HIPAA Notice of Privacy Practices Statement
Notice of Information Practices and Privacy Statement
For David A. Gilpin, M.D.
395 WALLACE ROAD, SUITE 201, NASHVILLE, TN 37211
We are members of an Organized Health Care Arrangement. Our offices, along with other health care providers and their authorized representatives, will be operationally and/or clinically integrated with one another and, as permitted by law, may use, disclose and receive your information. For example, to the extent permitted by law and in accordance with our policies, we will share your medical information with other doctors’ practices who are members of our organized health care arrangement.
How We Collect Information About You: David A. Gilpin, M.D. (DAG) and its employees and volunteers collect data through a variety of means including but not necessarily limited to letters, phone calls, emails, voice mails, and from the submission of applications that is either required by law, or necessary to process applications or other requests for assistance through our organization.
What We Do Not Do With Your Information: Information about your financial situation and medical conditions and care that you provide to us in writing, via email, on the phone (including information left on voice mails), contained in or attached to applications, or directly or indirectly given to us, is held in strictest confidence.
We do not give out, exchange, barter, rent, sell, lend, or disseminate any information about applicants or clients who apply for or actually receive our services that is considered patient confidential, is restricted by law, or has been specifically restricted by a patient/client in a signed HIPAA consent form.
How We Do Use Your Information: Your medical information may be used and disclosed for purposes of furthering our day-to- day operations, as well as improving our long term quality of care. These uses and disclosures are necessary to run our offices, to monitor the quality of care our patients receive, and to improve care to our patients. We may use subcontractors called “business associates” to help us conduct the activities described below, as well as other similar activities. The business associate agreement we will enter into with our business associates will protect your information in accordance with HIPAA:
For example: Subject to any limitations described in this notice or applicable law, our offices, the members of our organized health care arrangement and our business associates may use or disclose your medical information in order to provide the following services to us and the members of our organized health care arrangement:
- Review and evaluate the treatment and services performed by our staff in caring for you.
- Decide what additional services we should offer, what services are not needed, and whether certain new treatments are effective.
- Provide education for our physicians, staff, and members of our organized health care arrangement.
- Combine information from our offices with information from the offices of the members of our organized health care arrangement to compare how we are doing and see where we can improve the care and services offered. Information that identifies you in this set of medical information may be removed so others may use it to study health care and health care delivery without knowing who you are.
If you apply or attempt to apply to receive assistance through us and provide information with the intent or purpose of fraud or that results in either an actual crime of fraud for any reason including willful or un-willful acts of negligence whether intended or not, or in any way demonstrates or indicates attempted fraud, your non-medical information can be given to legal authorities including police, investigators, courts, and/or attorneys or other legal professionals, as well as any other information as permitted by law.
Limited Right to Use Non-Identifying Personal Information From Biographies, Letters, Notes, and Other Sources: Any pictures, stories, letters, biographies, correspondence, or thank you notes sent to us become the exclusive property of DAG. We reserve the right to use non-identifying information about our clients (those who receive services or goods from or through us) for fundraising and promotional purposes that are directly related to our mission.
Clients will not be compensated for use of this information and no identifying information (photos, addresses, phone numbers, contact information, last names or uniquely identifiable names) will be used without client’s express advance permission.
You may specifically request that NO information be used whatsoever for promotional purposes, but you must identify any requested restrictions in writing. We respect your right to privacy and assure you no identifying information or photos that you send to us will ever be publicly used without your direct or indirect consent.
YOU ARE ENTITLED TO A COPY OF THIS AUTHORIZATION AFTER YOU SIGN IT.