CARDIOVASCULAR SPECIALISTS OF CENTRAL MARYLAND
NOTICE OF PRIVACY PRACTICES

This notice describes how medical information about you may be used
and disclosed and how you may access this information.
PLEASE REVIEW IT CAREFULLY.

Cardiovascular Specialists of Central Maryland is dedicated to protecting your medical information. We are required by law to maintain the privacy of your Protected Health Information (PHI) and to provide you with this Notice of Privacy Practices. We are required to abide by the terms of this Notice of Privacy Practices, and we reserve the right to change the terms of our Notice at any time. The new notice will be effective for all protected health information that we maintain at that time. If we revise this Notice, we will post a revised Notice at the practice, and will make paper copies of this Notice of Privacy Practices available upon request. The Notice may also be accessed on our website at www.cvspecialists.net. If you have questions about this Notice, please contact Cardiovascular Specialists’ Executive Director:

Cathy L. Marlowe, MM, CMPE

Executive Director

Cardiovascular Specialists of Central Maryland

10710 Charter Drive, Suite 400

Columbia, Maryland 21044

Phone: (443) 276-9000

Fax: (443) 276-9610

Email: exec.director@cvspecialists.net

USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION (PHI)
Cardiovascular Specialists of Central Maryland physicians and office staff are required by law to protect the privacy of your Protected Health Information. The law permits us to use and disclose your Protected Health Information to carry out treatment; for payment and health care operations; and for other purposes that are permitted or required by law.

What is “Protected Health Information”?
Your Protected Health Information, or “PHI”, is personal information about you. Protected Health Information:

Includes demographic information, such as name, address or phone number;

Relates to your past, present or future health condition, diagnosis and/or treatment;

Includes payment and insurance information and other related health information.

Listed below are some examples to describe the types of uses and disclosures of PHI that may be made by our office. The list is not meant to be all-inclusive.

Treatment – We will use and disclose your PHI to evaluate your health, diagnose your medical condition, and provide, coordinate or manage your health care and related services. For example, we may disclose your PHI:

To a physician to whom you have been referred or who has referred you to our office;

When ordering a prescribed monitoring device for you from a medical equipment supply company;

To a hospital facility where you have been scheduled for a cardiac catheterization procedure;

In a message left on your home answering machine about your INR results or other time-sensitive test results and instructions unless you notify us of your objection.

Payment – Your PHI will be used, as needed, to obtain payment for the health care services we provide to you or recommend for you. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we provide or recommend for you, such as:

Making a determination of eligibility or coverage for insurance benefits;

Reviewing services provided to you for medical necessity; and

Undertaking utilization review activities.

For example, we may disclose your PHI to your health plan to obtain payment authorization for you to:

Wear a monitoring device, such as a 24-hour holter monitor;

Have a procedure performed, such as a cardiac catheterization;

Have a diagnostic test, such as an echocardiogram or nuclear stress test.

Healthcare Operations – We may use or disclose your PHI, as needed, in order to support Cardiovascular Specialists’ business activities. These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, licensing, marketing and fundraising activities, and conducting or arranging for other business activities. For example, we may

Use a sign-in sheet at the registration desk, where you will be asked to sign your name and indicate the time of your scheduled appointment.

Call you by name in the waiting room when your physician or other health care provider is ready to see you.

Use or disclose your Protected Health Information, as necessary, to contact you to remind you of your appointment or to obtain referral information.

Use or disclose your Protected Health Information, as necessary, to leave a message on your home answering machine concerning your INR or other time-sensitive test results and instructions unless you notify us of your objection.

We may use and disclose your PHI for marketing and charitable community activities. For example:

Your name and address may be used to send you news about our practice and any new services we may offer.

Your PHI may be used to send you information describing other health-related goods and services that we believe may interest you.

Your name and address may be used to send you information about American Heart Association or similar activities within the community.

You have the right to request not to receive materials about marketing and charitable community activities.

Uses and Disclosures of Protected Health Information Which Require Your Written Authorization – Other uses and disclosures of your Protected Health Information will be made only with your written authorization, unless otherwise permitted by law and/or described above. You may revoke this authorization at any time, in writing, except to the extent that your physician or Cardiovascular Specialists of Central Maryland has taken action in reliance on the use or disclosure permitted in the authorization. For example:

You will be required to fully complete and sign a medical records release authorization form in order to have copies of your medical records sent to another physician, insurance company, or hospital other than those involved in your treatment, payment for services, or our health care operations.

You will be required to fully complete and sign a medical records release authorization form in order to obtain copies of your medical records for your own use.

YOUR PATIENT RIGHTS: You have the right

To inspect and obtain a copy of your Protected Health Information.

To request a restriction on the release of your Protected Health Information.

To request to receive confidential communications from us by alternate means or at an alternate location.

To request an amendment or corrections to your Protected Health Information.

To receive an accounting of certain disclosures we have made, if any, of your Protected Health Information.

To obtain a paper copy of this notice from us, upon request.

Requests to Inspect or Amend Your Protected Health Information – Any requests to inspect, to copy, or to amend your Protected Health Information must be submitted in writing to the attention of the Executive Director at the address listed on the front of this Notice.

COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with us by contacting our Executive Director at the address listed on the front of this Notice. Please note that we will not retaliate against you for filing a complaint. A complaint must be filed within 180 days of when you knew, or should have known, that the act or omission complained of occurred.

You also have a right to file a complaint with the Office for Civil Rights:

Office of Civil Rights – HIPAA Medical Privacy

Department of Health and Human Services

150 South Independence Mall West

Suite 372, Public Ledger Building

Philadelphia, Pennsylvania 19106-9111

Phone: (800) 368-1019

Version 4 – Effective October 1, 2010