Gastroenterology Clinic
Endoscopy Center of Monroe

Effective Date: April 14, 2003

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.
We understand that medical information about you and your health is personal.  We are committed to protecting medical information about you.  We create a record of the care and services you receive at this Clinic and/or Center to provide you with quality care and to comply with certain legal requirements.  This notice applies to all of the records of your care generated by the Clinic and/or Center, whether made by office personnel or your personal physician.  We are required by law to: 1) Make sure that medical information that identifies you is kept private. 2) Give you this notice of our legal duties and privacy practices with respect to medical information about you; and 3) follow the terms of the notice that is currently in effect.  If you have any questions about this notice, please contact the Privacy Officer for the Gastroenterology Clinic and Endoscopy Center of Monroe at (318) 325-2634.

How we may use and disclose medical information about you:

  • Treatment - We may use medical information about you to provide you with medical treatment or services.  We may disclose medical information about you to doctors, nurses, technicians, or other personnel who are involved in taking care of you at the Clinic and/or Center.  For example, a doctor who is going to perform a Colonoscopy on you will need to know if you are on an anti-coagulant because this type of drug can cause bleeding.  In addition, the doctor may need to have the nurse call the laboratory for your most recent blood work so that he can determine if the anti-coagulant is at an acceptable level.  Different departments of the Gastroenterology Clinic and Endoscopy Center may also share medical information about you in order to coordinate the different things you need, such as prescriptions, lab work and x-rays.  We also may disclose medical information about you to people outside the Clinic and/or Center who may be involved in your medical care after you leave the facility, such as family members, or others who provide services that are part of your care.
  • Payment - We may use and disclose medical information about you so that the treatment and services you receive at the Gastroenterology Clinic and/or Endoscopy Center may be billed to and payment may be collected from you, an insurance company or a third party.  For example, we may need to give your health plan information about the services that you received at the Clinic and/or Center so that your health plan will pay us or reimburse you for the services.  We may also tell your health plan about a treatment or procedure you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment or procedure.
  • Healthcare Operations - We may use and disclose medical information about you for healthcare operations.  These uses and disclosures are necessary to run the office and make sure that all of our patients receive quality care.  For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you.  We may also combine medical information about many patients to decide what additional services the Clinic and/or Center should offer, what services are not needed, and whether certain new treatments are effective.   We may also disclose information to doctors, nurses, technicians, and other office personnel for review and learning purposes.
  • Appointment Reminders - We may use and disclose medical information to contact you as a reminder that you have an appointment or it is time to make an appointment for treatment or medical care at the Gastroenterology Clinic and/or Endoscopy Center.
  • Treatment Alternatives - We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
  • Health Related Benefits and Services - We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.
  • Business Associates - There are some services provided in our organization through contracts with business associates.  For example, AAAHC surveyors may review your medical record during our accreditation process.  To protect your health information, however, we require the business associate to appropriately safeguard your information.
  • Individuals Involved in Your Care or Payment for Your Care - We may release medical information about you to a family member or friend who is involved in your medical care.  We may also give information to someone who helps pay for your care.   We may also tell your family or friends your condition and that you are in the Gastroenterology Clinic and/or Endoscopy Center or office.  In addition, 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.
  • Research - Under certain circumstances, we may use and disclose medical information about you for research purposes.  For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another, for the same condition.  All research projects, however, are subject to a special approval process.  This process evaluates a proposed research project and its use of medical information, trying to balance the research needs with patients' need for privacy of their medical information.  Before we use or disclose medical information for research, the project will have been approved through this research approval process.  We may, however, disclose medical information about you to people preparing to conduct a research project, for example, to help them look for patients with specific medical needs, so long as the medical information they review does not leave the office. We will almost always ask your specific permission if the researcher will have access to your name, address or other information that reveals who you are or will be involved in your care at the Clinic and/or Center.
  • As Required By Law - We will disclose medical information about you when required to do so by federal, state or local law.
  • To Avert a Serious Threat to Health or 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 only be to someone able to help prevent the threat.

Special Situations:

  • Organ and Tissue Donation - If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
  • Military and Veterans - If you are a member of the armed forces, we may release medical information about you as required by military command authorities.
  • Worker's Compensation - We may release medical information about you for workers' compensation or similar programs.  These programs provide benefits for work-related injuries or illness.
  • Public Health Risks - We may disclose medical information about you for public health activities such as, to prevent or control disease, injury or disability; to report reactions to medications or problems with products; to notify people of recalls of products they may be using; to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and, to notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence.  In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.
  • Health Oversight Activities - We may disclose medical information to a health oversight agency for activities authorized by law.  These oversight activities include, for example, audits, investigations, inspections, and licensure.   These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
  • Lawsuits and Disputes - 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 medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
  • Law Enforcement - We may release medical information if asked to do so by a law-enforcement official - in response to a court order, subpoena, warrant, summons, or similar process; to identify or locate a suspect, fugitive, material witness, or missing person; about the victim of a crime if, under certain limited circumstances, we are unable to obtain the person's agreement; about a death we believe may be the result of criminal conduct; about criminal conduct at the Clinic or Center; and in emergency circumstances to report a crime;  the location of the crime or victims; or the identity, description or location of the person who committed the crime.
  • Coroners, Medical Examiners and Funeral Directors - We may release medical information to a coroner or medical examiner.  This may be necessary, for example, to identify a deceased person or determine the cause of death.  We may also release medical information about patients to funeral directors as necessary to carry out their duties.
  • National Security and Intelligence Activities - We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
  • Protective Services for the President and Others - We may disclose medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.
  • Department of State - We may use medical information about you to make decisions regarding your medical suitability for a security clearance or service abroad.  We may also release your medical suitability determination to the officials in the Department of State who need access to that information for these purposes.
  • Inmates - If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official.  This release would be necessary for the institution to provide you with health care; to protect your health and safety or the health and safety of others; or for the safety and security of the correctional institution.

Your rights regarding medical information 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.  Usually, this includes medical and billing records, but does not include psychotherapy notes.   To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to the Gastroenterology Clinic and/or Endoscopy Center, Attention: Release of Information.  If you request a copy of the information, we may charge a fee as permitted by state law for the costs of copy, mailing or other supplies associated with your request.  We may deny your request to inspect and copy in certain very limited circumstances.  If you are denied access to medical information, you may request that the denial be reviewed.  Another licensed health care professional chosen by the office 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 - If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information.  You have the right to request an amendment for as long as the information is kept by or for the office.  To request an amendment, your request must be made in writing and submitted to the Privacy Officer of the Gastroenterology Clinic and/or Endoscopy Center.  In addition, you must provide a reason that supports your request.  We may deny your request for an amendment if it is not in writing or does not include a reason to support the request.  In addition, we may deny your request if you ask us to amend information that was not created by us; is not part of the medical information kept by or the Clinic and/or Center; is not part of the information which you would be permitted to inspect and copy; or is accurate and complete.
  • Right to an Accounting of Disclosures - You have the right to request an "accounting of disclosures."  This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice of Privacy Practices.  It excludes disclosures we may have made to you, to family or friends involved in your care, or for notification purposes.   To request this list of disclosures, you must submit your request in writing to the Privacy Officer of the Gastroenterology Clinic and/or Endoscopy Center.  Your request must state a time-period that may not be longer than six years and may not include dates before April 14, 2003.
  • 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.  You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend.  For example, you could ask that we not use or disclose information about a procedure that you had at the Endoscopy Center.  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 to the Privacy Officer of the Gastroenterology Clinic and/or Endoscopy Center.  In your request, you must tell us what information you want to limit; whether you want to limit our use, disclosure, or both; and to whom you want the limits to apply, for example, disclosures to your spouse.
  • Right to Request 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.  For example, you can ask that we only contact you at work or by mail.  To request confidential communications, you must make your request in writing to the Privacy Officer of the Gastroenterology Clinic and/or Endoscopy Center.  We will not ask you the reason for your request.  We will accommodate all reasonable requests.  Your request must specify how or where you wish to be contacted.
  • Right to a Paper Copy of This Notice - You have the right to a paper copy of this notice.  You may ask us to give you a copy of this notice at any time.   You may also obtain a copy of this notice at our web site, www.gastromds.com.

Changes to this notice
We reserve the right to change this notice.  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.  We will post a copy of the current notice in the Clinic and the Center.  The effective date of the change will be at the top of the Notice.  You are entitled to a copy of the current notice in effect and can ask us for a paper copy or obtain the notice at our web site.

Complaints
If you believe your privacy rights have been violated, you may file a complaint with the office or with the Secretary of the Department of Health and Human Services.   To file a complaint with the office, contact our Privacy Officer at (318) 325-2634, Gastroenterology Clinic, 611 Grammont Street, Monroe, LA 71201 and/or Endoscopy Center of Monroe, 316 South 6th Street, Monroe, LA 71201.  All complaints must be submitted in writing.  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 or disclose medical information about you, you may revoke that permission, in writing, at any time.  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 our records of the care that we provided you.