We are legally required to protect the privacy of your health information. Called “Protected Health Information,” it includes information that can be used to identify information that we’ve created or received about your past, present or future health or condition, the provision of health care to you, or the payment of this health care. We are legally required to provide you with this notice about our privacy practices that explains how, when, and why we use and disclose your Protected Health Information. With limited exceptions, we may not use or disclose more of your Protected Health Information than is necessary to accomplish the purpose of the use or disclosure.
How We May Use and Discloses Your Protected Health Information. We use and disclose health information for many different reasons. For many of these uses and disclosures, we need your prior authorization. For the following reasons, we may use and disclose your Protected Health Information without your authorization for the following reasons:
- We will use and disclose your Protected Health Information in connection with your health care treatment. For example, your medical information may be used to provide health-related supplies and services to you and to coordinate with your doctor to ensure that you receive the supplies that your doctor has prescribed to you.
- We will also use and disclose your Protected Health Information as needed to collect payments for the products and services that you receive, such as when we bill Medicare, Medicaid, your private insurance carrier, or you directly for the supplies and services you receive.
- We may use and disclose your Protected Health Information as needed to manage and improve the quality of our health care operations, including uses such as quality assessments, audits, and other similar functions. Limited medical information about you may also be disclosed to your insurers or doctors for managing their internal health care operations.
- We may use or disclose your Protected Health Information to third parties that provide certain services to us, such as data processing, billing, legal, or accounting services, under contracts that protect your medical information from unauthorized use or disclosure.
- We may also use and disclose your Protected Health Information when such a disclosure is required by federal, state or local law, judicial or administrative proceedings, or law enforcement; for public health activities; for health oversight activities; for organ donation purposes; for research purposes; and to avoid harm.
Disclosure to Others Involved in Your Health Care. We may disclose health information about you to a relative, a friend, the subscriber of your services or any other person you identify, provided the information is directly relevant to that person’s involvement with your health care or payment for that care. For example, if a family member or a caregiver calls us with prior knowledge of a claim, we may confirm whether or not the claim has been received and paid. You have the right to restrict or limit this kind of disclosure by contacting our HIPAA Compliance Officer. This will allow you to request the proper documentation to restrict access to your personal health information.
Uses and Disclosures Requiring Your Written Authorization. In all other situations not described above, we will ask for your written authorization before using or disclosing your Protected Health Information. If you have given us an authorization, you may revoke it at any time, if we have not already acted on it. If you have questions regarding authorizations, please call the HIPAA Compliance Officer.
What Rights You Have Regarding Your Protected Health Information. You have the following rights with respect to your Protected Health Information:
- The right to request limits on uses and disclosure of your Protected Health Information.
- The right to choose how we send Protected Health Information to you.
- The right to see and get copies of your Protected Health Information.
- The right to get a list of the disclosures we have made.
- The right to correct and update your Protected Health Information
- The right to get this notice by e-mail.
You may make any of the requests described above, or may request a paper copy of this notice, by calling the HIPAA Compliance Office.
How to Complain about our Privacy Practices. If you think we may have violated your privacy rights, or you disagree with a decision we made about access to your Protected Health Information, you may file a complaint with our HIPAA Compliance Officer. You may also send a written complaint to the Secretary of the Department of Health and Human Services. We will not take retaliatory action against you if you file a complaint about our privacy practices.
This Notice is Subject to Change. We may change the terms of this notice and our privacy policies at any time. If we do, the new terms and policies will be effective for all the information that we already have about you, as well as any information that we may receive or hold in the future.
Please note that we do not destroy personal information about you when you terminate your relationship with us. It may be necessary to use and disclose this information for the purposes described above even after your relationship with us terminates, although policies and procedures will remain in place to protect you against inappropriate use or disclosure.
To Contact Us. If you have questions regarding this notice, please contact our HIPAA Compliance Office by mail at 11 Oak Park Drive, Woburn, MA 01801; by phone at 1-800-937-3028; or by email at email@example.com. Include your name and contact information.