treatment alternatives or other health-related products and services that may be of interest to you.

Sign In Sheets

We may use a sign-in sheet at the registration desk where you will be asked to sign your name. We may also call you by name in the waiting room when your practitioner is ready to see you.

Sale of the Practice

If we decide to sell this practice or merge or combine with another practice, we may share your Protected Health Information with prospective buyers or new owners.

Required By Law

We may use or disclose your Protected Health Information to the extent that the use or disclosure is required by Federal, State, or local law.

Public Health

We may disclose your Protected Health Information for public health activities to public health authorities who are legally authorized to receive such information. These activities include, but are not limited to, preventing or controlling disease, injury or disability; reporting vital events; and conducting public surveillance, public health investigations, and public health interventions, including notifying persons who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition.

Health Oversight

We may disclose Protected Health Information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections, licensure and disciplinary actions, and civil, administrative, and criminal proceedings or actions. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regulatory programs, and compliance with the civil rights laws.

Abuse or Neglect

We may disclose your Protected Health Information to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, if we believe that you have been a victim of abuse, neglect or domestic violence, we may disclose your Protected Health Information to a governmental entity or agency authorized by law to receive reports of abuse, neglect or domestic violence, including a social service or protective services agency. We will only make this disclosure if you agree or when required or authorized by law.

Food and Drug Administration (FDA)

We may disclose to the FDA Protected Health Information relative to adverse events with respect to food, supplements, product and product defects, or post-marketing surveillance information to enable product recalls, repairs, or replacement.

Legal Proceedings

We may disclose Protected Health Information about you in response to an order by a court or administrative tribunal. We may also disclose Protected Health Information about you in response to a subpoena, discovery request or other lawful processes by a party to a judicial or administrative proceeding, but only if efforts have been made to notify you about the subpoena, discovery request or legal process, or to obtain an order from the court or administrative tribunal protecting the information requested.

Law Enforcement

We may disclose your Protected Health Information in response to a court order, a court-ordered subpoena, warrant or summons, or similar process authorized by law. Also, in response to a request from a law enforcement official, we may disclose Protected Health Information for the purpose of identifying or locating a suspect, fugitive, material witness, or missing person; or pertaining to a known or suspected victim of a crime. Finally, we may disclose Protected Health Information to a law enforcement official:

1. To report a death that we suspect may be the result of criminal conduct
2. To report criminal conduct on our premises; or
3. In the event of a medical emergency (not on our premises), to report a crime, the location of the crime or victims, or the identity, description or location of the person who committed the crime

Serious Threat to Health or Safety

We may use and disclose your Protected Health Information if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. Under certain circumstances, we may also disclose Protected Health Information if it is necessary for law enforcement authorities to identify or apprehend an individual.

Military Activity and National Security

If you are a member of the armed forces, we may release Protected Health Information about you as required by military command authorities. We may also release Protected Health Information about foreign military personnel to the appropriate foreign military authority. Finally, we may release Protected Health Information about you to authorized federal officials so that they may:

1. Conduct intelligence, counter-intelligence, and other national security activities authorized by law; or
2. Provide protection to the President, other authorized persons or foreign heads of state, or conduct special investigations

Inmates

If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release Protected Health Information about you to the correctional institution or law enforcement official if necessary:

1. For provision of health care to you
2. To protect your health and safety or the health and safety of others
3. For law enforcement on the premises of the correctional institution, or
4. For the administration and maintenance of the safety and security of the correctional institution

Military/Veterans

We may disclose your Protected Health Information as required by military command authorities if you are a member of the armed forces.

Uses and Disclosures Upon Written Authorization

All other uses and disclosures of your Protected Health Information that are not described above will be made only with your written authorization. You may revoke your authorization, at any time, in writing. You understand that we cannot take back any use or disclosure we may have made under the authorization before we received your written revocation and that we are required to maintain a record of the medical care that has been provided to you. The authorization is a separate document, and you will have the opportunity to review any authorization before you sign it. With the exception of research-related treatment, we will not condition your treatment on whether or not you sign any authorization.

Although your personal health record is the physical property of the health care practitioner, the information belongs to you. You have the right to:

• Request a restriction on certain uses and disclosures of your information as provided by law. We ask that such requests be made in writing. Although we will consider your request, please be aware that we are under no obligation to accept it or to abide by it
• Obtain a paper copy of the Notice of Privacy Policy upon request
• Inspect and obtain a copy of your health record. This right does not apply to a very narrow category of medical information referred to as "psychotherapy notes." We may deny your request to inspect and/or copy your medical information in certain circumstances. If you are denied access, you may request that the denial be reviewed. A licensed health care professional chosen by us will review your request and the denial. We will comply with the outcome of the review
• Request an amendment to your health record. Such a request must be made in writing, and you must state a reason for the amendment. We are not required by law to honor your request if we determine, among other things, that the record is accurate and complete
• Obtain an accounting of disclosures of your health information. This is a list of certain disclosures we make of your medical information. We are not required to include in this accounting
• Disclosures made for treatment, payment or health care operations, or
• Disclosures that you authorize. Your request must state a time period, which may not be longer than six years
• Revoke your authorization to use or disclose health information except to the extent that action has already taken place

If you have questions and would like additional information, you may contact the Affordable Quality Care's Privacy Officer at (405) 217-9997.

If you believe that your privacy rights have been violated, you may file a complaint with us. These complaints must be submitted in writing, and you may send it to the Privacy Officer or Administration. You may also file a complaint with the Secretary of the Department of Health and Human Services. There will be no retaliation for filing a claim.