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HIPAA Privacy Policy
NOTICE OF HEALTH INFORMATION PRIVACY PRACTICES – PLEASE REVIEW CAREFULLY THIS NOTICE DESCRIBES HOW PLANNED PARENTHOOD MAR MONTE MAY USE OR DISCLOSE YOUR HEALTH INFORMATION AND HOW YOU CAN ACCESS THIS INFORMATION. If you have any questions about this notice, please contact the Planned Parenthood Mar Monte (PPMM) Privacy Official at: 408-287-7532, x 136. OUR PLEDGE REGARDING YOUR HEALTH INFORMATION We understand that health information about you and your healthcare is personal. We are committed to protecting your health information. We will create a record of the care and services you receive from us in order to provide you with quality care and to comply with HIPAA regulatory requirements and state law. This Notice applies to all of the health information records generated or received by PPMM, whether we generated or documented the health information, or another doctor forwarded it to us. This Notice tells you the ways in which we may use or disclose health information about you. This Notice also describes your rights to the health information we keep about you, and describes certain obligations we have regarding the use and disclosure of your health information. State law and the privacy and security provisions of the Health Insurance Portability and Accountability Act (HIPAA) require us to:
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU - The following categories describe different ways that we may use or disclose health information about you. Unless otherwise noted each of these uses and disclosures does not require your permission. For each category of use or disclosure, we will explain what we mean and give some examples. Not every use or disclosure in a category will be listed. However, unless we ask for a separate authorization, all of the ways we are permitted to use and disclose information will fall within one of the categories. For Treatment: We may use health information about you to provide you with healthcare treatment and services. We may disclose health information about you to doctors, nurses, technicians, health students, volunteers or other personnel who are involved in taking care of you. They may work at our offices, at a hospital if you are hospitalized under our supervision, or at another doctor’s office, lab, pharmacy, or other healthcare provider to whom we may refer you for consultation, to take x-rays, to perform lab tests, to have prescriptions filled, or for other treatment purposes. For example, a doctor treating you may need to know if you have diabetes because diabetes may slow the healing process. We may provide that information to a physician treating you at another institution. For Payment: We may use and disclose health information about you so that the treatment and services you receive from us can be billed to you, and payment collected from you, an insurance company, a state Medicaid agency (MediCal in CA) or a third party. For example, we may need to give your health insurance plan information about your office visit so your health plan will pay us or reimburse you for the visit. Alternatively, we may need to give your health information to the state Medicaid agency (MediCal in CA) so that we may be reimbursed for providing services to you. In some instances, we may need to tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment. For Healthcare Operations: We may use and disclose health information about you for operations of our healthcare practice. These uses and disclosures are necessary to run our practice and make sure that all of our patients receive quality care. For example, we may use health information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine health information about many patients to decide what additional services we should offer, what services are not needed, whether certain new treatments are effective, or to compare how we are doing with others and to see where we can make improvements. We may remove information that identifies you from this set of health information so others may use it to study healthcare delivery without learning the identity of our specific patients. Appointment Reminders: We may use and disclose health information to contact you as a reminder that you have an appointment. Please let us know if you do not wish to have us contact you concerning your appointment, or if you wish to have us use a different telephone number or address to contact you for this purpose. Research: There may be situations where we want to use and disclose health information about you for research purposes. Your identity will not be disclosed to research sponsors without your permission. For F800 04/03 – Notice of Health Information Privacy Practices 2 any research project that uses your health information, we will either obtain authorization from you, or ask an Institutional Review or Privacy Board to waive the requirement to obtain authorization. Any waiver of authorization will be based upon adequate assurance from the review Board that the researchers will adequately protect your personal health information. Results of your tests or other participation in research, and confidential information contained in your medical record may be inspected and/or photocopied by the Food and Drug Administration (FDA) and other State or Federal government agencies in the ordinary course of routine research monitoring functions. As Required By Law: We will disclose health information about you when required to do so by federal, state, or local law. To Avert a Serious Threat to Health or Safety: We may use and disclose health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat. Military and Veterans: If you are a member of the armed forces or are separated/discharged from military services, we may release health information about you as required by military command authorities or the Department of Veterans Affairs as may be applicable. We may also release health information about foreign military personnel to the appropriate foreign military authorities. Workers' Compensation: We may release health information about you for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness. Public Health Risks: We may disclose health information about you for public health activities. These activities generally include the following: · To prevent or control disease, injury or disability; Health Oversight Activities: We may disclose health information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws. Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, we may disclose health information about you in response to an order issued by a court or administrative tribunal. We may also disclose health information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only after efforts have been made to tell you about the request and you have time to obtain an order protecting the information requested. Law Enforcement: We may release health information if asked to do so by a law enforcement official: · In response to a court order, subpoena, warrant, summons or similar process; Such releases of information will be made only after efforts have been made to tell you about the request and you have time to obtain an order protecting the information requested. Coroners, Health Examiners and Funeral Director: We may release health information to a coroner or health examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release health information about patients to funeral directors as necessary to carry out their duties. Inmates: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release health information about you to the correctional institution or law enforcement official. This release would be necessary: (1) for the institution to provide you with healthcare; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution. YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU You have the following rights regarding health information we maintain about you: Right to Inspect and Copy: You have certain rights to inspect and copy health information that may be used to make decisions about your care. Usually, this includes health and billing records. This does not include psychotherapy notes. To inspect and copy health information that may be used to make decisions about you, you must submit your request in writing on a form provided by us to the Manager of the PPMM clinic where you received health services. If you request a copy of your health information, we may charge a fee for the costs of locating, copying, mailing or other supplies and services associated with your request. In California a provider must allow a patient to review her or his health information within five working days of receiving a request. (Cal Health & Safety Code-123110 (a)) If a patient requests a copy of this information, the provider must furnish the copy within 15 days of receiving the request. (Cal. Health & Safety Code – 123110 (b)) PPMM Health Centers in both California and Nevada comply with this state requirement. We may deny your request to inspect and copy records in certain very limited circumstances. If you are denied access to health information, you may in certain instances request that the denial be reviewed. Another licensed healthcare professional chosen by our practice will review your request and the denial. The person conducting the review will not be the person who denied your initial request. We will comply with the outcome of the review. Right to Amend: If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as we keep the information. To request an amendment, your request must be made in writing on a form provided by us and submitted to: “The Medical Director of Planned Parenthood Mar Monte.” According to HIPAA, PPMM must act on a patient’s request for amendment within 60 days of receiving it. ((45 C.F.R. – 164.526(b)) We may deny your request for an amendment if it is not on the form provided by us and does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that: · Was not created by us, unless the person or entity that created the information is no longer available to make the amendment; Any amendment we make to your health information will be disclosed to those with whom we disclose information as previously specified. Right to an Accounting of Disclosures: You have the right to request an accounting of any disclosures of your health information we have made, except for uses and disclosures for treatment, payment, and health care operations, as previously described. To request this list of disclosures, you must submit your request on a form that PPMM will provide. Your request must state a time period that may not be longer than six years and may not include dates before April 14, 2003 [The compliance date of the Privacy Regulation]. The first list of disclosures you request within a 12-month period will be free. For additional lists, we may charge you 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. We will mail you a list of disclosures in paper form within 30 days of your request, or notify you if we are unable to supply the list within that time period and by what date we can supply the list; but this date should not exceed a total of 60 days from the date you made the request. Right to Request Restrictions: You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment, or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care. While we will try to accommodate your request for restrictions, we are not required to do so if it is not feasible for us to ensure our compliance with law or we believe it will negatively impact the care we may provide you. If we decide not to comply with your request for restrictions, you will be informed in writing of our reasons for this decision. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request a restriction, you must make your request on a form that we will provide you. In your request, you must tell us what information you want to limit and to whom you want the limits to apply. Right to Request Confidential Communications: You have the right to request that we communicate with you about health matters in a certain manner or at a certain location. For example, you can ask that we only contact you at work or by mail to a post office box. During our intake process, we will ask you how you wish to receive communications about your health care or for any other instructions on notifying you about your health information. We will accommodate all reasonable requests. Right to a Paper Copy of This Notice: You have the right to obtain a paper copy of this Notice at any time upon request. You may also obtain a copy of this Notice on our website: http://www.ppmarmonte.org/. MINORS AND PERSONS WITH GUARDIANS - PPMM complies with California’s Minor Consent Laws in its service delivery in both California and Nevada. Unless a specific exception applies, a minor’s guardian or parent must consent to medical care. The exceptions include those described below, which are specifically related to PPMM’s scope of service. · A minor of any age may consent to medical care related to the prevention or treatment of pregnancy, except sterilization. (Cal Family Code 6925) The health care provider is not permitted to inform the minor’s parent or legal guardian. (Cal. Health & Safety Code 123110(a) and 123115(a)) COMPLAINTS: If you believe your privacy rights have been violated, you may file a complaint with PPMM or with the Secretary of the Department of Health and Human Services. To file a complaint contact: “The Privacy Official at Planned Parenthood Mar Monte.” All complaints must be submitted in writing. You will not be penalized for filing a complaint. OTHER USES OF HEALTH INFORMATION: Other uses and disclosures of health information not covered by this Notice or the laws that apply to us will be made only with your written permission. If you provide permission to use or disclose health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose health information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain the records of the care that we provided to you. CHANGES TO THIS NOTICE: At the time this Notice was prepared, a definitive, comprehensive comparison of California Privacy Laws with HIPAA regulations was not yet available to PPMM. When this information becomes available, it may require additions and/or corrections to the Notice of Health Information Privacy Practices. PPMM reserves the right to make these and other appropriate changes. We also reserve the right to make the revised or changed Notice effective for health information we already have about you as well as created or received in the future. We will post a copy of the current Notice in our clinics and on the PPMM website (www.ppmarmonte.org). The effective date of this Notice is April 14, 2003. In addition, each time you register for treatment or healthcare services at PPMM, you will have an opportunity to review and to receive a copy of the current notice in effect.
ACKNOWLEDGMENT OF RECEIPT OF NOTICE OF HEALTH INFORMATION PRIVACY PRACTICES FROM I HEREBY ACKNOWLEDGE receipt of Planned Parenthood Mar Monte’s NOTICE OF HEALTH INFORMATION PRIVACY PRACTICES. Please print your name, sign and date as indicated below: Name: _______________________________________________ Signature:_____________________________________________ Date:_____________________ (This acknowledgment will be kept in your medical record) |
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