HIPAA PRIVACY NOTICE
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.
Life Chiropractic College West is committed to maintaining the privacy of your protected health information (“PHI”), which includes information about your health condition and the care and treatment you receive from the Health Center. The creation of a record detailing the care and services you receive helps this office to provide you with quality health care. This Notice details how your PHI may be used and disclosed to third parties. This Notice also details your rights regarding your PHI. The privacy of PHI in patient files will be protected when the files are taken to and from the Health Center by placing the files in a box or brief case and kept within the custody of a doctor or employee of the Health Center authorized to remove the files from the Health Center’s office.
NO CONSENT REQUIRED
The Health Center may use and/or disclose your PHI for the purposes of:
- Treatment: In order to provide you with the health care you require, the Health Center will provide your PHI to those health care professionals, whether on the Health Center’s staff or not, directly involved in your care so that they may understand your health condition and needs.
- Your PHI will be reviewed by members of the College’s faculty who are involved in the administration of patient care.
- Payment: In order to get paid for services provided to you, the Health Center will provide your PHI, directly or through a billing service, to appropriate third-party payers, pursuant to their billing and payment requirements.
- Health Care Operations: In order for the Health Center to operate in accordance with applicable law and insurance requirements and in order for the Health Center to continue to provide quality and efficient care, it may be necessary for the Health Center to compile, use and/or disclose your PHI.
The Health Center may use and/or disclose your PHI, without a written Consent from you, in the following additional instances:
- De-identified Information: Information that does not identify you and, even without your name, cannot be used to identify you.
- Business Associate: To a business associate if the Health Center obtains satisfactory written assurance, in accordance with applicable law, that the business associate will appropriately safeguard your PHI. A business associate is an entity that assists the Health Center in undertaking some essential function, such as a billing company that assists the office in submitting claims for payment to insurance companies or other payers.
- Personal Representative: To a person who, under applicable law, has the authority to represent you in making decisions related to your health care.
- Emergency Situations:
- for the purpose of obtaining or rendering emergency treatment to you provided that the Health Center attempts to obtain your Consent as soon as possible; or
- to a public or private entity authorized by law or by its charter to assist in disaster relief efforts, for the purpose of coordinating your care with such entities in an emergency situation.
- Communication Barriers: If, due to substantial communication barriers or inability to communicate, the Health Center has been unable to obtain your Consent and the Health Center determines, in the exercise of its professional judgment, that your Consent to receive treatment is clearly inferred from the circumstances.
- Public Health Activities: Such activities include, for example, information collected by a public health authority, as authorized by law, to prevent or control disease and that does not identify you and, even with- out your name, cannot be used to identify you.
- Abuse, Neglect or Domestic Violence: To a government authority if the Health Center is required by law to make such disclosure. If the Health Center is authorized by law to make such a disclosure, it will do so if it believes that the disclosure is necessary to prevent serious harm.
- Health Oversight Activities: Such activities, which must be required by law, involve government agencies and may include, for example, criminal investigations, disciplinary actions, or general oversight activities relating to the community’s health care system.
- Judicial and Administrative Proceeding: For example, the Health Center may be required to disclose your PHI in response to a court order or a lawfully issued subpoena.
- Law Enforcement Purposes: In certain instances, your PHI may have to be disclosed to a law enforcement official. For example, your PHI may be the subject of a grand jury subpoena. Or, the Health Center may disclose your PHI if the Health Center believes that your death was the result of criminal conduct.
- Coroner or Medical Examiner: The Health Center may disclose your PHI to a coroner or medical examiner for the purpose of identifying you or determining your cause of death.
- Organ, Eye or Tissue Donation: If you are an organ donor, the Health Center may disclose your PHI to the entity to whom you have agreed to donate your organs.
- Research: If the Health Center is involved in research activities, your PHI may be used, but such use is subject to numerous governmental requirements intended to protect the privacy of your PHI and that does not identify you and, even without your name, cannot be used to identify you.
- Avert a Threat to Health or Safety: The Health Center may disclose your PHI if it believes that such disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public and the disclosure is to an individual who is reasonably able to prevent or lessen the threat.
- Workers’ Compensation: If you are involved in a Workers’ Compensation claim, the Health Center may be required to disclose your PHI to an individual or entity that is part of the Workers’ Compensation system.
- Your health care provider or a staff member may disclose your health information to contact you to provide appointment reminders. If you are not at home to receive an appointment reminder, a message will be left on your answering machine, voice mail, or with the person who answers the call.
- You have the right to refuse us authorization to contact you to provide appointment reminders. If you refuse us authorization, it will not affect the treatment we provide to you.
The Health Center may disclose to your family member, other relative, a close personal friend, or any other person identified by you, your PHI directly relevant to such person’s involvement with your care or the payment for your care unless you direct the Health Center to the contrary. The Health Center may also use or disclose your PHI to notify or assist in the notification (including identifying or locating) a family member, a personal representative, or another person responsible for your care, of your location, general condition or death. However, in both cases, the following conditions will apply:
(a) If you are present at or prior to the use or disclosure of your PHI, the Health Center may use or dis-close your PHI if you agree, or if the Health Center can reasonably infer from the circumstances, based on the exercise of its professional judgment that you do not object to the use or disclosure.
(b) If you are not present, the Health Center will, in the exercise of professional judgment, determine whether the use or disclosure is in your best interests and, if so, disclose only the PHI that is directly relevant to the person’s involvement with your care.
Uses and/or disclosures, other than those described above, will be made only with your written Authorization.
Your Right to Revoke Your Authorization
You may revoke your authorization to us at any time; however, your revocation must be in writing.
You may request restrictions on certain use and/or disclosure of your PHI as provided by law. However, the Health Center is not obligated to agree to any requested restrictions. To request restrictions, you must submit a written request to the Health Center’s Privacy Officer. In your written request, you must inform the Health Center of what information you want to limit, whether you want to limit the Health Center’s use or disclosure, or both, and to whom you want the limits to apply. If the Health Center agrees to your request, the Health Center will comply with your request unless the information is needed in order to provide you with emergency treatment.
You Have a Right to
Inspect and obtain a copy your PHI as provided by 45 CFR 164.524. To inspect and copy your PHI, you are requested to submit a written request to the Health Center’s Privacy Officer. The Health Center can charge you a fee for the cost of copying, mailing or other supplies associated with your request.
Receive confidential communications or PHI by alternative means or at alternative locations. You must make your request in writing to the Health Center’s Privacy Officer. The Health Center will accommodate all reasonable requests.
Prohibit report of any test, examination or treatment to your health plan or anyone else for which you pay in cash or by credit card.
Receive an accounting of disclosures of your PHI as provided by 45 CFR 164.528. The request should indicate in what form you want the list (such as a paper or electronic copy)
Receive a paper copy of this Privacy Notice from the Health Center upon request to the Health Center’s Privacy Officer.
Request copies of your PHI in electronic format if this office maintains your records in that format.
Amend your PHI as provided by 45 CFR 164.528. To request an amendment, you must submit a written request to the Health Center’s Privacy Officer. You must provide a reason that supports your request. The Health Center may deny your request if it is not in writing, if you do not provide a reason in support of your request, if the information to be amended was not created by the Health Center (unless the individual or entity that created the information is no longer available), if the information is not part of your PHI maintained by the Health Center, if the information is not part of the information you would be permitted to inspect and copy, and/or if the information is accurate and complete. If you disagree with the Health Center’s denial, you will have the right to submit a written statement of disagreement.
Receive notice of any breach of confidentiality of your PHI by the Health Center
- 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: hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html
- You can complain if you feel we have violated your rights by contacting us. To file a complaint with the Health Center, contact the Health Center’s Compliance Officer at Life Chiropractic College West, 25001 Industrial Blvd., Hayward, CA 94545, (510) 780-4567. All complaints must be in writing.
- 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 hhs.gov/ocr/privacy/hipaa/complaints/
- We will not retaliate against you for filing a complaint.
If you have any further questions or comments, please feel free to contact our Compliance Officer via phone: 510-780-4500, ext 2570, or email: email@example.com. Effective date of this notice is January 24, 2020.
Life Chiropractic College West adheres to section 1557 of the Patient Protection Affordable Care Act. Please follow the link below for further details. If you believe you have been discriminated against on one of the bases protected by Section 1557, please contact the Section 1557 Compliance Coordinator at firstname.lastname@example.org or by calling (510) 780-4500.
If you feel that you have been subject to discrimination in health care or health coverage, you may file a complaint of discrimination under Section 1557. Please visit OCR’s website at hhs.go/ocr to file a complaint or to request a complaint package, or call OCR’s toll free number at (800) 368-1019 or (800) 537-7697 (TDD) to speak with someone who can answer your questions and guide you through the process. OCR’s complaint forms are available in a
variety of languages. Individuals can also file lawsuits under Section 1557.