Privacy Policy
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EFFECTIVE DATE: March 2, 2023
THIS NOTICE SETS OUT HOW WE MIGHT DISCLOSE AND USE MEDICAL INFORMATION ABOUT YOU AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This Notice of Privacy Practices (“Notice”) describes how we may use and disclose your protected health information. This includes to carry out treatment, fulfil payment obligations or conduct health care operations. This may also include other purposes that are permitted or required by law. This Notice also describes your rights to access and control your protected health information. “Protected Health Information” or “PHI” 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 will abide by the terms of this Notice but this Notice is subject to change at any time. We will notify you through our website before we change this Notice at least thirty (30) days in advance. Your continued use of our Services is your consent to be bound by the updated Notice terms.
Your PHI May Be Used and Disclosed Without Your Authorization or Opportunity to Agree or Object in Certain Way
1.
Without further notice to you, your PHI may be used and disclosed by your physician, our office staff and others outside of our office who are involved in your care and treatment for the purpose of providing health care services to you. Your PHI may also be used and disclosed to pay your health care bills and to support the operation of your health care provider.
Following are examples of the types of uses and disclosures of your PHI that your health care provider is permitted to make. This list is not exhaustive and should not be treated as such.
Treatment: We may use and disclose your PHI to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with another provider. We will also disclose PHI to other physicians who may be treating you.
Payment: We may use and disclose your PHI to obtain payment for your health care services provided by us or by another provider on our behalf. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we 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.
Health Care Operations: We may use or disclose your PHI in order to support the business activities of your health care provider. These activities include, but are not limited to, quality assessment and compliance activities, employee review activities, training and licensing.
Business Associates: We may share your PHI with third party “business associates” that perform various activities (for example, accounting, or administrative services) for us. Whenever an arrangement between us and a business associate involves the use or disclosure of your PHI, we will have a written contract that contains terms that will protect the privacy of you and your PHI.
Certain Marketing Activities: We may use or disclose your PHI to provide you with information about treatment alternatives or other health-related benefits and services that we think may be of interest to you. Upon your request, we will not send you use your PHI in this manner.
Required By Law: We may use or disclose your PHI to the extent that we are required to do so by law. That use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law.
Public Health Authorities: We may disclose your PHI to a public health authority that is permitted by law to collect or receive the information for health and safety purposes. For example, a disclosure may be made to a public health authority for the purpose of preventing or controlling disease or preventing or reporting child abuse or neglect. We may also disclose your PHI to a person or company required by the Food and Drug Administration for the purpose of quality, safety, or effectiveness of FDA-regulated products or activities including, to report adverse events, product defects or problems, biologic product deviations, to track products; to enable product recalls; to make repairs or replacements, or to conduct post marketing surveillance, as required.
Health Oversight Agencies: We may disclose PHI 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 health care system, government benefit programs, other government regulatory programs and civil rights laws.
Victim of Abuse or Neglect: We may disclose your PHI to the police or another governmental authority if we believe that you or someone you are in control of (such as your children) have been a victim of abuse, neglect or domestic violence. In this case, the disclosure will be made consistent with the requirements and limitations of applicable federal and state laws.
Legal Proceedings: We may use disclose PHI during a judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), or in certain conditions in response to a subpoena, discovery request or other lawful process.
Law Enforcement: We may also disclose PHI, so long as applicable legal requirements are met, for certain law enforcement purposes. These law enforcement purposes including, without limitation,
(1) limited information requests for identification and location purposes,
(2) pertaining to victims of a crime,
(3) suspicion that death has occurred as a result of criminal conduct,
(4) in the event that a crime occurs on the premises of our business, and
(5) in the case of a medical emergency (not on our business’s premises) and it is likely that a crime has occurred.
Coroners, Funeral Directors, and Organ Donation: In the unfortunate circumstance of your demise, we may disclose PHI to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform any other duties they are authorized or required by law to do. We may also disclose PHI 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. PHI may be also used and disclosed for cadaveric organ, eye or tissue donation purposes.
Research: We may disclose your PHI to researchers in certain circumstances. For example, we may disclose such information when the research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your PHI.
Avert Imminent Threat to Health or Safety: Consistent with applicable federal and state laws, we may disclose your PHI, 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 PHI if it is necessary for law enforcement authorities to identify or apprehend an individual.
Military Activity and National Security: When appropriate and extraordinary conditions apply, we may use or disclose PHI of individuals who are Armed Forces personnel
(1) for activities deemed necessary by appropriate military authorities;
(2) for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits, or
(3) to a foreign military authority if you are a member of that foreign military services and to do so would not be in conflict with any other laws that apply to us. We may also disclose your PHI 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: We may disclose your PHI to comply with workers’ compensation laws and other similar legally-established programs.
Inmates: We may use or disclose your PHI if you are a lawful inmate of a correctional facility or other custodial institution in certain circumstances. For example, we may use or disclose such information if the institution or facility represents that such information is necessary for your care, or for the health or safety of you, other inmates, or facility staff.
We may use and disclose your PHI in the following instances but only if we first notify of our intent to do so. You have the opportunity to agree or object to the use or disclosure of all or part of your PHI. If you are not present or able to agree or object to the use or disclosure of the PHI, then your provider may, using professional judgment, determine whether the disclosure is in your best interest.
Other Ways We May Use or Disclose Your PHI That Require Providing You the Opportunity to Agree or Object
2.
To Others Involved in Your Health Care or Payment for your Care: Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your PHI but only to the extent that the PHI 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. We may use or disclose PHI 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.
Ways We May Use or Disclose Your PHI that Requires Your Written Authorization
3.
Other uses and disclosures of your PHI will be made by us only with your written authorization, unless otherwise permitted or required by law as described below. This includes but is not limited to any use or disclosure of your psychotherapy notes (as defined by HIPAA), as well as the use of your PHI for marketing activities that require patient authorization under HIPAA and/or applicable state law. You may revoke any such authorization in writing at any time. If you revoke your authorization, we will no longer use or disclose your PHI for the reasons covered by your written authorization, but please understand that we are unable to take back any disclosures already made with your authorization.
Your Rights Under Applicable Law
4.
You have the right to inspect, duplicate and retain a copy your PHI. This means that we will provide you with a copy of your PHI in our possession so long as it is in our possession. If permitted by federal or state law, we may charge you a reasonable copy fee for a copy of your records. This does not apply to certain record types though. Under federal law, 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 laboratory results that are subject to law that prohibits access to PHI. In some circumstances, you may have a right to have this decision reviewed. Please reach out to our Privacy Officer if you have questions about access to your medical records.
You have the right to request a restriction of your PHI. This means you may ask us not to use or disclose any part of your PHI for any purpose, including the purposes of treatment, payment or health care operations. You may also request that any part of your PHI not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice. To make such a request, you must forward a written request stating the specific restriction requested and to whom you want the restriction to apply. We are not required to agree to a restriction that you may request, except for restriction requests pertaining to disclosures to health plans for payment or health care operations purposes for items or services paid for in full by you.
You have the right to request to receive confidential communications from us by alternative means or at an alternative location. We 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. We will not request an explanation from you as to the basis for the request. Please make this request in writing to our Privacy Officer.
You may have the right to request that your provider amend your PHI maintained in a designated record set. 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 Officer if you have questions about amending your medical record.
You have the right to receive a record of certain disclosures we have made, if any, of your PHI. This right applies to disclosures for purposes other than treatment, payment or health care operations, and other permissible uses or disclosures exempted from such accountings by applicable laws and regulations.
The following is a statement of your rights with respect to your PHI and a brief description of how you may exercise these rights.
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.
5.
You may complain to us or to the Secretary of the U.S. Department of Health and Human Services if you believe your privacy rights have been violated by us. More information about this complaint process is available at https://www.hhs.gov/hipaa/filing-a-complaint/complaint-process/index.html. You may also file a complaint with us by notifying our Privacy Officer of your complaint. You can reach our Privacy Officer by calling our office at (833) 900-1741. We will not retaliate against you for filing a complaint.
