Notice of Privacy Practices
Notice of Privacy Practices
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.
If you have any questions or need further information, please contact our practice Privacy Officer at (701) 483-9353 or info@connectmedicalclinic.com
OUR OBLIGATIONS:
We are required by law to:
- Maintain the privacy of protected health information
- Give you this notice of our legal duties and privacy practices regarding health information about you
- Notify affected individuals following a breach of unsecured protected health information
- Follow the terms of our notice that is currently in effect
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION:
The following describes how we may use and disclose health information that identifies you (“Health Information”), in accordance with CFR § 164.506. Except for the purposes described below, we will use and disclose Health Information only with your written permission. You may revoke such permission by writing to our practice Privacy Officer at 683 State Ave N Suite E, Dickinson, ND 58601.
For Treatment. We may use and disclose Health Information to treat you and provide you with treatment-related health care services. For example, we may disclose Health Information to doctors, nurses, technicians, or other personnel, including people outside our office, who are involved in your medical care and need the information to provide you with medical care.
For Health Care Operations. We may use and disclose your health information for health care operations. These activities are necessary to provide quality care to all of our patients and to effectively manage our office. For example, we may review patient records to evaluate and improve the obstetrical or gynecological care you receive. We may also share information with other entities that have a relationship with you, so they can carry out their own health care operations.
Appointment Reminders, Treatment Alternatives, and Health-Related Benefits and Services. We may use and disclose Health Information to contact you to remind you that you have an appointment with us. We may also use and disclose Health Information to tell you about treatment alternatives or health-related benefits and services that may be of interest to you.
Individuals Involved in Your Care or Payment for Your Care. When appropriate, we may share Health Information with a person who is involved in your medical care or payment for your care, such as your family or a close friend. We also may notify your family about your location or general condition or disclose such information to an entity assisting in a disaster relief effort.
Health Information Sharing and Medication History :
Our clinic participates in health information exchange through the CommonWell Health Alliance network and our electronic health record system. This allows authorized healthcare providers and organizations involved in your care to securely access and exchange health information for treatment, care coordination, and patient safety.
We may also obtain your medication history from pharmacies and pharmacy benefit managers through our electronic health record system to support safe and effective treatment and medication management.
Participation in health information exchange is voluntary. You may request to opt out of health information sharing through these exchange services. Opting out may limit the ability of participating healthcare providers to access your health information when providing care. Information shared before an opt-out request is processed may remain available to organizations that previously received it. Contact our Privacy Officer for more information or to submit an opt-out request.
SPECIAL SITUATIONS:
As Required by Law. We will disclose Health Information when required by federal, state, or local law.
To Avert a Serious Threat to Health or Safety. We may use and disclose Health Information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Disclosures, however, will be made only to someone who may be able to help prevent the threat.
Business Associates. We may disclose Health Information to our business associates who perform functions on our behalf or provide us with services if the information is necessary for such functions or services. For example, we may use another company to perform billing services on our behalf. All of our business associates are obligated to protect the privacy of your information. They are not allowed to use or disclose any information other than as specified in our contract.
Incidental Uses and Disclosures. Sometimes, there may be limited, unintentional disclosures of your health information that occur as a by-product of an otherwise permitted use or disclosure. These are called “incidental disclosures,” and they are only allowed when the primary use or disclosure is permitted under HIPAA. To protect your privacy, we take reasonable steps to limit the information shared to the minimum necessary, use appropriate safeguards to protect your information, and apply policies and procedures that reduce the chance of unnecessary disclosures
Organ and Tissue Donation. If you are an organ donor, we may use or release Health Information to organizations that handle organ procurement or other entities engaged in procurement, banking, or transportation of organs, eyes, or tissues to facilitate organ, eye, or tissue donation and transplantation.
Military and Veterans. If you are an armed forces member, we may release Health Information as required by military command authorities. We may also release Health Information to the appropriate foreign military authority if you are a foreign military member.
Workers’ Compensation. We may release Health Information for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illnesses.
Public Health Risks. We may disclose Health Information for public health activities. These activities generally include disclosures to prevent or control disease, injury, or disability; report births and deaths; report child abuse or neglect; report reactions to medications or problems with products; notify people of recalls of products they may be using; a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and 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.
Data Breach Notification Purposes. We may use or disclose your Protected Health Information to provide legally required notices of unauthorized access to or disclosure of your health information.
Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose Health Information in response to a court or administrative order. We also may disclose Health Information in response to a subpoena, discovery request, or other lawful process by someone involved in the dispute, but only if efforts have been made to tell you about the request or obtain an order protecting the information requested.
Law Enforcement. We may release Health Information if asked by a law enforcement official if the information is: (1) in response to a court order, subpoena, warrant, summons, or similar process; (2) limited information to identify or locate a suspect, fugitive, material witness, or missing person; (3) about the victim of a crime even if, under certain very limited circumstances, we are unable to obtain the person’s agreement; (4) about a death we believe may be the result of criminal conduct; (5) about criminal conduct on our premises; and (6) in an emergency to report a crime, the location of the crime or victims, or the identity, description or location of the person who committed the crime.
Coroners, Medical Examiners, and Funeral Directors. We may release Health Information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We also may release Health Information to funeral directors as necessary for their duties. Under HIPAA, these protections for health information continue for 50 years after a person’s death. After that time, the information is no longer considered protected health information.
National Security and Intelligence Activities. We may release Health Information to authorized federal officials for intelligence, counter-intelligence, and other national security activities authorized by law.
Protective Services for the President and Others. We may disclose Health Information to authorized federal officials so they may protect the President, other authorized persons, or foreign heads of state or conduct special investigations.
Inmates or Individuals in Custody. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release Health Information to the correctional institution or law enforcement official. This release would be, if necessary: (1) for the institution to provide you with health care; (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.
USES AND DISCLOSURES THAT REQUIRE US TO GIVE YOU AN OPPORTUNITY TO OBJECT:
Individuals Involved in Your Care or Payment for Your Care. Unless you object, we may disclose to a member of your family, a relative, a close friend, or any other person you identify, your Protected Health Information directly related to that person’s involvement in your health care. If you cannot agree or object to such a disclosure, we may disclose such information as necessary if we determine it is in your best interest based on our professional judgment.
Disaster Relief. We may disclose your Protected Health Information to disaster relief organizations that seek your Protected Health Information to coordinate your care or notify family and friends of your location or condition in a disaster. We will provide you with an opportunity to agree or object to such a disclosure whenever we can practically do so.
YOUR WRITTEN AUTHORIZATION IS REQUIRED FOR OTHER USES AND DISCLOSURES:
The following uses and disclosures of your Protected Health Information will be made only with your written authorization:
- Uses and disclosures of Protected Health Information for marketing purposes; and
- Disclosures that constitute a sale of your Protected Health Information
- Disclosures when it is sought to investigate or impose liability on individuals, healthcare providers, or others who seek, obtain, provide, or facilitate productive health care that is lawful under the circumstances in which such health care is provided or to identify persons for such activities.
Other uses and disclosures of Protected Health Information not covered by this Notice or the laws that apply to us will be made only with your written authorization. If you authorize us, you may revoke it at any time by submitting a written revocation to our Privacy Officer, and we will no longer disclose Protected Health Information under the authorization. However, the revocation will not affect the disclosure we made based on your authorization before you revoked it.
HOW WE MAY NOT USE AND DISCLOSE HEALTH INFORMATION:
The following describes how we are prohibited to use and disclose health information under CFR § 164.502(a)(5)(iii) regarding reproductive health care. The Privacy Rule only applies when reproductive health care is legal in the state where it was provided, allowed under federal law, and presumed to be lawful. This is called a “presumption of legality”. That means that unless we have strong facts showing that the care was illegal in the state where it occurred, we treat it as legal and continue to protect your privacy.
For Investigation. We will not use or share your information to conduct any kind of investigation just because you or someone else sought, received, provided, or helped with reproductive health care. We won’t share your records with law enforcement just because you had or helped someone get reproductive health services.
For Legal or Financial Penalties. We will not use or share your information to help punish anyone—criminally, civilly, or through government action just for being involved in reproductive health care. For example, we won’t disclose information that could be used to fine, arrest, or sue a person or provider simply for giving or receiving reproductive care.
For Identifying People for These Reasons. We will not use or share information to try to identify who was involved in getting, providing, or supporting reproductive health care in any way. For example, we won’t help anyone track down a patient or provider by using health records to name or locate them because they were involved in reproductive services.
SCOPE:
When we say "reproductive health care," we mean a wide range of activities beyond just getting or providing medical services. This includes things like asking about care, scheduling or paying for it, sharing information, helping someone get care, approving coverage, counseling, or simply expressing interest. It also includes anyone who supports, arranges, insures, or helps in any way, even before the care occurs.
AN ATTESTATION IS REQUIRED FOR OTHER USES AND DISCLOSURES:
In certain situations, we may need an attestation, or a formal written statement, before using or disclosing your protected health information (PHI). An attestation is required when someone requests PHI for purposes that could potentially involve investigations, legal actions, or other activities related to reproductive health care. For example, if law enforcement or another agency asks for your PHI to investigate someone for seeking or providing reproductive health services, we must first receive an attestation from the requester confirming that the use or disclosure is not for prohibited purposes. This helps protect your privacy and ensures your health information is not used improperly.
YOUR RIGHTS:
You have the following rights regarding Health Information we have about you:
Right to Inspect and Copy. You have a right to inspect and copy Health Information that may be used to make decisions about your care or payment for your care. This includes medical and billing records other than psychotherapy notes. To inspect and copy this Health Information, you must make your request in writing to Connect Medical Clinic. We have up to 15 days to make your Protected Health Information available to you, and we will not charge you a fee for routine patient requests to access or obtain copies of your own medical records. For large-volume record requests requiring mailing, we may charge cost-based postage fees on a case-by-case basis. We may deny your request in certain limited circumstances. If we do deny your request, you have the right to have the denial reviewed by a licensed healthcare professional who was not directly involved in the denial of your request, and we will comply with the outcome of the review.
Right to an Electronic Copy of Electronic Medical Records. If your Protected Health Information is maintained in an electronic format (an electronic medical record or an electronic health record), you have the right to request that an electronic copy of your record be given to you or transmitted to another individual or entity. We will make every effort to provide access to your Protected Health Information in the form or format you request if it is readily producible in such form or format. If the Protected Health Information is not readily producible in the form or format you request, your record will be provided in either our standard electronic format or, if you do not want this form or format, a readable hard copy form. We may charge you a reasonable, cost-based fee for the labor associated with transmitting the electronic medical record.
You Have the Right to Get Notice of a Breach. You have the right to be notified when your unsecured Protected Health Information is breached.
Right to Amend. If you feel that the Health Information we have is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for our office. To request an amendment, you must make your request in writing to Connect Medical Clinic.
Right to an Accounting of Disclosures. You have the right to request a list of certain disclosures we made of Health Information for purposes other than treatment, payment, and health care operations, law compliance, and for purposes you provided a written authorization for. To request an accounting of disclosures, you must write to Connect Medical Clinic.
Right to Request Restrictions. You have the right to request a restriction or limitation on the Health Information we use or disclose for treatment, payment, or health care operations. You also have the right to request a limit on the Health Information we disclose to someone involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not share information about a particular diagnosis or treatment with your spouse. To request a restriction, you must make your request in writing to Connect Medical Clinic. We are not required to agree to your request unless you ask us to restrict the use and disclosure of your Protected Health Information to a health plan for payment or health care operation purposes. Such information you wish to restrict pertains solely to a health care item or service you have paid us “out-of-pocket” in full. If we agree, we will comply with your request unless the information is needed to provide emergency treatment.
Out-of-Pocket-Payments. If you paid out-of-pocket (or in other words, you have requested that we not bill your health plan) in full for a specific item or service, you have the right to ask that your Protected Health Information concerning that item or service not be disclosed to a health plan for purposes of payment or health care operations, and we will honor that request.
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 by mail or at work. To request confidential communications, you must make your request in writing to Connect Medical Clinic. Your request must specify how or where you wish to be contacted. We will accommodate reasonable requests.
Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy.
CHANGES TO THIS NOTICE:
We reserve the right to change this notice and make the new notice apply to the Health Information we already have and any information we receive in the future. We will post a copy of our current notice at our office. The notice will contain the effective date on the first page, in the top right-hand corner.
REDISCLOSURE:
Once your health information is shared with someone outside of our organization as allowed by law, that person or group may not be required to follow the same privacy protections we do. This means your information could be shared again (redisclosed) by the recipient and may no longer be protected under federal privacy rules. We encourage you to ask questions if you have concerns about who will receive your information and how it may be used.
FUNDRAISING:
We may share certain limited PHI and contact you to ask for fundraising efforts to help our organization. If you receive these messages, you have the right to opt out and choose not to receive any more fundraising communications from us.
COMPLAINTS:
If you believe your privacy rights have been violated, you may file a complaint with our office or the Secretary of the Department of Health and Human Services. Contact the Connect Medical Clinic's Privacy Officer to file a complaint with our office. All complaints must be made in writing. You can not be penalized for filing a complaint.