NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL, INCLUDING MENTAL HEALTH, INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. During the process of providing services to you, YCMATS LLC dba Preventive Health Now (“PHN”) will obtain, record, and use mental health and medical information about you that is Protected Health Information. Ordinarily that information is confidential and will not be used or disclosed, except as described below.
I. USES AND DISCLOSURES OF PROTECTED INFORMATION
A. General Uses and Disclosures Not Requiring the Individual’s Consent. PHN will use and disclose Protected Health Information in following ways.
1. Treatment. Treatment refers to the provision, coordination, or management of health care, including mental health care, and related services by one or more health care providers. PHN is not a health care provider and does not share your Protected Health Information with anyone for treatment purposes unless it has your express consent to do so.
2. Payment. Payment refers to the activities undertaken by PHN to obtain or provide reimbursement for the provision of health care. Your employer or health plan pays PHN for the services that it hires PHN to provide to you. If you would like PHN to perform tests in addition to those tests paid for by your employer or health plan, you may request these additional tests from PHN and you would be required to pay PHN out of pocket for those tests which you select to be performed outside of the tests paid for by your employer or health plan.
3. Health Care Operations. Health Care Operations refers to activities undertaken by PHN that are regular functions of management and administrative activities of the practice. For example, PHN may use or disclose your health information in the monitoring of service quality, staff evaluation, and obtaining legal services.
4. Contacting the Individual. PHN may contact you to remind you of appointments, to notify you of test results and to tell you about treatments or other services that might be of benefit to you.
5. Required by Law PHN will disclose Protected Health Information when required by law or necessary for health care oversight. This includes, but is not limited to when (a) reporting child abuse or neglect; (b) court ordered to release information; (c) there is a legal duty to warn or take action regarding imminent danger to others; (d) the Individual is a danger to self or others or gravely disabled; (e) a coroner is investigating the Individual’s death; or (f) to health oversight agencies for oversight activities authorized by law and necessary for the oversight of the health care system, government health care benefit programs, or regulatory compliance.
6. Crimes on the premises or observed by the provider. Crimes that are observed by PHN or PHN’s staff, crimes that are directed toward PHN or PHN’s staff, or crimes that occur on the premises will be reported to law enforcement.
7. Business Associates. Some of the functions of PHN may be provided by contracts with Business Associates. For example, the laboratory work is performed by a laboratory company and our examiners are independent contractors. In those situations, Protected Health Information will be provided to those contractors as is needed to perform their contracted tasks. Business Associates are required to enter into an agreement maintaining the Protected Health Information privacy of the Protected Health Information released to them.
8. Research. PHN may use or disclose Protected Health Information for research purposes if the relevant limitations of the Federal HIPAA Privacy Rule are followed.
45 C.F.R. § 164.512(i).
9. Family Members. Except for certain minors, incompetent Individuals, or involuntarily treated Individuals, Protected Health Information cannot be provided to family members without the Individual’s consent. In situations where family members are present during a discussion with the Individual, and it can be reasonably inferred from the circumstances that the Individual does not object, information may be disclosed in the course of that discussion. However, if the Individual objects, Protected Health Information will not be disclosed.
10. Emergencies. In life threatening emergencies, PHN will disclose information necessary to avoid serious harm or death.
B. Statements That Certain Uses and Disclosures Require Authorization. PHN must obtain your Authorization in order to use or disclose your Protected Health Information as follows: (1) for marketing purposes; and (2) to sell your Protected Health Information to a third party.
C. Individual Authorization or Release of Information. PNH may not use or disclose Protected Health Information in any other way than set forth in this Notice without a signed Authorization. When you sign an Authorization, it may later be revoked, provided that the revocation is in writing. The revocation will apply, except to the extent PHN has already taken action in reliance thereon.
II. YOUR RIGHTS AS AN INDIVIDUAL
A. Access to Protected Health Information. You have the right to inspect and obtain a copy of the Protected Health Information the provider has regarding you, in the designated record set. If records are used or maintained as electronic health record, you have a right to receive a copy of the PHI maintained in the electronic health record in an electronic format. There are other limitations to this right, which will be provided to you at the time of your request, if any such limitation applies. To make a request, ask PHN.
B. Amendment of Your Record. You have the right to request that PHN amend your Protected Health Information. PHN is not required to amend the record if it is determined that the record is accurate and complete. There are other exceptions, which will be provided to you at the time of your request, if relevant, along with the appeal process available to you. To make a request, ask PHN.
C. Accounting of Disclosures. You have the right to receive an Accounting of certain disclosures PHN has made regarding your Protected Health Information. However, that Accounting does not include disclosures that were made for the purpose of Treatment, Payment, or Health Care Operations what are HCO’s?. In addition, the Accounting does not include disclosures made to you or disclosures made pursuant to a signed Authorization. There are other exceptions that will be provided to you, should you request an Accounting. To make a request, ask PHN.
D. Additional Restrictions. You have the right to request additional restrictions on the use or disclosure of your health information. Unless you pay for your services out-of-pocket, PHN does not have to agree to that request, and there are certain limits to any restriction, which will be provided to you at the time of your request. If you pay for a service out of pocket, you are permitted to demand that information regarding the service not be disclosed to the patient’s health plan or insurance. To make a request, ask PHN.
E. Alternative Means of Receiving Confidential Communications. You have the right to request that you receive communications of Protected Health Information from PHN by alternative means or at alternative locations. For example, if you do not want PHN to mail bills or other materials to your home, you can request that this information be sent to another address. There are limitations to the granting of such requests, which will be provided to you at the time of the request process. To make a request, ask PHN.
F. Breach Notification. In the event of any breach of your unsecured PHI, PHN will notify you of such breach within thirty (30) days of the date PHN learns of the breach.
G. Copy of this Notice. You have a right to obtain another copy of this Notice upon request.
III. ADDITIONAL INFORMATION
A. Privacy Laws. PHN is required by State and Federal law to maintain the privacy of Protected Health Information. In addition, PHN is required by law to provide Individuals with notice of PHN’s legal duties and privacy practices with respect to Protected Health Information. That is the purpose of this Notice.
B. Terms of the Notice and Changes to the Notice. PHN is required to abide by the terms of this Notice, or any amended Notice that may follow. PHN reserves the right to change the terms of its Notice and to make the new Notice provisions effective for all Protected Health Information that it maintains. When the Notice is revised, the revised Notice will be posted at PHN’s service delivery sites and will be available upon request.
C. Complaints Regarding Privacy Rights. If you believe the provider has violated your privacy rights, you have the right to complain to PHN. You also have the right to complain to the United States Secretary of Health and Human Services by sending your complaint to Andrea Oliver Regional Manager, Office for Civil Rights U.S. Department of Health & Human Services 1961 Stout Street Room 08-148 Denver, Colorado 80294 Phone: (800) 368-1019 TDD: (800) 537-7697 Fax: (202) 619-3818 Email: email@example.com
It is the policy of PHN that there will be no retaliation for your filing of such complaints.
D. Contact Information. If you have questions about this Notice or desire additional
information about your privacy rights, please contact our Privacy Officer at: M Lonigro 7771 E 29th Ave Denver CO 80238 (303) 834-1019
E. Effective Date. This Notice is effective April 20, 2018