ADVANCED WOMEN’S CARE, INC.
HIPAA NOTICE OF PRIVACY PRACTICES
Effective Date: September 23, 2013
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
The mission of ADVANCED WOMEN’S CARE is to enhance and promote the mental and emotional well being and optimal social functioning of all persons. This mission is accomplished by providing a comprehensive and integrated continuum of outpatient mental health and related services. In conjunction with the provision of such services, at times it may be necessary for us to use and to disclose your protected health information (PHI). PHI refers to information in your health record that could identify you. It includes information about your symptoms, test results, diagnosis, treatment, and related medical information.
ADVANCED WOMEN’S CARE is required by law to maintain the privacy of your PHI and to provide you with notice of the legal duties and privacy practices regarding PHI and to notify you following a breach of unsecured PHI. We understand that your health information is highly personal, and we are committed to safeguarding your privacy.
I. Disclosure of Your PHI Without Your Authorization
This Notice sets forth different reasons for which we may use and disclose your PHI. The Notice does not list every possible use and disclosure; however, all the reasons for which we are permitted to use and disclose your PHI are listed. The amount of health information used or disclosed will be limited to information that excludes most direct identifiers, such as name, address, and Social Security number, unless more information is needed. If additional information is needed, it will be limited to the “minimum necessary” to accomplish the purpose of the use or disclosure.
· To You — ADVANCED WOMEN’S CARE may disclose your PHI to you, the individual who is the subject of the information.
· Treatment, Payment, & Health Care Operations — ADVANCED WOMEN’S CARE may use or disclose your PHI for treatment, payment, and health care operations purposes. Treatment is when we provide, coordinate, or manage your health care and other services related to your care. An example would be when we consult with another health care provider, such as your family physician or specialist. Payment is when we obtain reimbursement for your health care. Examples of payment are when we disclose your PHI to your health insurer to obtain reimbursement for our services to you or to determine eligibility or coverage. Health Care Operations are activities that relate to the performance and operation of our practice. Examples of this are quality improvement activities, business-related matters (such as audits and administrative services), case management, and care coordination. Use applies only to activities within our practice, such as sharing, applying, utilizing, examining, and analyzing information that identifies you. Disclosure applies to activities outside ADVANCED WOMEN’S CARE’s practice, such as releasing, transferring, or providing access to information about you to other parties.
· Incidental Use and Disclosure — ADVANCED WOMEN’S CARE may use of disclosure your PHI as a result of, or as “incident to,” an otherwise permitted use or disclosure, as long as it has adopted reasonable safeguards as required by HIPAA and the information being shared is limited to the “minimum necessary.”
· Where Required by Law — ADVANCED WOMEN’S CARE may use and disclose your PHI as required by law, including, but not limited to, statute, regulation, or court order.
· Public Health Activities — ADVANCED WOMEN’S CARE may disclose your PHI to: (1) public health authorities authorized by law to collect or receive such information for preventing or controlling disease, injury, or disability and to public health or other government authorities authorized to receive reports of child abuse and neglect; (2) entities subject to FDA regulation regarding FDA regulated products or activities for purposes such as adverse event reporting, tracking of products, product recalls, and post-marketing surveillance; (3) individuals who may have contracted or been exposed to a communicable disease when notification is authorized by law; and (4) employers, regarding employees, when requested by employers, for information concerning a work-related illness or injury or workplace related medical surveillance, because such information is needed by the employer to comply with the Occupational Safety and Health Administration (OHSA), the Mine Safety and Health Administration (MHSA), or similar state law.
· Victims of Abuse, Neglect or Domestic Violence — In situations involving abuse, neglect, or domestic violence, ADVANCED WOMEN’S CARE may disclose your PHI to appropriate government authorities.
· Health Oversight Activities — ADVANCED WOMEN’S CARE may disclose your PHI to health oversight agencies for purposes of legally-authorized health oversight activities, such as audits and investigations necessary for oversight of the health care system and government benefit programs.
· Judicial and Administrative Proceedings — ADVANCED WOMEN’S CARE may disclose your PHI in a judicial or administrative proceeding if the request for the information is through an order from a court or administrative tribunal. Such information may also be disclosed in response to a subpoena or other lawful process if certain assurances regarding notice to the individual or a protective order are provided.
· Law Enforcement Purposes — ADVANCED WOMEN’S CARE may disclose your PHI to law enforcement officials for law enforcement purposes under the following six circumstances, and subject to specified conditions: (1) as required by law (including court orders, court-ordered warrants, subpoenas) and administrative requests; (2) to identify or locate a suspect, fugitive, material witness, or missing person; (3) in response to a law enforcement official’s request for information about a victim or suspected victim of a crime; (4) to alert law enforcement of a person’s death, if ADVANCED WOMEN’S CARE suspects that criminal activity caused the death; (5) when ADVANCED WOMEN’S CARE believes that PHI is evidence of a crime that occurred on its premises; and (6) by ADVANCED WOMEN’S CARE in a medical emergency not occurring on its premises, when necessary to inform law enforcement about the commission and nature of a crime, the location of the crime or crime victims, and the perpetrator of the crime.
· Decedents — ADVANCED WOMEN’S CARE may disclose your PHI to funeral directors as needed, and to coroners or medical examiners to identify a deceased person, determine the cause of death, and perform other functions authorized by law.
· Cadaveric Organ, Eye, or Tissue Donation — ADVANCED WOMEN’S CARE may use or disclose PHI to facilitate the donation and transplantation of cadaveric organs, eyes, and tissue.
· Research — “Research” is any systematic investigation designed to develop or contribute to generalized knowledge. ADVANCED WOMEN’S CARE may use and disclose your PHI for research purposes, provided that it obtains either: (1) documentation that an alteration or waiver of individuals’ authorization for the use or disclosure of PHI about them for research purposes has been approved by an Institutional Review Board or Privacy Board; (2) representations from the researcher that the use or disclosure of PHI is solely to prepare a research protocol or for similar purpose preparatory to research, that the researcher will not remove any PHI from ADVANCED WOMEN’S CARE, and that PHI for which access is sought is necessary for the research; or (3) representations from the researcher that the use or disclosure sought is solely for research on PHI of decedents, that the PHI sought is necessary for the research, and, at the request of ADVANCED WOMEN’S CARE, documentation of the death of the individuals about whom information is sought.
· Serious Threat to Health or Safety — ADVANCED WOMEN’S CARE may disclose your PHI if it believes such disclosure is necessary to prevent or lessen a serious and imminent threat to a person or the public, when such disclosure is made to someone they believe can prevent or lessen the threat (including the target of the threat).
· Essential Government Functions — ADVANCED WOMEN’S CARE may disclosure your PHI for certain essential government functions, including assuring proper execution of a military mission, conducting intelligence and national security activities that are authorized by law, providing protective services to the President, making medical suitability determinations for U.S. State Department employees, protecting the health and safety of inmates or employees in a correctional institution, and determining eligibility for or conducting enrollment in certain government benefit programs.
· Workers’ Compensation — ADVANCED WOMEN’S CARE may disclose your PHI as authorized by, and to comply with, workers’ compensation laws and other similar programs providing benefits for work-related injuries or illnesses.
· Limited Data Set — A limited data set is PHI from which certain specified direct identifiers of individuals and their relatives, household members, and employers have been removed. ADVANCED WOMEN’S CARE may disclose for research, health care operations, and public health purposes, a limited data set, provided the recipient of the limited data set enters into a data use agreement promising specified safeguards for PHI within the limited data set.
II. Disclosure of PHI With Your Authorization
In all other instances (including most uses or disclosures of PHI consisting of psychotherapy notes), ADVANCED WOMEN’S CARE may use or disclose your PHI only with your authorization. “Authorization” is written permission that allows ADVANCED WOMEN’S CARE to disclosure specific PHI. You may revoke all such authorizations at any time, provided each revocation is in writing. You may not revoke an authorization to the extent that—1) we have relied on that authorization or 2) if the authorization was obtained as a condition of obtaining insurance coverage and the law provides the insurer the right to contest the claim under the policy.
We will obtain a written authorization for any use or disclosure of psychotherapy notes, except: (1) to carry out the following treatment, payment, or health care operations: use by us for treatment; use or disclosure by us for our own training programs in which students, trainees, or practitioners in mental health learn under supervision to practice or improve their skills in group, joint, family, or individual counseling; or use or disclosure by us to defend ourselves in a legal action or other proceeding brought by you; and (2) a use or disclosure that is: required by the Secretary of the United States Department of Health and Human Services when the Secretary is investigating or determining our compliance with the HIPAA privacy rule; permitted by law; for health oversight with respect to the oversight of our operations; to a coroner or medical examiner for the purpose of identifying a decedent; or to avert a serious threat to health or safety.
III. Disclosures That Will Not Be Made
Please note that we do not use your PHI for marketing or fundraising efforts. We do not sell your PHI. We also do not use or disclose your genetic information PHI for underwriting purposes, which is prohibited by the Genetic Information Nondiscrimination Act (GINA) of 2008.
IV. Your Rights under HIPAA
· Right to Request Restrictions — You have the right to request restrictions on certain uses and disclosures of your PHI; however, we are not required to agree to a restriction at your request except for restrictions for any disclosures to be made to a health plan for payment or health care operations functions (but not for treatment purposes) involving a health care item or service for which you have paid us out of pocket in full.
· Right to Receive Confidential Communications by Alternative Means and at Alternative Locations — You have the right to request and receive confidential communication of PHI by alternative means and at alternative locations. For example, you may not want a family member to know that you are receiving services at ADVANCED WOMEN’S CARE. Upon your request, we will send your statements to another address.
· Right to Inspect and Copy — You have the right to inspect or obtain a copy (or both) of PHI records used to make decisions about you for as long as the PHI is maintained in the record. If the we maintain your PHI in an electronic format (including in an electronic health record), you have a right to obtain a copy of such information in an electronic format and, if you so choose, direct us to transmit such copy directly to another entity or person. We may deny your request to inspect and copy your PHI in certain limited circumstances. In some circumstances, you may request that the denial be reviewed.
· Right to Amend — You have the right to request an amendment of PHI for as long as the PHI is maintained in the record. On your request we will discuss with you the details of the amendment process. We may accept or deny your request.
· Right to an Accounting — Generally, you have the right to receive an accounting of disclosures of PHI for which you have not provided either consent or authorization (as described in Section III of this Notice). You also have the right to request an accounting of disclosures of your PHI through an electronic health record made by us to carry out our payment activities or health care operations within the past three years from the date of your request. On your request, we will discuss with you the details of the accounting process.
· Right to a Paper Copy — You have the right to obtain a paper copy of the notice from ADVANCED WOMEN’S CARE upon request, even if you have agreed to receive the notice electronically.
· Right to Receive Notification — You are entitled to receive notification from us if the confidentiality of any of your PHI maintained in an unsecured form is compromised.
V. ADVANCED WOMEN’S CARE’s Duties Under HIPAA
· We are required by law to maintain the privacy of PHI and to provide you with a notice of our legal duties and privacy practices with respect to PHI.
· We reserve the right to change the privacy policies and practices described in this notice. We are required to abide by the terms currently in effect, unless we notify you of such changes.
· We reserve the right to change the terms of this notice and to make the provisions of the new notice effective for all PHI that we maintain. If we revise our policies and procedures that will affect your PHI, we will send a notice of these changes to you by regular mail to your last known address that we have on file for you.
VI. Questions and Complaints
· If you have questions about this notice, disagree with our decision about access to your records, or have other concerns about your privacy rights, you may contact the Privacy Officer for ADVANCED WOMEN’S CARE, in writing, at ADVANCED WOMEN’S CARE, 1111 Boardman-Canfield Rd., Boardman, OH 44512. Phone 330.965.0909. Fax 330.965.0897
· If you believe that your privacy rights have been violated and wish to file a complaint, you may send your written complaint to the Privacy Officer at ADVANCED WOMEN’S CARE, 1111 Boardman-Canfield Rd., Boardman, OH 44512.
· You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services at 200 Independence Avenue, SW, in Washington, D.C., 20201.
· We will not retaliate against you for exercising your right to file a complaint.