Go to a printable page!

Plastic & Reconstructive Surgery, PC
Jim N. Brantner, MD

Notice of Privacy Practices for Protected Health Information
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!

Our office is permitted by federal privacy laws to make uses and disclosures of your health information for purposes of treatment, payment, and health care operations. Protected health information is the information we create and obtain in providing our services to you. Such information may include documenting your symptoms, examination and test results, diagnoses, treatment, and applying for future care or treatment. It also includes billing documents for those services.

EXAMPLES OF USES OF YOUR HEALTH INFORMATION FOR TREATMENT PURPOSES ARE:

  • An employee obtains treatment information about you and records it in a health record.
  • During the course of your treatment, Dr. Brantner determines he will need to consult with another specialist in the area. He will share the information with such specialist and obtain his/her input.

    EXAMPLE OF USE OF YOUR HEALTH INFORMATION FOR PAYMENT ARE:

  • We submit requests for payment to your health insurance company. The health insurance company or business associate helping us obtain payment requests information from us regarding your medical care. We will provide information to them about you and the care provided.

    EXAMPLE OF USE OF YOUR INFORMATION FOR HEALTH CARE OPERATIONS:

  • In obtaining services from business associates such as quality assessment, quality improvement, outcome evaluation, protocol and clinical guidelines development, training programs, credentialing, medical review, legal services, and insurance, we may share your information with such business associates as necessary.

    YOUR HEALTH INFORMATION RIGHTS:

    1. Request a restriction on certain uses and disclosures of your health information by delivering the request in writing to our office—we are not required to grant the request but we will comply with any request granted;
    2. Obtain a paper copy of this Notice of Privacy Practices for Protected Health Information ("Notice") by making a request at our office; (NOTE: A current copy of this “NOTICE” will always be available in our waiting room)
    3. Right to inspect and copy your health and billing records. This request must be in writing to our office. You may appeal a denial of access to your protected health information except in certain circumstances;
    4. Right to request that your We are not required to make requested amendments). You may file a statement of disagreement if your amendment is denied, and require that the request for amendment and any denial be a part of all future disclosures of your protected health information;
    5. Right to receive an accounting of disclosures of your health information as required to be maintained by law by delivering a written request to our office. An accounting will not include internal uses of information for treatment, payment, or operations, disclosures made to you or made at your request, or disclosures made to family members or friends in the course of providing care;
    6. Right to confidential communication by requesting that communication of your health information be made by alternative means or at an alternative location by delivering the request in writing to our office.
    NOTE: We reserve the right to charge a fee to cover our cost of copying records, or an office visit fee for time with Dr. Brantner or office staff to answer questions or explain the record contents, or if you request a summary statement of explanation of your medical record.

    If you want to exercise any of the above rights, please contact our Reception office, in person or in writing, during office hours. They will assist you by providing information regarding the steps to take to exercise your rights. You may also ask to speak with our Office Manager when you’re in the office; by phone at 423/283-0323 during office hours [Monday – Thursday, 8:00 AM – 5:00 PM] or by writing % Office Manager.

    OUR RESPONSIBILITIES

  • Maintain the privacy of your health information as required by law;
  • Provide notice as to our duties and privacy practices regarding the information we collect and maintain about you;
  • Abide by the terms of this Notice;
  • Notify you if we cannot accommodate a requested restriction or request; and
  • Accommodate your reasonable requests regarding methods to communicate health information with you.
  • Accommodate your request for an accounting of disclosures. We reserve the right to amend, change, or eliminate provisions in our privacy practices and access practices and to enact new provisions regarding the protected health information we maintain. If our information practices change, we will amend our Notice. You are entitled to receive the revised Notice by visiting our office and picking up a copy.

    TO REQUEST INFORMATION OR FILE A COMPLAINT:

  • If you have questions, would like additional information, or want to report a problem regarding the handling of your information, you may contact our Office Manager at 423/283-0323 during regular office hours [Monday – Thursday 8:00 AM – 5:00 PM]
  • Additionally, if you believe your privacy rights have been violated, you may file a complaint by delivering the written complaint to our office manager. You may also file a complaint by contacting the Secretary of Health and Human Services in writing. The address is: 200 Independence Avenue SW, Washington, DC 20201, the toll free phone number is: 877/696-6775, the website is: www.os.dhhs.gov. At this time, we have no direct e-mail address available for filing complaints with DHHS. It may be possible to obtain one by calling the toll free number above.
  • We cannot, and will not, require you to waive the right to file a complaint with the Secretary of Health and Human Services (HHS) as a condition of receiving treatment from this office.
  • We cannot, and will not, retaliate against you for filing a complaint with the Secretary of Health and Human Services.

    FOLLOWING IS A LIST OF OTHER USES AND DISCLOSURES ALLOWED BY THE PRIVACY RULE:

  • We may contact you to provide you with appointment reminders, with information about treatment alternatives, or with information about other health-related benefits and services that may be of interest to you. We may contact you as part of a fund raising effort.

    NOTIFICATION – WITH OPPORTUNITY TO AGREE OR OBJECT:

  • Unless you object we may use or disclose your protected health information to notify, or assist in notifying, a family member, personal representative, or other person responsible for your care, about your location, and about your general condition, or your death.
  • Communication with Family - Using our best judgment, we may disclose to a family member, other relative, close personal friend, or a person you identify, health information relevant to that person's involvement in your care or in payment for such care if you do not object. In an emergency, we will discuss your care with a family member or friend who is present if necessary to provide appropriate medical care for you.
    NOTE: On our CONSENT FOR DISCLOSURE OF PROTECTED HEALTH INFORMATION sheet, you provide the name(s) of a relative(s), friend(s) or others to whom you do not object to having us discuss your private health information. However, you must be aware that in designating specific individual(s), you eliminate everyone else. We will abide by the information you give us on that sheet, and anyone who requests information about you must be prepared to identify themselves and provide specific information about you, as noted on that sheet, before we will discuss your care with them.
  • We may use and disclose your protected health information to assist in disaster relief efforts.

    OPPORTUNITY TO AGREE OR OBJECT NOT REQUIRED FOR THE FOLLOWING:

    PUBLIC HEALTH ACTIVITIES

  • Controlling Disease - As required by law, we may disclose your protected health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.
  • Child Abuse & Neglect - We may disclose protected health information to public authorities as allowed by law to report child abuse or neglect.
  • Food and Drug Administration (FDA) - We may disclose to the FDA your protected health information relating to adverse events with respect to food, supplements, products and product defects, or post-marketing surveillance information to enable product recalls, repairs, or replacements.
  • Occupational Safety and Health Administration – We may disclose to your employer your protected health information relating to injury or illness if the employer needs the findings in order to comply with OSHA regulations.
  • Victims of Abuse, Neglect, or Domestic Violence
    We can disclose protected health information to governmental authorities to the extent the disclosure is authorized by statute or regulation and in the exercise of professional judgment the doctor believes the disclosure is necessary to prevent serious harm to the individual or other potential victim.
  • Oversight Agencies
    Federal law allows us to release your protected health information to appropriate health oversight agencies or for health oversight activities to include audits, civil, administrative or criminal investigations: inspections; licensures or disciplinary actions, and for similar reasons related to the administration of healthcare.
  • Judicial/Administrative Proceedings
    We may disclose your protected health information in the course of any judicial or administrative proceeding as allowed or required by law, or as directed by a proper court order or administrative tribunal, provided that only the protected health information released is expressly authorized by such order, or in response to a subpoena, discovery request or other lawful process.
  • Law Enforcement
    We may disclose your protected health information for law enforcement purposes as required by law, such as when required by court order, including laws that require reporting of certain types of wounds or other physical injury.
  • Coroners, Medical Examiners and Funeral Directors
    We may disclose your protected health information to funeral directors or coroners consistent with applicable law to allow them to carry out their duties.
  • Research
    We may disclose information to researchers, when an institutional review board that has reviewed the research proposal, and established protocols to ensure the privacy of your protected health information has approved the research.
  • Organ Procurement Organizations
    Consistent with applicable law, we may disclose your protected health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs, eyes, or tissue for the purpose of donation and transplant.
  • Threat to Health and Safety
    To avert a serious threat to health or safety, we may disclose your protected health information consistent with applicable law to prevent or lessen a serious, imminent threat to the health or safety of a person or the public.
  • Specialized Governmental Functions
    We may disclose your protected health information for specialized government functions as authorized by law such as to Armed Forces personnel, for national security purposes, or to public assistance program personnel.
  • Correctional Institutions
    If you are an inmate of a correctional institution, we may disclose to the institution or it’s agents the protected health information necessary for your health and the health and safety of other individuals.
  • Workers Compensation
    If you are seeking compensation through Workers Compensation, we may disclose your protected health information to the extent necessary to comply with laws relating to Workers Compensation.

    OTHER USES AND DISCLOSURES:

  • Other uses and disclosures besides those identified in this Notice will be made only as otherwise authorized by law or with your written authorization which you may revoke except to the extent information or action has already been taken.

    Website

  • We maintain a website (jimbrantnermd.com) as well as a web-page through the American Society of Plastic Surgeons, which provides information about our practice. A current copy of this Notice will be on the website.

  • Effective Date: April 1, 2003
  • Reviewed and Revised: 10/07