Your Privacy

Notice of Privacy Practices for Patients

This notice of our privacy policies will be followed by the following personnel employed directly by or contracted to our practice:

• All physicians and healthcare professionals working as part of Community Hospitalists
• All employees of the practice
• All employees of our contracted billing group
• All employees of any affiliated entities including Physician Staffing, Inc., Medical Services of Ohio, LLC, and The Premium Group, Inc.

We understand and agree that medical information about you is personal and private and we as a practice are committed to protecting that information. The information we collect about you will be used only for the following reasons as is permitted by law:

1. To provide appropriate medical treatment to you while under our care
2. To operate our practice
3. To obtain payment for the services we provide to you

This notice will explain to you the ways in which we may disclose medical information about you. It will also describe your rights and our obligations regarding the use and disclosure of your medical information.

Our Requirements:

We are required by law to:

• Make sure medical information that identifies you is kept private
• Give you this notice of our legal duties and privacy practices with respect to medical information about you
• Follow the terms of the notice that is currently in effect

The following categories further describe the ways we may use and disclose medical information. Not every use and disclosure in each category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of these categories

Treatment – We may use medical information about you to provide you with medical treatment and services. We may disclose medical information about you to doctors, nurses, technicians and other hospital personnel involved in your care. We may also disclose medical information about you to people who will provide your care once you are discharged from the hospital, including your family, home health agencies, clergy, and others.

Payment – We may disclose medical information about you so the treatment and services you receive from our practice may be billed to and payment may be collected from you and/or your family, an insurance company or a third party.

Health Care Operations – We may use and disclose medical information about you for practice operations. These uses and disclosures are necessary to run the practice and ensure that all our patients receive quality care.

As Required By Law – We will disclose medical information about you when required to do so by federal, state, or local law. If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose information about you in response to a subpoena, discovery request, or other lawful process.

To Avert Serious Threat to Health and Safety
– We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would be to someone able to help prevent the threat. These disclosures would include those made because of a public health risk such as disease control, reporting of births and deaths, child abuse, product recalls, medication reactions, and exposure to a disease.

We will provide notification to government authorities if we believe a patient is the victim of abuse, neglect, or domestic violence. These disclosures will only be made only if you agree or when required or authorized by law.

Your Rights:

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

• You have a right to inspect and copy medical information we maintain about you, including billing records. Your medical record is maintained by the hospital to which you were admitted. Please follow the hospital’s policies on obtaining copies of your medical record. Copies of billing records can be obtained by written request to this address: 30680 Bainbridge Rd, Cleveland, OH 44139.
• You have a right to amend your medical record and can do so by following the hospital’s policy on amending the medical record.
• You have a right to request an “accounting of disclosures” of your medical information. This would be a list of any disclosures of medical information made about you. Since your medical record is maintained by the hospital, you must follow the hospital policy for obtaining the list of disclosures.
• You have a right to request a restriction or limitation on the information we use and disclose about you for treatment, payment and healthcare operations.
• You may also limit the information we disclose about you to someone who is involved in your care, such as family members or friends. If you need emergency treatment, we are not required to comply with your request.
• You have a right to obtain a paper copy of this notice. If you have any questions regarding this policy, please contact:

Christine States
Chief Compliance Officer
440.542.5025

Changes to this Notice – We reserve the right to change this notice. We also reserve the right to make the revised or changed notice effective for medical information we already have about you as well as information we receive in the future. If the notice changes, you will receive a new copy upon your next hospital admission to our practice.

Complaints – If you believe your privacy rights have been violated, you may file a complaint with our practice to this address: 30680 Bainbridge Rd, Cleveland, OH 44139, the hospital to which you were admitted, or with the Secretary of the Department of Health and Human Services. You will not be penalized for filing a complaint.

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 and disclose information about you, you may revoke that permission in writing at any time. You understand that we are unable to take back any previous disclosures made with your permission, and that we are required to retain our records of the care we provided to you.