This notice describes how medical information about you may be used and disclosed and how to get access to this information. Please read it carefully.

If you have any questions regarding this notice, you may contact our Privacy Officer at:
Campbell & Philbin Medical Associates, Attention: Privacy Officer
1400 Locust Street, Suite 5109
Pittsburgh, PA 15219
Phone: 412-281-2575, Fax: 412-281-3970

I. Your Protected Health Information (PHI)
Campbell & Philbin Medical Associates is required by the federal privacy rule (Health Insurance Portability & Accountability Act- HIPAA) to maintain the privacy of your health information that is protected by the rule, and to provide you with notice of our legal duties and privacy practices with respect to your "protected healthcare information." We are required to abide by the terms of the notice currently in effect.

Generally speaking, your protected health information is any information that relates to your past, present or future physical or mental health or condition, the provision of healthcare to you, or to identify you. Your medical and billing records at our practice are examples of information that usually will be regarded as your protected health information (PHI).

II. Uses and Disclosures of Your Protected Health Information 
A. Treatment, Payment and Operations (TPO)
This section describes how we may use and disclose your protected health information for treatment, payment, and healthcare operations purposes. The descriptions may include examples. Not every possible use or disclosure for treatment, payment, and healthcare operations purposes will be listed.

1. Treatment: We may use and disclose your protected health information for our treatment purposes as well as the treatment purposes of other healthcare providers. Treatment includes the provision, coordination, or management of healthcare services to you by one or more healthcare provider. Some examples of treatment uses/disclosures include:

• During an office visit, physicians and other staff involved in your care may review your medical record and share and discuss your medical information with each other.
• We may share/discuss your medical information with an outside physician to whom we have referred you for care; a physician with whom we are consulting regarding you; or with another healthcare provider who seeks this information for the purpose of treating you.
• We may share/discuss your medical information with an outside laboratory, radiology center or other healthcare facility where we have referred you for testing: an outside home health agency, durable medical equipment agency, pain management or other healthcare provider to whom we have referred you for related services or products; or a hospital, physical therapy or other healthcare facility where we are admitting or treating you.
• We may use a patient sign-in sheet in the reception area, which may be accessible to other patients.
• We may call patients in the reception area by name when it is time for them to go to an examining room.
• We may use electronic images and/or data (electronic medical records) to manage care.
• We may use electronic prescribing to transmit information to your pharmacy.
• We may contact patients via telephone, mail, email, etc. to confirm appointments or request a return call.

2. Payment: We may use and disclose your protected health information for our payment purposes as well as the payment purposes of other healthcare providers and health plans. Payment uses and disclosures include activities conducted for us to obtain payment for the care provided to you or so that you can obtain reimbursement for that care (for example, from your health insurance company). Some examples of payment uses and disclosures include:

• Sharing information with your health insurer to determine whether you are eligible for coverage or whether proposed treatment is a covered service; obtaining co-payment, co-insurance and deductible amounts; submitting a claim form to you health insurer; or providing supplemental information to your insurer so that your health insurer can obtain reimbursement from another health plan under a "coordination or benefits" clause in your subscriber agreement.
• Sharing your demographic information (for example, your address or phone number) with other healthcare providers who seek this information to obtain payment for healthcare services provided to you.
• Mailing you bills in envelopes with our practice name and return address; or provision of a bill to a family member or other person designated as "responsible" for payment for services rendered to you.
• Providing medical records and other documentation to your health insurer to support the medical necessity of a health service; or allowing you health insurer access to your medical record for a quality review audit.
• Providing information to a collection agency/attorney for purposes of securing payment of a delinquent account
• Disclosing information in a legal action for purposes of securing payment of a delinquent account.

3. Healthcare Operations: We may use and disclose your protected health information for our healthcare operation purposes as well as certain healthcare operation purposes of other healthcare providers and health plans. Some examples of healthcare operation purposes include:

• Quality assessment and improvement activities; training programs for medical and other students; or healthcare fraud/abuse detection and compliance programs.
• Accreditation, certification, licensing, and credentialing activities.
• Conducting other medical review, legal services, and auditing functions.
• Other business management and general administrative activities, such as compliance with the federal privacy rule, state and local regulations, and resolution of patient grievances.

B. Uses and Disclosures for Other Purposes

We may use and disclose your protected health information for other purposes. This section generally describes those purposes by category. Each category includes one or more examples. Not every use or disclosure in a category will be listed. Some examples fall into more than one category- not just the category under which they are listed.

1. Individuals involved in care or payment for care: We may disclose your protected health information to someone involved in your care or payment for your care, such as a spouse, a family member, or close friend. For example, if you have surgery, we may discuss your physical limitations with a family member assisting in your post-operative care. We assume that any individual accompanying you to the office in the exam room, hospital, etc. is involved in your care and the physicians and staff will speak freely about your care in their presence.

2. Notification purposes: We may use and disclose your protected health information to notify, or to assist in the notification of, a family member, a personal representative, or another person responsible for your care, regarding your location, general condition, or death.

3. Required by law: We may use and disclose protected health information when required by federal/state/local law.

4. Other public health activities: We may use and disclose protected health information for public health activities, including:

• Child abuse and neglect reports.
• FDA-related reports and disclosures.
• Public health warnings to third parties at risk of a communicable disease or condition.
• OSHA requirements for workplace surveillance and injury reports.

5. Victims of abuse, neglect or domestic violence: We may use and disclose protected health information for purposes of reporting abuse, neglect or domestic violence in addition to child abuse.

6. Health oversight activities: We may use and disclose protected health information for purposes of health oversight activities authorized by law. These activities could include audits, inspections, investigations, licensure actions, and legal proceedings.

7. Judicial and administrative proceedings: We may use and disclose protected health information disclosures in judicial and administrative proceedings in response to a court order or subpoena, discovery request or other lawful process.

8. Law enforcement purposes: We may use and disclose protected health information for certain law enforcement purposes including to:

• Comply with legal process (i.e. search warrant) or legal requirement (i.e. mandatory reporting gun shot wounds).
• Respond to a request for information for identification/location purposes or information about a crime victim.
• Report a death suspected to have resulted from criminal activity or provide information regarding a crime on the premises or report a crime in an emergency.

9. Coroners and medical examiners: We may use and disclose protected health information for purposes of providing information to a coroner or medical examiner for the purpose of identifying a deceased patient, determining a cause of death, or facilitating their performance of other duties required by law.

10. Funeral directors: We may use and disclose protected health information for the purposes of providing information to funeral directors as necessary to carry out their duties.

11. Organ and tissue donation: For purposes of facilitating organ, eye and tissue donation and transplantation, we may use protected health information and disclose protected health information to entities engaged in the procurement, banking, or transplantation of cadaver organs, eyes, or tissue.

12. Threat to public safety: We may use and disclose protected health information for purposes involving a threat to public safety, including protection of a third party from harm and identification and apprehension of a criminal.

13. Specialized government functions: We may use and disclose protected health information for purposes involving specialized government functions including:

• Military and veterans activities; national security and intelligence or protective services for the President.
• Medical suitability determinations for the Department of State; or correctional institutions and other law enforcement custodial situations.

14. Workers' Compensation (and similar programs): We may use and disclose protected health information as authorized by and to the extent necessary to comply with state or federal laws relating to workers' compensation or similar programs, established by law, that provide benefits for work-related injuries or illness without regard to fault. For example, this would include submitting a claim, office notes, test results, work restrictions and related information to your employer's workers' compensation carrier (or agents of employer or carrier, including occupational medicine/referring physicians, panel providers, case managers, etc.) for purposes of treatment and coordination of your care, payment for the services, or related healthcare operations if we treat you for a work injury.

15. Business associates: Certain functions of the practice are performed by a "business associate" such as a billing, electronic medical records, and/or radiology software company, collection agency, accounting firm, or law firm. We may disclose protected health information to our business associates and allow them to create and receive protected health information on our behalf.

16. Creation of de-identified information: We may use protected health information about you in the process of de-identifying the information (the process of removing those aspects which could identify a patient).

17. Incidental disclosures: We may disclose protected health information as by-product of an otherwise permitted use or disclosure. For example, other patients may overhear your name in our office, (for example, in and around exam rooms as physicians and staff coordinate your care, sign-in sheets, etc.) or telephone messages, etc.

C. Uses and disclosures with authorization

For all other purposes which do not fall under a category listed above (remember not all examples are provided in each category), we will obtain your written authorization to use or disclose your protected health information. Your authorization can be revoked at any time except to the extent that we have relied on the authorization.

III. Patients Privacy Rights

A. Further restriction on use or disclosure
You have a right to request that we further restrict use and disclosure of your protected health information to carry out treatment, payment, or healthcare operations, to someone who is involved in their care or the payment for your care, or for notification purposes. We are not required to agree to a request for a further restriction. To request a further restriction, you must submit a written request to our Privacy Officer. The request must tell us: (a) what information that you want restricted; (b) how you want the information restricted; and (c) to whom you want the restriction to apply.

B. Confidential communication
You have a right to request that we communicate your protected health information to you by a certain means or at a certain location. We are not required to agree to requests for confidential communications that are unreasonable. To make a request for confidential communication, you must submit a written request to our Privacy Officer. The request must tell us how or where you want to be contacted. In addition, if another individual or entity is responsible for payment, the request must explain how payment will be handled. You have a right to request, in writing, that we restrict communication to your health plan regarding a specific treatment or service that you, or someone on your behalf, has paid for in full, out-of-pocket. We are not permitted to deny this specific type of requested restriction.

C. Accounting/Listing of disclosures

You have a right to obtain, upon request, a list of certain disclosures of your protected health information by us (or a business associate for us).  This right is limited to disclosures within six years of the request and other limitations. Also, in limited circumstances, we may charge you for providing the accounting. To request this accounting/listing, you must submit a written request to our Privacy Officer. The request should designate the applicable time period.

D. Inspection and copying
You have a right to inspect and obtain a copy of your protected health information that we maintain in a designated records set. This right is subject to limitations and we may impose charge for the labor and supplies involved in providing copies as established by professional, state, or federal guidelines. To exercise your right of access, you must submit a written request to our Privacy Officer. The request must: (a) describe the health information to which access is requested, (b) state how you want to access the information, such as inspection, pick-up of copy, mailing of copy, (c) specify any requested form or format, such as paper copy or an electronic means, and (d) include the mailing address, if applicable.

E. Right to amendment
You have a right to request that we amend protected health information that we maintain about you in a designated records set if the information is incorrect or incomplete. This right is subject to limitation. To request an amendment, you must submit a written request to our Privacy Officer. The request must specify each change that you want and provide a reason to support each requested change.

F. Notice of Privacy Breach
You have the right to receive written notification if the practice discovers a breach of your unsecured PHI, and determines through a risk assessment that notification is required.

G. Paper copy of privacy notice
You have a right to receive, upon request, a paper copy of our Notice of Privacy. To obtain a paper copy, contact our Privacy Officer.

IV. Changes to this Notice
We reserve the right to change this notice at any time. We further reserve the right to make any change effective for all protected health information that we maintain at the time of the change- including information that we created or received prior to the effective date of the change. A copy of our current Notice is available in all offices (see the receptionist). At any time, patients may review the current Notice by contacting our Privacy Officer.

V. Complaints
If you believe that we have violated your privacy rights, you may submit a complaint to the practice or directly to the Secretary of the Department of Health and Human Services. To file a complaint with the practice, submit the complaint in writing to our Privacy Officer. We will not retaliate against you for filing a complaint.

VI. Legal Effect of this Notice
This notice is not intended to create contractual or other rights independent of those created in the federal privacy rule.