HIPAA

PLANNED PARENTHOOD OF NORTHEAST AND MID-PENN
P.O. Box 813 Trexlertown, PA  18087 - - -  (610) 481-0481

NOTICE OF HEALTH INFORMATION PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED
OR DISCLOSED BY PPNMP AND HOW TO ACCESS THIS INFORMATION.
 
PLEASE REVIEW THIS NOTICE CAREFULLY

OUR PLEDGE REGARDING YOUR HEALTH INFORMATION

We understand that health information about you and your healthcare is personal. We are committed to
protecting health information about you. We will create a record of the care and services you receive
from us. We do so to provide you with quality care and to comply with any legal or regulatory requirements.
This Notice applies to all of the records generated or received by Planned Parenthood of Northeast and
Mid-Penn whether we documented the health information, or another doctor forwarded it to us. This
Notice will tell 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 describe certain obligations
we have regarding the use and disclosure of your health information.
Our pledge regarding your health information is backed-up by Federal law. The privacy and security
provisions of the Health Insurance Portability and Accountability Act (“HIPAA”) require us to:

Make sure that health information that identifies you is kept private;
Make available this notice of our legal duties and privacy practices with respect to health information
about you; and follow the terms of the notice that is currently in effect.

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 may be made without 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 may be billed to and payment collected from you, an insurance company, a state
Medicaid agency 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 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
who our specific patients are.

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.

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;
To report births and deaths;
To report child abuse or neglect;
To report reactions to medications or problems with products;
To notify people of recalls of products they may be using;
To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading
a disease or condition;
To notify the appropriate government authority if we believe a patient has been the victim of abuse,
neglect, or domestic violence. We will only make this disclosure if you agree or when required or
authorized by law.    

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;
To identify or locate a suspect, fugitive, material witness, or missing person;
If you are the victim of a crime and we are unable to obtain your consent;
About a death we believe may be the result of criminal conduct;
In an instance of criminal conduct at our facility; and
In emergency circumstances to report a crime; the location of the crime or victims; or the identity,
description, or location of the person who committed the crime.
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 Directors. 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 Privacy Official at Planned Parenthood of
Northeast and Mid-Penn” 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.
We may deny your request to inspect and copy 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 Privacy Official at Planned Parenthood of Northeast and Mid- Penn”
We may deny your request for an amendment if it is not 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;
Is not part of the health information kept by or for our practice;
Is not part of the information which you would be permitted to inspect and copy; or
Is accurate and complete.
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 a list (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 we will provide to you.
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. For example, you could ask that access to your health
information be denied to a particular member of our workforce who is known to you personally.
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 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.
      
MINORS AND PERSONS WITH GUARDIANS
Minors have all the rights outlined in this Notice with respect to health information relating to
reproductive healthcare, except for abortion and in emergency situations or when the law requires
reporting of abuse and neglect. In the case of abortion, if a parent provides consent to your abortion, the
parent has all the rights outlined in this Notice, including the right to access the health information
relating to abortion. However, if you obtain a judicial bypass of the consent requirement, you have the
same rights as an adult with respect to health information relating to your abortion. If you are a minor or
a person with a guardian obtaining healthcare that is not related to reproductive health, your parent or
legal guardian may have the right to access your medical record and make certain decisions regarding the
uses and disclosures of your health information.

CHANGES TO THIS NOTICE
We reserve the right to change this Notice. We reserve the right to make the revised or changed Notice
effective for health information we already have about you as well as any information we receive in the
future. We will post a copy of the current Notice in our facility. The Notice contains the effective date
on the first page. In addition, each time you register for treatment or healthcare services, we will show
you a copy of the current Notice in effect.

COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with us or with the
Secretary of the Department of Health and Human Services. To file a complaint with us, contact : “The
Privacy Official at Planned Parenthood of Northeast and Mid-Penn. 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 us 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.