Privacy Statement

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 the Tennessee Oncology Privacy Officer:
Edward T. Augustine
Telephone #: 931-906-2004, Fax #: 931-906-2009
Mailing Address: 776 Weatherly Drive, Clarksville, TN 37043
E-mail address: eaugustine@tnonc.com

This notice of privacy practices describes how we may use and disclose your protected health information to carry out treatment, payment or healthcare 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, which may identify you and that relates to your past, present or future physical or mental health or condition and related healthcare
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. Upon your request we will provide you with any revised notice of privacy practices, by calling our office and requesting a copy be sent to you in the mail or asking for one at the time of your next appointment.

Uses and Disclosures of Protected Health Information-
You will be asked by your physician’s office staff to sign a consent form. Once you have consented to use and disclosure of your protected health information for treatment, payment and healthcare operations by signing the consent form, your physician will use or disclose your protected health information as described in this document. Your protected health information may be used and disclosed by your physician, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing healthcare services to you. Your protected health information may also be used and disclosed to pay your healthcare bills and to support the operations of Tennessee Oncology.

The following are examples of the types of uses and disclosures of your protected health information that Tennessee Oncology is permitted to make once you have signed our consent form. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by Tennessee Oncology once you have provided consent.

Treatment: We will use and disclose your protected health information to provide, coordinate or manage your healthcare and any related services. This includes the coordination or management of your healthcare with a third party that has already obtained your permission to have access to your protected health information for example, we would disclose your protected health information, 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 you when we have the necessary permission from you to disclose your protected health information. For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.

In addition, we may disclose your protected health information from time-to-time to another physician or healthcare provider (e.g. a specialist or laboratory) whom at the request of Tennessee Oncology, becomes involved in your care by providing assistance with your healthcare diagnosis or treatment.

Payment: Your protected health information will be used, as needed, to obtain payment for your healthcare services. This may include certain activities that your healthcare insurance plan may undertake before it approves or pays for the healthcare services we recommended for you, such as; making a determination of eligibility or coverage of insurance benefits, reviewing services provided to you for medical necessity and the undertaking of a utilization review. For example, obtaining approval for a hospital admission may require that your relevant protected health information be disclosed to the health plan to obtain approval for the hospital admission.

Healthcare Operations: We may use or disclose, as-needed, your protected health information in order to support the business activities of Tennessee Oncology. These activities include, but are not limited to, quality assessment activities, periodic review activities, training of medical/nursing students, licensing, marketing and fund raising activities and conducting or arranging for other business activities that support Tennessee Oncology.

For example, we may disclose your protected health information to medical/nursing students that see Tennessee Oncology patients in our clinics. In addition, we may use a sign-in sheet at the clinic check in area where you will be asked to sign your name and indicate which physician your are seeing. Our office staff may call you by name in the waiting room when your physician is ready to see you. We may use or disclose your protected health information when necessary, to contact you to remind you of your appointment. Tennessee Oncology may use or disclose your protected health information in other healthcare operational situations in the course of conducting business activities.

We will share your protected health information with third party “Business Associates” that perform various activities (e.g. billing, transcription services, etc.) for Tennessee Oncology. Whenever an arrangement between Tennessee Oncology and a business associate involve the use or disclosure of your protected health information, Tennessee Oncology will have a written agreement that contains terms that will protect the privacy of your protected health information.

Tennessee Oncology 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. We may also use and disclose your protected health information for other marketing activities. For example, your name and address may be used to send you a newsletter about Tennessee Oncology and the services we offer. We may also send you information about products or services that we believe may be beneficial to you. You may contact our privacy officer to request that these materials not be sent to you.

We may use or disclose your demographic information and the dates that you received treatment from Tennessee Oncology, as necessary, in order to contact you for fundraising supported by Tennessee Oncology. If you do not want to receive these materials, please contact our privacy officer and request that these fundraising materials not be sent 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 Tennessee Oncology has taken an action in reliance on the use or disclosure indicated in the authorization.

Other 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/Tennessee Oncology 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 healthcare will be disclosed.

Others Involved in Your Healthcare:
Unless you object, your physician/Tennessee Oncology may disclose to a member of your family, a relative, a close friend or any other person you identify, your protected health information that directly relates to that person’s involvement in your healthcare. If you are unable to agree or object to such a disclosure, such information as necessary will be disclosed, if the physician/Tennessee Oncology determines that it is in your best interest based on our professional judgement. We may use or disclose protected health information
to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care, of your location, general condition or death. Finally, the physician/Tennessee Oncology may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your healthcare.

Emergencies:
We may use or disclose your protected health information in an emergency treatment situation. If this happens, your physician/Tennessee Oncology shall try to obtain your consent, as soon as, reasonably practicable after the delivery of treatment. If your physician/Tennessee Oncology is required by law to treat you and we have attempted to obtain your consent but are unable to obtain your consent, the physician/Tennessee Oncology may still use or disclose your protected health information to treat you.

Communication Barriers:
Tennessee Oncology may use and disclose your protected health information if your physician or another physician in Tennessee Oncology 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;

Required by Law:
Tennessee Oncology 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. You will be notified, as required by law, of any such uses or disclosures.

Public Health:
Tennessee Oncology may disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. This disclosure will be made for the purpose of controlling disease, injury or disability. We may also disclose your protected health information, if directed by the public health authority, to a foreign government agency that is collaborating with the public health authority.

Communicable Disease:
Tennessee Oncology may disclose your protected health information, if authorized by law, 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.

Health Oversight:
Tennessee Oncology may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations and inspections. Oversight agencies seeking this information include government agencies that oversee the healthcare system, government benefit programs, other government regulatory programs and civil rights laws.

Abuse or Neglect:
Tennessee Oncology may disclose your protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your protected health information if we believe that you have been a victim of abuse, neglect or domestic violence to the governmental entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.

Food and Drug Administration:
Tennessee Oncology 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.

Legal Proceedings:
Tennessee Oncology 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.

Law Enforcement:
Tennessee Oncology may disclose protected health information, so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include (1) legal processes and as otherwise required by law, (2) limited information requests for identification and location purposes, (3) pertaining to victims of a crime, (4) suspicion that death has occurred as a result of criminal conduct, (5) in the event that a crime occurs on the premises of Tennessee Oncology, (6) medical emergency (not on Tennessee Oncology premises) and it is likely that a crime has occurred.

Coroners, Funeral Directors and Organ Donation:
Tennessee Oncology may disclose protected health information to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law. We may also disclose protected health information to a funeral director, as authorized by law, in order to permit the funeral director to carry out their duties. We may also disclose such information in reasonable anticipation of death. Protected health information may be used and disclosed for cadaveric organ, eye or tissue donation purposes.

Research:
Tennessee Oncology 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, Tennessee Oncology 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.

Military Activity and National Security:
Tennessee Oncology, when the appropriate conditions apply, may use or disclose protected health information of individuals who are Armed Forces personnel (1) for activities deemed necessary by appropriate military command authorities, (2) for the purpose of a determination by the Department of Veteran Affairs of your eligibility for benefits or (3) to foreign military authority if you are a member of that foreign military service. We may also disclose your protected health information to authorized federal officials for conducting national security and intelligence activities, including for the provision of protective services to the President or others legally authorized.

Workers’ Compensation:
Tennessee Oncology may disclose your protected health information as authorized to comply with workers’ compensation laws and other similar legally established programs.

Inmates:
Tennessee Oncology may use or disclose your protected health information if you are an inmate of a correctional facility and Tennessee Oncology created or received your protected health information in the course of providing care to you.

Your Rights as a Patient of Tennessee Oncology
The following is a statement of your rights with respect to your protected health information and a brief description of how you may exercise these rights.

You have the right to inspect and copy your protected health information. This means you may inspect and obtain a copy of protected health information about you that is contained in a designated record set for as long as Tennessee Oncology maintains the protected health information. A “designated record set” contains medical and billing records and any other records that Tennessee Oncology uses for making decisions about
you.

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 the protected health information. Depending on the circumstances, a decision to deny access may be re-viewable. In some circumstances, you may have the right to have this decision reviewed. Please contact our privacy officer if you have questions about access to your medical record.

You have the right to request a restriction on the release of your protected health information. This means you may ask Tennessee Oncology not to use or disclose any part 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 purposes as described in this notice of privacy practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.

Tennessee Oncology is not required to agree to a restriction that you may request. If Tennessee Oncology 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 Tennessee Oncology 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 Tennessee Oncology physician or the Tennessee Oncology privacy officer. The procedure for requesting a restriction on the use and disclosure of your protected health information is that it must be in writing, and addressed to the Tennessee Oncology physician treating you or to the Tennessee Oncology privacy officer. Once received and reviewed you will receive written confirmation or denial pertaining to your request on the use and disclosure of your protected health information.

You have the right to request to receive confidential communications from Tennessee Oncology by alternative means or at an alternative location. Tennessee Oncology will 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. Tennessee Oncology will not request an explanation from you as to the basis for the request. Please make this request in writing to the Tennessee Oncology privacy officer. The Tennessee Oncology privacy officer will review your request in consultation with the Tennessee Oncology physician that is treating you. You will receive written confirmation or denial of your request from the Tennessee Oncology privacy officer.

You have the right to have your physician amend your protected health information. This means you may request an amendment of protected health information about you in a designated record set for as long as Tennessee Oncology maintains this information. In certain cases, we may deny your request for an amendment. If Tennessee Oncology denies your request for an amendment, you have the right to file a statement of disagreement with Tennessee Oncology and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact our privacy officer to determine if you have questions about amending your medical record.

You have the right to receive an accounting of certain disclosures Tennessee Oncology has 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 for you, for a facility directory, to family members or friends involved in your care, or for notification purposes. You have the right to receive specific information regarding these disclosures that occur on or 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 of privacy practices at anytime from Tennessee Oncology.

Complaints:
You have the right to file complaint with Tennessee Oncology and or to the Secretary of Health and Human Services if you believe we have violated your privacy rights. You may file a complaint with us by notifying our privacy officer of your compliant. We will not retaliate against you for filing a complaint.

You may contact the Tennessee Oncology privacy officer via the following means;
Tennessee Oncology
Attn: Privacy Officer
Edward T. Augustine
776 Weatherly Drive
Clarksville, TN 37043

Telephone #: 931-906-2004, FAX #: 931-906-2009

E-mail: eaugustine@tnonc.com

This notice was published and became effective 1 January, 2003.
Reviewed: 01/01/2005/ 01/01//200701/01/2008, 01/01/2010, 01/01/2011/ 01/01/2012/01/01/2013, 01/01/2015.