Marcia D. Wolf, M.D.
19 Walker Ave Suite 101; Pikesville, MD 21208 THIS OFFICE IS NOW CLOSED. DR. WOLF has retired.
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. If you have any questions about this Notice please contact: our Privacy Contact, Candace Herbert.
This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.
We are required to abide by the terms of this Notice of Privacy Practices. We may 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. You may obtain any revised Notice of Privacy Practices by accessing www.mdpmr.net, calling the office and requesting a revised copy or asking for one at the time of your next appointment.
We have chosen to participate in the Chesapeake Regional Information System for our Patients, Inc. (CRISP), a statewide health information exchange. As permitted by law, your health information will be shared with this exchange in order to provide faster access, better coordination of care and assist providers and public health officials in making more informed decisions. You may “opt-out” and disable all access to your health information available through CRISP by calling 1-877-952-7477 or completing and submitting an Opt-Out form to CRISP by mail, fax or through their website at www.crisphealth.org.
I Uses and Disclosures of Protected Health Information
Uses and Disclosures of Protected Health Information Based Upon Your Written Consent
You may be asked by your physician to sign a consent form for use and disclosure of your protected health information for treatment, payment and health care operations but it is not required by federal law. This physician will use or disclose your protected health information as described in this Section 1. Your protected health information may be used and disclosed by this physician, our office staff and others outside of our office for the purpose of providing health care services to you. Your protected health information may also be used and disclosed to pay your health care bills and to support the operation of the physician’s practice.
Following are examples of the types of uses and disclosures of your protected health care information that the physician’s office is permitted to make. These examples are not meant to be exhaustive, but to describe types of uses and disclosures that may be made by us.
Treatment: We will use and disclose your protected health information to provide, coordinate or manage your health care and any related services. This includes the coordination or management of your health care with a third party. For example, as necessary, to a home health agency that provides care to you. We will also disclose protected health information to other physicians who may be treating. For example, a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you or to another physician or health care provider (e.g., a specialist, therapist or laboratory) who, at the request of your physician, becomes involved in your care by providing assistance with your health care diagnosis or treatment to your physician. We may use or disclose, as-needed, your protected health information in order to prescribe medication for you, help you with prescription coverage issues, obtain non-formulary approval, discuss off-label medication use, or to “patient in need programs”. Controlled substances When applicable, we may use, obtain and disclose your protected health information with regard to your use access, handling, transporting etc of any controlled prescription, medication or “street” substance with any healthcare provider of any type, any law enforcement agent, appropriate state federal agency representative, or any family member, or other party with knowledge of your involvement.
Payment: Your protected health information will be used, as needed, to obtain payment for your health care services. This may also include activities that your insurer may undertake before it approves or pays for health care services for you such as; making a determination of eligibility or coverage, reviewing services provided to you for medical necessity, and undertaking utilization review activities. You have the right to deny information release to your insurer for services which you exclusively pay.
Healthcare Operations: We may use or disclose, as-needed, your protected health information in order to support the business activities of the physician’s practice. These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, residents, fellows or physical/occupational therapists, licensing, and conducting or arranging for other business activities. For example, we may disclose your protected health information to medical school students that see patients at our office. In addition, we may use a sign-in sheet and we may call you by name in the waiting room. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment, to give you test results or notify you of prescription refill status. We may leave such information on your voice mail or answering machine, or with your agent at a telephone # you have provided. For example a message may be left “this is Dr. Wolf’s office Mr. XXX your x-ray/blood work was with-in normal limits or your appointment is on Tuesday may 10th at 2:00 PM”.
We will share your protected health information with third party “business associates” that perform various activities (e.g., billing, transcription services) for the practice. Whenever an arrangement between our office and a business associate involves the use or disclosure of your protected health information, we will implement by the due date a written contract that contains terms that protects the privacy of your protected health information. We may use or disclose your protected health information, as necessary, to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you.
Uses and Disclosures of Protected Health Information Based upon Your Written Authorization
Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law as described below. You may revoke this authorization, at any time, in writing, except to the extent that your physician or the physician’s practice has taken an action in reliance on the use or disclosure indicated in the authorization.
Others Involved In Payment/legal Issues: You may indicate that you are represented by counsel, union or other representative that requests your protected health information. We request your written authorization to disclose information to these entities. Once your written authorization is, obtained we will potentially disclose ALL your protected health information (in whatever form) to the designated entity or their representative. You have the right to revoke future disclosures except where required by subpoena.
Other Permitted and Required Uses and Disclosures That May Be Made With Your Consent, Authorization or Opportunity to Object
We may use and disclose your protected health information in the following instances. You have the opportunity to agree or object to the use or disclosure of all or part of your protected health information. If you are not present or able to agree or object to the use or disclosure of the protected health information, then your physician may, using professional judgement, determine whether the disclosure is in your best interest. In this case, only the protected health information that is relevant to your health care will be disclosed.
Others Involved in Your Healthcare: Unless you object, we may disclose to a relative, close friend or other person you identify, your protected health information that directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment
Communication Barriers: We may use and disclose your protected health information if your physician attempts to obtain consent from you but is unable to do so due to substantial communication barriers and the physician determines, using professional judgement, that you intend to consent to use or disclosure under the circumstances.
Other Permitted and Required Uses and Disclosures That May Be Made Without Your Consent, Authorization or Opportunity to Object
We may use or disclose your protected health information in the following situations without your consent or authorization. These situations include:
Workers’ Compensation: Your protected health information may be disclosed by us as authorized to comply with workers’ compensation laws and other similar legally established programs.
Legal Proceedings: We may disclose protected health information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request or other lawful process. We will comply with all legal subpoenas. You will NOT be notified by us of these disclosures. The obligatory notice to you or your legal representative should be provided by the entity making the request.
Other Allowed or Required By Law: We may use or disclose your protected health information to the extent that the use or disclosure is required by law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. For example for public health activities and purposes, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition, a health oversight agency, or if we believe that you or a child have been a victim of abuse, neglect or domestic violence. We may also disclose protected health information, so long as applicable legal requirements are met, for law enforcement purposes.
Food and Drug Administration: We may disclose your protected health information to a person or company required by the Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations, track products; to enable product recalls; to make repairs or replacements, or to conduct post marketing surveillance, as required.
Research: We may disclose your protected health information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information.
Criminal Activity: Consistent with applicable federal and state laws, we may disclose your protected health information, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose
protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.
II Your Rights
You have the right to inspect and copy (fee applicable) your protected health information for as long as we maintain the protected health information. Under federal law, however, you may not inspect or copy the following records; psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information. Depending on the circumstances, a decision to deny access may be reviewable. In some circumstances, you may have a right to have this decision reviewed.
You have the right to opt out of receiving information about any fundraising conducted by us, we cannot sell your PHI without your explicit authorization, and if your PHI accidentally goes public, we must notify you about the breach.
You have the right to request a restriction of your protected health information for the purposes of treatment, payment or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification. Your request must state the specific restriction requested and to whom you want the restriction to apply. Your physician is not required to agree to a restriction. Your physician may refuse to provide treatment to you if you request a restriction. If physician believes it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted. If your physician does agree to the requested restriction, we may not use or disclose your protected health information in violation of that restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request with your physician. You may request a restriction by submitting the request in writing. It must be dated and contain your original signature.
You have the right to request to receive confidential communications from us by alternative means or at an alternative location. We will attempt to accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. Please make this request in writing to our Privacy Contact.
You may have the right to have your physician amend your protected health information. you may request an amendment information about you in a designated record set for as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact our Privacy Contact if you have questions about amending your medical record.
You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information. 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 or to your legal representative, at your written request, to family members or friends involved in your care, or for notification purposes. You have the right to receive specific information regarding the disclosures that occurred after April 14, 2003. You may request a shorter timeframe. The right to receive this information is subject to certain exceptions, restrictions and limitations.
You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice electronically.
III. Complaints You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our privacy contact of your complaint. We will not retaliate against you for filing a complaint.
You may contact our Privacy Contact at 410-461-1299 for further information about the complaint process.
This notice was published and becomes effective on February 1, 2003. Updated 09/26/2018 UPDATED 12/31/18