Privacy Notice

Your Rights. Our Responsibilities. 

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.

Your Rights 

When it comes to your health information, you have certain rights. This section explains your  rights and some of our responsibilities to help you. 

Get a copy of your  

health and claims records 

You can ask to see or get a copy of your health records and other health information we have about you. Ask us how to do this.  
We will provide a copy or a summary of your health and claims records, usually within 30 days of your request. We may charge a reasonable, cost-based fee. 
Ask us to correct health and claims records You can ask us to correct your health and claims records if you think they are  incorrect or incomplete. Ask us how to do this. 
We may say “no” to your request, but we’ll tell you why in writing within  60 days. 
Request confidential communicationsYou can ask us to contact you in a specific way (for example, home or office  phone) or to send mail to a different address. 
We will consider all reasonable requests, and must say “yes” if you tell us you  would be in danger if we do not. 
Ask us to limit what we use or shareYou can ask us not to use or share certain health information for treatment, payment, or our operations.
We are not required to agree to your request, and we may say “no” if it  would affect your care.
Get a list of those with whom we’ve shared informationYou can ask for a list (accounting) of the times we’ve shared your health  information for six years prior to the date you ask, who we shared it with, and why.
We will include all the disclosures except for those about treatment,  payment, and health care operations, and certain other disclosures (such as  any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable,cost-based fee if you ask for another one within 12 months.  

 

Get a copy of this privacy notice You can ask for a paper copy of this notice at 

any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly. 

Choose Someone to act for you If you have given someone medical power of attorney or if someone is your  legal guardian, that person can exercise your rights and make choices about  your health information.
We will make sure the person has this authority and can act for you before  we take any action. 
File a complaint if you feel your rights are violated You can complain if you feel we have violated your rights by contacting us  using the information on page 1. 

You can file a complaint with the U.S. Department of Health and Human  Services Office for Civil Rights by sending a letter to 200 Independence  Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. 

We will not retaliate against you for filing a complaint. 

Your Choices

For certain health information, you can tell us your choices about what we share. If you  have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to: Share information with your family, close friends, or others involved in payment for your care.
Share information in a disaster relief situation.
Contact you for fundraising efforts. 
If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety. 
In these cases we never share your information unless you give us written permission: Marketing Purposes.

Sale of your information.

Our Uses and Disclosures

How do we typically use or share your health information? We typically use or share your health information in the following ways.

Help manage  the health care  treatment you  receive  We can use your health information and share it with professionals who are treating you.  Example: A doctor sends us information  about your diagnosis and treatment plan  so we can arrange additional services. 
Run our organization  We can use and disclose your  

information to run our organization  and contact you when necessary.

Example: We use health information  about you to develop better services  for you. 
We are not allowed to use genetic  information to decide whether  we will give you coverage and the  price of that coverage. This does  not apply to long term care plans.        
Pay for your health services We can use and disclose your health  information as we pay for your health  services.  Example: We share information about  you with your dental plan to coordinate  payment for your dental work
Administer your planWe may disclose your health information to your health plan sponsor for plan administration.Example: Your company contracts with us  to provide a health plan, and we provide  your company with certain statistics to  explain the premiums we charge.

Other Uses

How else can we use or share your health information? We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see. www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

Help with public health

and safety issues

We can share health information about you for certain situations such as:

  Preventing disease

  Helping with product recalls

  Reporting adverse reactions to medications

  Reporting suspected abuse, neglect, or domestic violence

  Preventing or reducing a serious threat to anyone’s health or safety

Do research We can use or share your information for health research.

 

Comply with the law We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
Respond to organ and tissue

donation requests and work

with a medical examiner or

funeral director

We can share health information about you with organ procurement organizations.

We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Address workers’

compensation, law

enforcement, and other government requests

We can use or share health information about you:

For workers’ compensation claims

For law enforcement purposes or with a law enforcement official

With health oversight agencies for activities authorized by law

For special government functions such as military, national security, and presidential protective services

Respond to lawsuits and

legal actions

We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Special Notes:  We never market or sell your personal information. 

Our Responsibilities

  • We are required by law to maintain the privacy and security of your protected health information.  
  • We will let you know promptly if a breach occurs that may have compromised the privacy or security of  your information. 
  • We must follow the duties and privacy practices described in this notice and give you a copy of it.  
  • We will not use or share your information other than as described here unless you tell us we can in  writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you  change your mind.  

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html. 

Changes to the Terms of This Notice 

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, and on our website. 

The effective date of this is 10.07.2021

You may contact our privacy officer with your questions.

Gricelda Prado – (425) 775-3561 – Ask for Gricelda concerning a privacy matter