THIS NOTICE explains how your medical information may be used and disclosed, as well as how you can have access to it. PLEASE READ IT THOROUGHLY.
We collect your personal health information from various sources including treatment, payment, healthcare activities, and the enrollment process. This information includes any data, whether spoken, written, or recorded, created or received by healthcare entities such as physicians, hospitals, and health insurance companies or plans. The law provides strict protection for health information that can be used to identify you as an individual patient, such as your name, address, social security number, and other identifying details.
We may not use or share your personal health information without your authorization in general. Furthermore, once we have gained your permission, we must use or disclose your personal health information in line with the terms of that authorization. The following are the legal circumstances in which we may use or disclose your personal health information.
We may use or disclose your personal health information without your consent in order to provide you with the services and treatment you require or request, or to collect payment for those services, and to conduct other connected health care activities otherwise permitted or required by law. In addition, we are entitled to disclose your personal health information within and among our personnel for the same purposes. Even with your agreement, we are still obligated to limit such uses or disclosures to the minimum amount of personal health information that is reasonably required to deliver those services or accomplish those activities.
Treatment activities include:
Payment activities include:
Healthcare operations include:
We may use or disclose your personal health information to the extent allowed by law, and only to the extent that such use or disclosure complies with and is restricted to the relevant requirements of such law. Examples of situations in which we are compelled to disclose your personal health information include:
We cannot use or disclose your personal health information without your explicit authorization, except as permitted or required by law as mentioned above. Additionally, we must follow the conditions of your authorization when using or disclosing your personal health information. You can withdraw your authorization for the use or disclosure of your personal health information at any time, except if we have already acted based on your authorization, or if you provided the authorization as a requirement to obtain insurance coverage, and another law allows the insurer to challenge a claim under the policy.
We may contact you to remind you of your appointments or to provide information about treatment options or other health-related benefits and services that may be relevant to you. Additionally, we may contact you to request funds for the Covered Entity. If we are a group health plan or health insurance issuer, or an HMO in relation to a group health plan, we may disclose your personal health information to the sponsor of the plan.
HIPAA grants you specific rights concerning your personal health information. The following is a concise summary of these rights and our obligations in upholding them.
You have the right to request restrictions on certain uses and disclosures of your personal health information. You may request restrictions on the following uses or disclosures:
While we are not required to agree to any requested restriction, if we agree to a restriction, we are bound not to use or disclose your personal healthcare information in violation of such restriction, except in certain emergency situations. We will not accept a request to restrict uses or disclosures that are otherwise required by law.
You have the right to receive your personal health information in a confidential manner. We may require written requests for such confidential communications and may ask for information on how payment will be handled and an alternate address or method of contact. However, we cannot require an explanation of why you are requesting confidential communications. We must accommodate reasonable requests from you to receive personal health information through alternative means or locations. If we are a healthcare plan, we must also accommodate reasonable requests for alternative communications if you state that disclosing the information could endanger you. We may require that such requests include a statement indicating that disclosure of the requested information could endanger you.
Your designated record set contains medical and billing records, enrollment, payment, claims adjudication, and case or medical management records, as applicable. You have the right to access and obtain a copy of your personal health information in your designated record set, except for psychotherapy notes, information compiled for use in a legal proceeding, or health information that is prohibited by law. You may need to provide a written request for access. We will provide your personal health information in the form or format requested by you if readily producible, or in a readable hard copy form if not. Alternatively, we may provide a summary of the information or an explanation of the personal health information provided, if you agree to the fees and format in advance.
We will provide you with timely access to your personal health information and can arrange a convenient time and place for inspection or mailing a copy to you upon request. We may charge a reasonable fee for copying, postage, and preparing an explanation or summary, as agreed upon in advance. We reserve the right to deny access to certain personal health information as permitted by law, but we will make every effort to accommodate your request. If we deny your request, we will provide a written explanation of the legal basis for the denial and your rights to file a complaint. If we do not maintain the information you requested, we will inform you of where to direct your request.
You have the right to request that we amend your personal health information or a record about you contained in your designated record set, for as long as the designated record set is maintained by us. We have the right to deny your request for amendment if:
If we deny your request, we will provide you with a written denial stating the basis of the denial, your right to submit a written statement disagreeing with the denial, and a description of how you may file a complaint with us or the Secretary of the U.S. Department of Health and Human Services (“DHHS”). This denial will also include a notice that if you do not submit a statement of disagreement, you may request that we include your request for amendment and the denial with any future disclosures of your personal health information that is the subject of the requested amendment. Copies of all requests, denials, and statements of disagreement will be included in your designated record set. If we accept your request for amendment, we will make reasonable efforts to inform and provide the amendment within a reasonable time to persons identified by you as having received personal health information of yours prior to amendment and persons that we know have the personal health information that is the subject of the amendment and that may have relied, or could foreseeably rely, on such information to your detriment. All requests for amendment shall be sent to Prevention Medical Center.
You have the right to receive a written accounting of all disclosures of your personal health information that we have made immediately preceding the date on which the accounting is requested. You may request an accounting of disclosures for a period of less than six (6) years from the date of the request. Such disclosures will include the date of each disclosure, the name and, if known, the address of the entity or person who received the information, a brief description of the information disclosed, and a brief statement of the purpose and basis of the disclosure, or, in lieu of such statement, a copy of your written authorization or written request for disclosure pertaining to such information. We are not required to provide accountings of disclosures for the following purposes:
We reserve our right to temporarily suspend your right to receive an accounting of disclosures to health oversight agencies or law enforcement officials, as required by law. We will provide the first accounting to you in any twelve (12) month period without charge but will impose a reasonable, cost-based fee for responding to each subsequent request for accounting within that same twelve (12) month period. All requests for an accounting shall be sent to Prevention Medical Center.