THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This Notice of Privacy Practices (the “Notice”) tells you about the ways we may use and disclose your protected health information (“PHI”) and your rights and our obligations regarding the use and disclosure of your PHI. “We” refers to, and this Notice applies to the trained and licensed personnel working through the practices with which MIDI Health, Inc. contracts, including but not limited to Integrative Women’s Care, P.C., and Women’s Midlife Care (collectively, the “Practice”).
PHI is information about you, including demographic information, that may identify you and that relates to your past, present or future physical health or condition, treatment or payment for health care services. This Notice also describes your rights to access and control your PHI.
- OUR OBLIGATIONS
We maintain the privacy of your PHI and notify affected individuals following a breach of unsecured PHI, in each case to the extent required by state and federal law. We provide you this Notice explaining our legal duties and privacy practices with respect to PHI about you.
- HOW WE MAY USE AND DISCLOSE PHI ABOUT YOU
The following categories describe the different ways that we typically use and disclose PHI, the purposes for such uses and disclosures, and the reasons for such uses and disclosures.
- For Treatment. We may use and disclose PHI about you to provide you with health care treatment and related services, including coordinating and managing your health care. We may disclose PHI about you to physicians, nurses, other health care providers and personnel who are providing or involved in providing health care to you (both within and outside of the Practice). For example, should your care require referral to a pharmacy for the provision of prescription drugs, we may provide that pharmacy with your PHI in order to aid the pharmacist in his or her treatment of you.
- For Payment. We may use and disclose PHI about you so that we or may bill and collect from you, an insurance company, or a third party for the health care services we provide. This may also include the disclosure of PHI to obtain prior authorization for treatment and procedures from your insurance plan. For example, we may send a claim for payment to your insurance company, and that claim may have a code on it that describes the services that have been rendered to you. If, however, you pay for an item or service in full, out of pocket and request that we not disclose to your health plan the PHI solely relating to that item or service, as described more fully in Section 4 of this Notice, we will follow that restriction on disclosure unless otherwise required by law.
- For Health Care Operations. We may use and disclose PHI about you for our health care operations. These uses and disclosures are necessary to operate and manage our practice and to promote quality care. For example, we may need to use or disclose your PHI in order to assess the quality of care you receive or to conduct certain cost management, business management, administrative, or quality improvement activities or to provide information to our insurance carriers.
- Quality Assurance and Utilization Review. We may need to use or disclose your PHI for our internal processes to assess and facilitate the provision of quality care to our patients. We may need to use or disclose your PHI to perform a review of the services we provide in order to evaluate whether that the appropriate level of services is received, depending on condition and diagnosis.
- Credentialing and Peer Review. We may need to use or disclose your PHI in order for us to review the credentials, qualifications and actions of our health care providers.
- Treatment Alternatives. We may use and disclose PHI to tell you about or recommend possible treatment options or alternatives that we believe may be of interest to you.
- Appointment Reminders and Information about Health Related Benefits and Services. We may use and disclose PHI, in order to contact you (including, for example, contacting you by phone and leaving a message on an answering machine) to provide appointment reminders and other information. We may use and disclose PHI to tell you about health-related benefits or services that we believe may be of interest to you. See also the specific types of communications noted above.
- Vendors. There are some services (such as billing or legal services) that may be provided to or on behalf of the Practice through contracts with third parties, including MIDI Health. When these services are contracted, we may disclose your PHI to our vendors so that they can perform the jobs we have asked them to do. To protect your PHI, however, we require the vendors, as business associates, to appropriately safeguard your information.
- As Required by Law. We will disclose PHI about you when required to do so by federal, state, or local law or regulations.
- Other. Subject to applicable legal requirements, and where appropriate for your medical care or required by law, we may also use your PHI (i) to avert an imminent threat of injury to health or safety, (ii) for organ donation purposes, (iii) for research, (iv) to appropriate military authorities if you are in the armed forces, (v) for workers’ compensation programs, (vi) for public health activities, (vii) for health oversight activities, (viii) for other legal matters, (ix) for law enforcement purposes, or (x) to coroners and medical examiners.
- Electronic Disclosures of PHI. Under the law of certain states, we are required to provide notice to you if your PHI is subject to electronic disclosure. This Notice serves as general notice that we may disclose your PHI electronically for treatment, payment, or health care operations or as otherwise authorized or required by state or federal law.
- De-Identified Data. We may de-identify your PHI in accordance with applicable law, such that it no longer can be used to identify you individually. Once so de-identified, we may use the data alone or in aggregated form for any purpose allowable by law.
- OTHER USES OF PHI
- Authorizations. There are times we may need or want to use or disclose your PHI for reasons other than those listed above, but to do so we will need your prior authorization. Any uses or disclosures of your PHI not described herein will require your specific written authorization.
If you provide us with written authorization to use or disclose your PHI for such other purposes, you may revoke that authorization in writing at any time. If you revoke your authorization, we will no longer use or disclose your PHI for the reasons covered by your written authorization. You understand that we are unable to take back any uses or disclosures we have already made in reliance upon your authorization, and that we are required to retain our records of the care that we provided to you.
- Psychotherapy Notes, Marketing and Sale of PHI. Most uses and disclosures of “psychotherapy notes,” uses and disclosures of PHI for marketing purposes, and disclosures that constitute a “sale of PHI” under HIPAA require your authorization. The Practice does not anticipate that it will maintain psychotherapy notes or sell PHI.
- YOUR RIGHTS REGARDING PHI ABOUT YOU
Certain laws and regulations provide you with certain rights regarding the PHI we have about you. The following is a summary of those rights.
- Right to Inspect and Copy. Under most circumstances, you have the right to request access to, inspect and/or copy your PHI that we maintain in our possession in a designated record set, which generally includes your medical and billing records. If you request a copy of your information, we may charge a fee for the costs of copying, mailing, or certain supplies associated with your request. The fee we may charge will be the amount allowed by state law. In certain very limited circumstances allowed by law, we may deny your request to review or copy your PHI. We will provide any such denial in writing. If you are denied access to PHI, you may request that the denial be reviewed.
- Right to Amend. If you feel the PHI we have about you is incorrect or incomplete, you may ask us to amend the information. In your request, you must provide a reason as to why you want this amendment. If we accept your request, we will notify you of that in writing. We may deny your request for an amendment under certain circumstances. If we deny your request, we will notify you of that denial in writing, and provide you with an opportunity to appeal.
- Right to an Accounting of Disclosures. You have the right to request an accounting of certain disclosures of your PHI that we have made, except for disclosures which were made pursuant to an authorization, for purposes of treatment, payment or health care operations, or for certain other purposes. Your request must state a time period, which may not be longer than six years. The first list you request within a twelve-month period will be free. For additional lists, we may charge you a reasonable fee for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
- Right to Request Restrictions. You have the right to request a restriction or limitation on our use or disclosure of your PHI. Your request must be in writing and state the specific restriction and to whom you want the restriction to apply. We are not required to agree to your request for a restriction or limitation, except if the requested restriction is on a disclosure to a health plan for a payment or health care operations purpose regarding a service that has been paid in full out-of-pocket. If we do agree, we will comply with your request unless the information is needed to provide emergency treatment. In addition, there are certain situations where we won’t be able to agree to your request, such as when we are required by law to use or disclose your PHI.
- 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 through a personal email address and not at work or, conversely, only at work and not a personal email address. We will use our best efforts to accommodate all reasonable requests, but there are some requests with which we will not be able comply. Your request must be in writing and specify how and where you wish to be contacted.
- Right to an Email or Paper Copy of This Notice. You have the right to a paper copy of this Notice, upon request, even if you have previously requested its receipt electronically. You may ask us to give you a copy of this Notice at any time.
- Right to Breach Notification. In certain instances, we may be obligated to notify you (and potentially other parties) if we become aware that your PHI has been improperly disclosed or otherwise subject to a “breach” as defined in and/or required by applicable law.
- CHANGES TO THIS NOTICE
We reserve the right to change this Notice at any time, along with our privacy policies and practices. We reserve the right to make the revised or changed Notice effective for PHI we already have about you as well, as any information we receive in the future. We will post a copy of the current notice, along with an announcement that changes have been made, as applicable, on our website.
If you believe that your privacy rights as described in this Notice have been violated, you may file a complaint with the Practice at : Operations@JoinMidi.com
The Practice will not retaliate against any individual who files a complaint. You may also file a complaint with the Secretary of the Department of Health and Human Services.
In addition, if you have any questions about this Notice, please contact Operations@JoinMidi.com.
- ACKNOWLEDGEMENT OF RECEIPT OF NOTICE OF PRIVACY PRACTICES
By click signing this agreement, you acknowledge that you have received or been given an opportunity to receive this Notice.