Notice of Privacy Practices
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.
01. Our duties
We are required by law to maintain the privacy of your medical information and to provide you with notice of our legal duties and privacy practices. We are required to abide by the terms of the Notice of Privacy Practices currently in effect. We reserve the right to change those terms, and any changes made will be effective for all medical information we maintain. A copy of a revised Notice will be available on our website, at any of our office locations, or from our Privacy Coordinator. Please call or write to Bernhard Zunkeler, M.D., P.A., Attention: Privacy Coordinator, The Exchange, 1122 Kenilworth Drive, Suite 116, Towson, MD 21204. You may include questions regarding our privacy practices, your privacy rights, or requests for additional information regarding your privacy.
02. Permitted uses
We may use and disclose your medical information for specific reasons:
Treatment: At your request, we will provide your doctor or other health-care provider with the results of the examinations Dr. Zünkeler performs and his conclusions and treatment recommendations. We will call you to remind you of upcoming appointments. Dr. Zünkeler may also contact you after appointments or procedures to discuss your progress.
Payment: We will bill your insurance company, you directly, or another person who may be responsible for payment of your account. We may need to contact your insurance company to determine whether agreed-upon medical services are covered. Your insurance company may be entitled to ask us for your medical information. In cases in which you elect to pay by credit card through a PayPal account, your name and your credit card or PayPal account information will be disclosed to PayPal. A comment may be placed on your account describing the nature of your payment for account reconciliation purposes (e.g. “copay” or “Type and Complexity of Visit: New Patient Consult 99244”) and the date of payment. No diagnostic codes or other medical or personal information will be conveyed to the credit card company. For your security, we do not keep a written record of your credit card number in our office. We may keep a copy of the credit card receipt from PayPal in your record for confirmation purposes. In the unlikely event that we need to start collection proceedings against you, we will provide the collection agency or attorney with as much information about you and your case as is necessary to collect the money owed. The information that we provide to the collection agency will contain your name, your contact information, and the dates of treatment and may also include the procedure codes that were applied to your account. Typically, medical information (e.g. clinical reports and lab results) are not shared with the collection agency because it is irrelevant to the collection of a claim.
Health-care operations: We intermittently review the charts of past patient encounters to maintain high-quality standards. That means that we may select your chart for review by an individual who is qualified in reviewing medical charts and who will be held to strict patient confidentiality. We may also select your billing information for review by us or by external auditors.
03. Disclosures without authorization
We may use and disclose medical information about you without your specific authorization under the following circumstances:
Disclosures required by law: We may be required by federal, state, or local law to disclose your medical information.
Public health activities: We may disclose your medical information to a public agency such as the Food and Drug Administration (FDA) if you experience an adverse effect from any of the drugs, supplies, or equipment we use.
Victims of abuse, neglect, or domestic violence: We may be required to disclose your medical information if we feel that you have been abused or neglected.
Health oversight activities: We may be required to disclose your medical information to Medicare or a related agency if your case is selected for a medical review.
Judicial and administrative proceedings: We may be required to disclose your medical information subpoenaed by a judge or administrative tribunal.
Law enforcement: We may be required to disclose your medical information in conjunction with a criminal investigation by a federal, state, or law enforcement agency.
Serious threats to health or safety: We may be required to disclose your medical information if, in our opinion, doing so will help avert a serious threat to the public.
Military personnel: We may be required to disclose your medical information to the appropriate command authorities.
Workers’ Compensation: We may be required to disclose your medical information to comply with laws regarding Workers’ Compensation.
04. Patient rights
You have certain rights with respect to your medical information:
Requesting restrictions: You may ask us to limit our use or disclosure of your protected health information. Although we are not required to agree to your request, we will try to do so except as required by law, in emergencies, or when the information is necessary to treat you. Your request must 1) be in writing, 2) describe the information that you want restricted, 3) state if the restriction is to limit our use or disclosure, and 4) state to whom the restriction applies.
Confidential communications: You may ask that we communicate with you in a particular way or at a certain location to maintain your confidentiality. Your request must be in writing, must specify how you intend to handle your financial responsibility, and must include an alternative way that we can contact you confidentially. You do not have to give a reason for your request.
Inspect and copy: You may request to inspect and copy your medical information maintained in our records. Your request must be in writing. Upon receipt, we will comply within 21 days. If we deny or are unable to meet your request (e.g. if your records have been purged after 7 years), we will inform you, and you may request a review of the denial. We may charge you a fee for this service.
Amendment: You may ask us to amend your health information if you believe that it is incorrect or incomplete. Your request must be in writing and must include a reason to support the amendment. Your request may be denied if we believe that the information is complete and accurate, if the information is not part of the medical information that you would be permitted to inspect or copy, or if we did not create the information.
Accounting of disclosures: We will make an effort to keep a list of all disclosures of your health information beyond the individuals who are listed by name in your medical records (e.g. your primary care provider). You may request a copy of this list covering the past 7 years.
Paper copy of this notice: You are entitled to receive a paper copy of our Notice of Privacy Practices. Please see our contact information.
File a complaint: If you believe that we have violated your privacy rights, you may file a complaint directly with us using our contact information. You may also file a complaint with the U.S. Secretary of Health and Human Services. You will not be penalized for complaining.
Provide authorization for other uses and disclosures: We may request your written authorization for uses and disclosures of your medical information that are not identified in this notice or permitted by law. You may revoke your authorization at any time in writing.
05. Patient agreement with Office Policy
In addition to this Notice of Privacy Practices, we recommend that you read our Office Policy, which further defines some procedures and your options and additional services as a patient in our office.
06. Independent Medical Evaluation examinees
Some of the provisions of this Notice of Privacy Practices do not apply to examinees who are seen for independent medical evaluation (IMEs). Please see the consent to IME for the differences between an IME and a patient-physician treatment relationship.