Notice of Privacy Practices

Effective Date: May 28, 2015

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.

OUR OBLIGATIONS

We are required by law to:

  • Maintain the privacy of protected health information (“PHI” or “Health Information”);
  • Give you this notice of our legal duties and privacy practices regarding health information about you;
  • Notify you if a breach occurs that may have compromised the privacy or security of your PHI; and
  • Follow the terms of our notice that is currently in effect.

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION

The following describes the ways we may use and disclose Health Information that identifies you.

USES AND DISCLOSURES THAT DO NOT REQUIRE YOUR AUTHORIZATION OR AN OPPORTUNITY FOR YOU TO OBJECT OR OPT OUT

For Treatment.  We may use and disclose Health Information for your treatment and to provide you with treatment-related health care services.  For example, we may disclose Health Information to doctors, nurses, technicians, or other personnel, including people outside our office, who are involved in your medical care and need the information to provide you with medical care.

For Payment.  We may use and disclose Health Information so that we or others may bill and receive payment from you, an insurance company or a third party for the treatment and services you received.  For example, we may give your health plan information about you so that they may pay for your treatment.

For Health Care Operations.  We may use and disclose Health Information for health care operations purposes.  These uses and disclosures are necessary to make sure that all individuals receive quality care and to operate and manage our office.  For example, we may use and disclose information to make sure the care you receive is of the highest quality.  We also may share information with other entities that have a relationship with you for their health care operation activities.

Appointment Reminders, Treatment Alternatives and Health Related Benefits and Services.  We may use and disclose Health Information to contact you to remind you that you have an appointment with us or third-party centers or clinics with whom we contract or otherwise provide services.  We also may use and disclose Health Information to tell you about treatment alternatives or health-related benefits and services that may be of interest to you.

Individuals Involved in Your Care or Payment for Your Care.  When appropriate, we may share Health Information with a person who is involved in your medical care or payment for your care, such as your family or a close friend.  We also may notify your family about your location or general condition or disclose such information to an entity assisting in a disaster relief effort.

Research.  Under certain circumstances, we may use and disclose Health Information for research.  For example, a research project may involve comparing the health of patients who received one treatment to those who received another, for the same condition.

SPECIAL SITUATIONS

As Required by Law.  We will disclose Health Information when required to do so by applicable law.

To Avert a Serious Threat to Health or Safety.  We may use and disclose Health Information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.

Business Associates.  We may disclose Health Information to our business associates that perform functions on our behalf or provide us with services if the information is necessary for such functions or services.  For example, we may use another company to perform data collection or management services on our behalf.  All of our business associates are obligated to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contracts with such business associates.

Organ and Tissue Donation.  If you are an organ donor, we may use or release Health Information to organizations that handle organ procurement or other entities engaged in procurement, banking or transportation of organs, eyes or tissues to facilitate organ, eye or tissue donation and transplantation.

Military and Veterans.  If you are a member of the armed forces, we may release Health Information as required by military command authorities.  We also may release Health Information to the appropriate foreign military authority if you are a member of a foreign military.

Workers’ Compensation.  We may release Health Information for workers’ compensation or similar programs.  These programs provide benefits for work-related injuries or illness.

Public Health Risks.  We may disclose Health Information for public health activities.  These activities generally include disclosures to prevent or control disease, injury or disability; report births and deaths; report child abuse or neglect; report reactions to medications or problems with products; notify people of recalls of products they may be using; a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and the appropriate government authority if we believe an individual has been the victim of abuse, neglect, or domestic violence.

Health Oversight Activities.  We may disclose Health Information to a health oversight agency for activities authorized by law.  These oversight activities include, for example, audits, investigations, inspections, and licensure.  These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.

Data Breach Notification Purposes.  We may use or disclose your PHI to provide legally required notices of unauthorized access to or disclosure of your health information.

Lawsuits and Disputes.  If you are involved in a lawsuit or a dispute, we may disclose Health Information in response to a court or administrative order.  We also may disclose Health Information in response to a subpoena or other lawful process.

Law Enforcement.  We may release Health Information if asked by a law enforcement official if the information is: (1) in response to a court order, subpoena, warrant, summons or similar process; (2) limited information to identify or locate a suspect, fugitive, material witness, or missing person; (3) about the victim of a crime even if, under certain very limited circumstances, we are unable to obtain the person’s agreement; (4) about a death we believe may be the result of criminal conduct; (5) about criminal conduct on our premises; and (6) in an emergency to report a crime, the location of the crime or victims, or the identity, description or location of the person who committed the crime.

Coroners, Medical Examiners and Funeral Directors.  We may release Health Information to a coroner or medical examiner.  This may be necessary, for example, to identify a deceased person or determine the cause of death.  We also may release Health Information to funeral directors as necessary for their duties.

National Security and Intelligence Activities.  We may release Health Information to authorized federal officials for intelligence, counter-intelligence, and other national security activities authorized by law.

Protective Services for the President and Others.  We may disclose Health Information to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state, or to conduct special investigations.

Inmates or Individuals in Custody.  If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release Health Information to the correctional institution or law enforcement official.  This release would be, if necessary: (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) the safety and security of the correctional institution.

USES AND DISCLOSURES THAT REQUIRE US TO GIVE YOU AN OPPORTUNITY TO OBJECT OR OPT OUT

Individuals Involved in Your 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 that 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.

Disaster Relief.  We may disclose your PHI to disaster relief organizations that seek your PHI to coordinate your care, or notify family and friends of your location or condition in a disaster.  We will provide you with an opportunity to agree or object to such a disclosure whenever we practically can do so.

Fundraising.  We may use or disclosure to a Business Associate or to an institutionally related foundation the following PHI for the purpose of raising funds for our own benefit, without obtaining an authorization from the individual: (a) Demographic information relating to an individual, including name, address, other contact information, age, gender, and date of birth; (b) Dates of health care provided to an individual; (c) Department of service information; (d) Treating physician; (e) Outcome information; and (f) Health insurance status.  We, or an agent on our behalf, may contact you to raise funds for ourselves, but you have the right to opt out of receiving such communications.  You may opt out by contacting our Privacy Official.

YOUR WRITTEN AUTHORIZATION IS REQUIRED FOR OTHER USES AND DISCLOSURES

The following uses and disclosures of your PHI will be made only with your written authorization:

  1.  Uses and disclosures of PHI for marketing purposes, subject to limited exceptions; and
  1.  Disclosures that constitute a sale of your PHI.

Other uses and disclosures of PHI not covered by this Notice or the laws that apply to us will be made only with your written authorization.  If you do give us an authorization, you may revoke it at any time by submitting a written revocation to our Privacy Official and we will no longer disclose PHI under the authorization.  But disclosure that we made in reliance on your authorization before you revoked it will not be affected by the revocation.

YOUR RIGHTS

You have the following rights regarding Health Information we have about you:

Right to Inspect and Copy.  You have a right to inspect and copy Health Information that may be used to make decisions about your care or payment for your care.  This includes medical and billing records, other than psychotherapy notes.  To inspect and copy this Health Information, you must make your request, in writing, to the Privacy Official.  Upon obtaining your written approval in advance, we may provide you with a summary of requested Health Information.  We have up to 30 days, or, with respect to Health Information maintained on an electronic health care records system, up to 15 business days, to make your Health Information, or a summary thereof, available to you after we receive a request; and we may charge you a reasonable fee for the costs of copying, mailing, or other supplies associated with your request.  We may not charge you a fee if you need the information for a claim for benefits under the Social Security Act or any other state of federal needs-based benefit program.  We may deny your request in certain limited circumstances.  If we do deny your request, you will generally have the right, with certain exceptions, to have the denial reviewed by a licensed healthcare professional who was not directly involved in the denial of your request, and we will comply with the outcome of the review.

Right to an Electronic Copy of Electronic Medical Records. If your PHI is maintained in an electronic format (known as an electronic medical record or an electronic health record), you have the right to request that an electronic copy of your record be given to you or transmitted to another individual or entity.  We will make every effort to provide access to your PHI in the form or format you request, if it is readily producible in such form or format.  If the PHI is not readily producible in the form or format you request your record will be provided in either our standard electronic format or if you do not want this form or format, a readable hard copy form.  We may charge you a reasonable, cost-based fee for the labor associated with transmitting the electronic medical record.

Right to Get Notice of a Breach.  You have the right to be notified upon a breach of any of your unsecured PHI.

Right to Amend.  If you feel that Health Information we have is incorrect or incomplete, you may ask us to amend the information.  You have the right to request an amendment for as long as the information is kept by or for our office.  To request an amendment, you must make your request, in writing, to our Privacy Official.  Please be advised that we have the option to deny your request for appropriate, lawful reasons.  If we deny the request, we will notify you in writing of such denial within 60 days of our receipt of your properly submitted written request.  Otherwise, if the amendment is accepted, we will make the appropriate amendment and inform you thereof within 60 days of our receipt of your properly submitted written request.

Right to an Accounting of Disclosures.  You have the right to request a list of certain disclosures we made of Health Information for purposes other than treatment, payment, and health care operations or for which you provided written authorization.  To request an accounting of disclosures, you must make your request, in writing, to our Privacy Official.

Right to Request Restrictions.  You have the right to request a restriction or limitation on the Health Information we use or disclose for treatment, payment, or health care operations.  You also have the right to request a limit on the Health Information we disclose to someone involved in your care or the payment for your care, like a family member or friend.  For example, you could ask that we not share information about a particular diagnosis with your spouse.  To request a restriction, you must make your request, in writing, to our Privacy Official.  We are not required to agree to your request unless you are asking us to restrict the use and disclosure of your PHI to a health plan for payment or health care operation purposes and such information you wish to restrict pertains solely to a health care item or service for which you have paid us “out-of-pocket” in full. If we agree, we will comply with your request unless the information is needed to provide you with emergency treatment.

Right to Request Confidential Communications.  You have the right to request that we communicate with you about medical matters in a certain way or at a certain location.  For example, you can ask that we only contact you by mail or at work.  To request confidential communications, you must make your request, in writing, to our Privacy Official.  Your request must specify how and/or where you wish to be contacted.  We will accommodate reasonable requests.

Right to a Paper Copy of This Notice.  You have the right to a paper copy of this Notice upon request.  You may ask us to give you a copy of this Notice at any time.  Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy of this Notice.  To obtain a paper copy of this notice, please contact our Privacy Official.

CHANGES TO THIS NOTICE

We reserve the right to change this Notice and make the new notice apply to Health Information we already have as well as any information we receive in the future.  We will post a copy of our current Notice at our office.  The Notice will contain the effective date on the first page, in the top right-hand corner.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services.  To file a complaint with our office, please contact HIPAA Privacy Official for Online for Life, Inc. at:  [P.O. Box and e-mail address].  All complaints must be made in writing.  You will not be penalized for filing a complaint.

QUESTIONS

If you have any questions about this Notice of Privacy Practices (“Notice”), please contact the HIPAA Privacy Official for Online for Life, Inc. at the address or e-mail address set forth above.