NOTICE OF PRIVACY PRACTICES
This notice describes how information about you may be used and disclosed and how you can get access to this information.
You have the right to obtain a copy of this notice at any time.
How we may use and disclose your health information
We may …
- Disclose your medical information to a health care provider to provide care and treatment to you (such as lab tests or prescriptions). Additionally, we may disclose your PHI to others who may assist in your care, such as your spouse, children, or parents.
- Disclose your medical information to your health plan/insurance company to obtain payment for services or obtain approval for treatment.
- Disclose medical information to contact you as a reminder that you have an appointment for services.
- Disclose health information to a family member, other relative, close personal friend, or any other person you identify, if the information is relevant to that person’s involvement with your care or payment for your care. You can prohibit disclosure of this information.
- Disclose health information, as authorized or required by local, state, or federal law, for the following purposes:
- To report certain diseases and wounds, births and deaths, and suspected cases of abuse, neglect, or domestic violence;
- To help identify, locate, or report criminal suspects, crime victims, suspicious deaths, or criminal conduct on the premises of our Company;
- To respond to a court order, subpoena, or other judicial process;
- To assist federal disaster relief efforts;
- To enable product recalls, repairs, or replacements;
- To respond to an audit, inspection, or investigation by a health-related government agency;
- To assist in federal intelligence, counterintelligence, and national security issues;
- To facilitate organ and tissue donations;
- To assist coroners, medical examiners, and funeral directors;
- To respond to a request from a jail or prison regarding an inmate’s health or medical treatment;
- To respond to a request from military command authority for veterans or current armed forces;
- To provide information to a workers’ compensation program.
- Disclose health information for activities that are needed to operate the Company such as: quality improvement, staff evaluations, education and training, etc.
- Transfer medical information to a third party in conjunction with the sale of our Company.
- Some services are provided through contracts with business associates. The Company will disclose health information so they can perform the job. However, they are required to protect your information.
- There are special privacy protections for alcohol and drug abuse information. This information will not be disclosed unless there is a written consent; a court order; a medical emergency; or to report a crime or a threat to commit a crime, or to report abuse or neglect as required by law.
Your Health Information Rights
- Request that we communicate health information to you by an alternate means or location other than your home address and telephone number.
- Request that we restrict the use or disclosure of your health information for treatment, payment, or health care operations. While we are not required to agree to your request, if we do agree, your request will be complied with, unless the information is needed to provide emergency treatment to you.
- Review and obtain a copy of your health information (with processing fees), with certain exceptions. Usually, this includes medical and billing records, but does not include
- Ask for an amendment of health information if you believe it is incomplete or incorrect.
- Request a list of disclosures of your health information, except for treatment, payment, or health care operations, those authorized by you, and certain other disclosures. This will be done at no cost to you once a year. Other disclosures in that same year will incur a fee.
2013 Modifications to the Privacy Rules
- You have the right to be notified of a data breach.
- You have the right to ask for a copy of your electronic medical record in an electronic form.
- You have the right to opt out of fundraising communications from the Company, and the Company cannot sell your health information without your permission.
- Certain uses of your medical data, such as use of patient information in marketing, require prior disclosure and your authorization. Uses and disclosures not described in this notice will be made only with your authorization.
- If you pay out of pocket (i.e., cash, check, money order, credit or debit card) for your treatment, you can instruct the Company not to share information about your treatment with your health plan/insurance company.
To Report a Complaint
If you believe your health information privacy rights have been violated, you can file a complaint with us or with the Secretary of the United States Department of Health and Human Services. There will not be any penalty or retaliation against you for making a complaint.
If you have any questions or need information regarding our legal duties and privacy practices, or how to exercise any of your health information rights listed in this notice, please contact: