We may use or disclose your PHI in the following situations without your authorization or providing you the opportunity to object.

• • Required by the Secretary of the Department of Health and Human Services: We may be required to disclose your PHI to the Secretary of the Department of Health and Human Services (“Secretary”) to investigate or determine our compliance with the requirements of the final rule on Standards for Privacy of Individually Identifiable Health Information.
    • Required By Law: We may use or disclose your PHI to the extent that the use or disclosure is otherwise required by federal, state or local law. Public Health: We may disclose your PHI for public health activities, such as disclosures to a public health authority or other government agency that is permitted by law to collect or receive the information (e.g., the Food and Drug Administration).
    • Health Oversight: We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.
    • Abuse or Neglect: If you have been a victim of abuse, neglect, or domestic violence, we may disclose your PHI to a government agency authorized to receive such information. In addition, we may disclose your PHI to a public health authority that is authorized by law to receive reports of child abuse or neglect.
    • Judicial and Administrative Proceedings: We may disclose your PHI in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), and, in certain circumstances, in response to a subpoena, discovery request or other lawful process.
    • Law Enforcement: We may disclose your PHI, so long as applicable legal requirements are met, for law enforcement purposes, such as providing information to the police about the victim of a crime.
    • Coroners and Funeral Directors: We may disclose your PHI to a coroner, medical examiner, or funeral director if it is needed to perform their legally authorized duties.
    • Organ Donation: If you are an organ donor, we may disclose your PHI to organ procurement organizations as necessary to facilitate organ donation or transplantation.
    • Research: Under certain circumstances, we may disclose your PHI to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your PHI.
    • Serious Threat to Health or Safety: We may disclose your PHI if we believe it is necessary to prevent a serious and imminent threat to the public health or safety and the disclosure is made to someone, we reasonably believe is able to prevent or lessen the threat.
    • Specialized Government Functions: When the appropriate conditions apply, we may disclose PHI for purposes related to military or national security concerns, such as for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits.
    • Workers’ Compensation: We may disclose your PHI as necessary to comply with workers’ compensation laws and other similar programs.
    • Inmates: We may use or disclose your PHI if you are an inmate of a correctional facility and we created or received your PHI in the course of providing care to you.
    • • Business Associates: We may disclose your PHI to persons who perform functions, activities or services to us or on our behalf that require the use or disclosure of PHI. To protect your health information, we require the business associate to appropriately safeguard your information.

[/vc_column_text][/vc_column][/vc_row]

We may use or disclose your PHI in the following situations without your authorization or providing you the opportunity to object.

• • Required by the Secretary of the Department of Health and Human Services: We may be required to disclose your PHI to the Secretary of the Department of Health and Human Services (“Secretary”) to investigate or determine our compliance with the requirements of the final rule on Standards for Privacy of Individually Identifiable Health Information.
    • Required By Law: We may use or disclose your PHI to the extent that the use or disclosure is otherwise required by federal, state or local law. Public Health: We may disclose your PHI for public health activities, such as disclosures to a public health authority or other government agency that is permitted by law to collect or receive the information (e.g., the Food and Drug Administration).
    • Health Oversight: We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.
    • Abuse or Neglect: If you have been a victim of abuse, neglect, or domestic violence, we may disclose your PHI to a government agency authorized to receive such information. In addition, we may disclose your PHI to a public health authority that is authorized by law to receive reports of child abuse or neglect.
    • Judicial and Administrative Proceedings: We may disclose your PHI in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), and, in certain circumstances, in response to a subpoena, discovery request or other lawful process.
    • Law Enforcement: We may disclose your PHI, so long as applicable legal requirements are met, for law enforcement purposes, such as providing information to the police about the victim of a crime.
    • Coroners and Funeral Directors: We may disclose your PHI to a coroner, medical examiner, or funeral director if it is needed to perform their legally authorized duties.
    • Organ Donation: If you are an organ donor, we may disclose your PHI to organ procurement organizations as necessary to facilitate organ donation or transplantation.
    • Research: Under certain circumstances, we may disclose your PHI to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your PHI.
    • Serious Threat to Health or Safety: We may disclose your PHI if we believe it is necessary to prevent a serious and imminent threat to the public health or safety and the disclosure is made to someone, we reasonably believe is able to prevent or lessen the threat.
    • Specialized Government Functions: When the appropriate conditions apply, we may disclose PHI for purposes related to military or national security concerns, such as for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits.
    • Workers’ Compensation: We may disclose your PHI as necessary to comply with workers’ compensation laws and other similar programs.
    • Inmates: We may use or disclose your PHI if you are an inmate of a correctional facility and we created or received your PHI in the course of providing care to you.
    • • Business Associates: We may disclose your PHI to persons who perform functions, activities or services to us or on our behalf that require the use or disclosure of PHI. To protect your health information, we require the business associate to appropriately safeguard your information.

[/vc_column_text][/vc_column][/vc_row]In these cases, we never share your information unless you give us written permission:

• • Marketing purposes
  • Sale of your information

If you give such permission, you may later revoke it by sending written notice of revocation.

Routine Uses and Disclosures of Protected Health Information

We are permitted under federal law to use and disclose PHI, without your written authorization, for certain routine uses and disclosures, such as those made for treatment, payment, and the operation of our business. The following are examples of the types of routine uses and disclosures of PHI that we are permitted to make. While this list is not exhaustive, it should give you an idea of the routine uses and disclosures we are permitted to make.

For Treatment: We will use and disclose your PHI to provide, coordinate, or manage your treatment. We may disclose medical information about you to our physicians, to other health care providers treating you who are not part of Healthspan By Design, and to other personnel involved in your health care.

For Payment: Your PHI will be used, as needed, to obtain payment for the health care services we provide you. We may use and disclose medical information about your treatment and services to bill and collect payment from you.

For Health Care Operations: We may use or disclose your PHI in order to support the business activities of this medical practice. These activities may include, but are not limited quality assessment activities, practice accreditation, employee review activities, billing, and licensing, marketing, legal advice, accounting support and conducting or arranging for other business activities. For example, we may use or disclose your protected health information, as necessary, to contact you by mail to remind you of your appointment by reminder cards.

Other Uses and Disclosures That May Be Made Without Your Authorization

We may use or disclose your PHI in the following situations without your authorization or providing you the opportunity to object.

• • Required by the Secretary of the Department of Health and Human Services: We may be required to disclose your PHI to the Secretary of the Department of Health and Human Services (“Secretary”) to investigate or determine our compliance with the requirements of the final rule on Standards for Privacy of Individually Identifiable Health Information.
    • Required By Law: We may use or disclose your PHI to the extent that the use or disclosure is otherwise required by federal, state or local law. Public Health: We may disclose your PHI for public health activities, such as disclosures to a public health authority or other government agency that is permitted by law to collect or receive the information (e.g., the Food and Drug Administration).
    • Health Oversight: We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.
    • Abuse or Neglect: If you have been a victim of abuse, neglect, or domestic violence, we may disclose your PHI to a government agency authorized to receive such information. In addition, we may disclose your PHI to a public health authority that is authorized by law to receive reports of child abuse or neglect.
    • Judicial and Administrative Proceedings: We may disclose your PHI in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), and, in certain circumstances, in response to a subpoena, discovery request or other lawful process.
    • Law Enforcement: We may disclose your PHI, so long as applicable legal requirements are met, for law enforcement purposes, such as providing information to the police about the victim of a crime.
    • Coroners and Funeral Directors: We may disclose your PHI to a coroner, medical examiner, or funeral director if it is needed to perform their legally authorized duties.
    • Organ Donation: If you are an organ donor, we may disclose your PHI to organ procurement organizations as necessary to facilitate organ donation or transplantation.
    • Research: Under certain circumstances, we may disclose your PHI to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your PHI.
    • Serious Threat to Health or Safety: We may disclose your PHI if we believe it is necessary to prevent a serious and imminent threat to the public health or safety and the disclosure is made to someone, we reasonably believe is able to prevent or lessen the threat.
    • Specialized Government Functions: When the appropriate conditions apply, we may disclose PHI for purposes related to military or national security concerns, such as for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits.
    • Workers’ Compensation: We may disclose your PHI as necessary to comply with workers’ compensation laws and other similar programs.
    • Inmates: We may use or disclose your PHI if you are an inmate of a correctional facility and we created or received your PHI in the course of providing care to you.
    • • Business Associates: We may disclose your PHI to persons who perform functions, activities or services to us or on our behalf that require the use or disclosure of PHI. To protect your health information, we require the business associate to appropriately safeguard your information.

[/vc_column_text][/vc_column][/vc_row]

In these cases, we never share your information unless you give us written permission:

• • Marketing purposes
  • Sale of your information

If you give such permission, you may later revoke it by sending written notice of revocation.

Routine Uses and Disclosures of Protected Health Information

We are permitted under federal law to use and disclose PHI, without your written authorization, for certain routine uses and disclosures, such as those made for treatment, payment, and the operation of our business. The following are examples of the types of routine uses and disclosures of PHI that we are permitted to make. While this list is not exhaustive, it should give you an idea of the routine uses and disclosures we are permitted to make.

For Treatment: We will use and disclose your PHI to provide, coordinate, or manage your treatment. We may disclose medical information about you to our physicians, to other health care providers treating you who are not part of Healthspan By Design, and to other personnel involved in your health care.

For Payment: Your PHI will be used, as needed, to obtain payment for the health care services we provide you. We may use and disclose medical information about your treatment and services to bill and collect payment from you.

For Health Care Operations: We may use or disclose your PHI in order to support the business activities of this medical practice. These activities may include, but are not limited quality assessment activities, practice accreditation, employee review activities, billing, and licensing, marketing, legal advice, accounting support and conducting or arranging for other business activities. For example, we may use or disclose your protected health information, as necessary, to contact you by mail to remind you of your appointment by reminder cards.

Other Uses and Disclosures That May Be Made Without Your Authorization

We may use or disclose your PHI in the following situations without your authorization or providing you the opportunity to object.

• • Required by the Secretary of the Department of Health and Human Services: We may be required to disclose your PHI to the Secretary of the Department of Health and Human Services (“Secretary”) to investigate or determine our compliance with the requirements of the final rule on Standards for Privacy of Individually Identifiable Health Information.
    • Required By Law: We may use or disclose your PHI to the extent that the use or disclosure is otherwise required by federal, state or local law. Public Health: We may disclose your PHI for public health activities, such as disclosures to a public health authority or other government agency that is permitted by law to collect or receive the information (e.g., the Food and Drug Administration).
    • Health Oversight: We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.
    • Abuse or Neglect: If you have been a victim of abuse, neglect, or domestic violence, we may disclose your PHI to a government agency authorized to receive such information. In addition, we may disclose your PHI to a public health authority that is authorized by law to receive reports of child abuse or neglect.
    • Judicial and Administrative Proceedings: We may disclose your PHI in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), and, in certain circumstances, in response to a subpoena, discovery request or other lawful process.
    • Law Enforcement: We may disclose your PHI, so long as applicable legal requirements are met, for law enforcement purposes, such as providing information to the police about the victim of a crime.
    • Coroners and Funeral Directors: We may disclose your PHI to a coroner, medical examiner, or funeral director if it is needed to perform their legally authorized duties.
    • Organ Donation: If you are an organ donor, we may disclose your PHI to organ procurement organizations as necessary to facilitate organ donation or transplantation.
    • Research: Under certain circumstances, we may disclose your PHI to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your PHI.
    • Serious Threat to Health or Safety: We may disclose your PHI if we believe it is necessary to prevent a serious and imminent threat to the public health or safety and the disclosure is made to someone, we reasonably believe is able to prevent or lessen the threat.
    • Specialized Government Functions: When the appropriate conditions apply, we may disclose PHI for purposes related to military or national security concerns, such as for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits.
    • Workers’ Compensation: We may disclose your PHI as necessary to comply with workers’ compensation laws and other similar programs.
    • Inmates: We may use or disclose your PHI if you are an inmate of a correctional facility and we created or received your PHI in the course of providing care to you.
    • • Business Associates: We may disclose your PHI to persons who perform functions, activities or services to us or on our behalf that require the use or disclosure of PHI. To protect your health information, we require the business associate to appropriately safeguard your information.

[/vc_column_text][/vc_column][/vc_row]

In these cases, you have both the right and choice to tell us to:

• • Share information with your family, close friends, or others involved in payment for your care
  • Share information in a disaster relief situation

 

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases, we never share your information unless you give us written permission:

• • Marketing purposes
  • Sale of your information

If you give such permission, you may later revoke it by sending written notice of revocation.

Routine Uses and Disclosures of Protected Health Information

We are permitted under federal law to use and disclose PHI, without your written authorization, for certain routine uses and disclosures, such as those made for treatment, payment, and the operation of our business. The following are examples of the types of routine uses and disclosures of PHI that we are permitted to make. While this list is not exhaustive, it should give you an idea of the routine uses and disclosures we are permitted to make.

For Treatment: We will use and disclose your PHI to provide, coordinate, or manage your treatment. We may disclose medical information about you to our physicians, to other health care providers treating you who are not part of Healthspan By Design, and to other personnel involved in your health care.

For Payment: Your PHI will be used, as needed, to obtain payment for the health care services we provide you. We may use and disclose medical information about your treatment and services to bill and collect payment from you.

For Health Care Operations: We may use or disclose your PHI in order to support the business activities of this medical practice. These activities may include, but are not limited quality assessment activities, practice accreditation, employee review activities, billing, and licensing, marketing, legal advice, accounting support and conducting or arranging for other business activities. For example, we may use or disclose your protected health information, as necessary, to contact you by mail to remind you of your appointment by reminder cards.

Other Uses and Disclosures That May Be Made Without Your Authorization

We may use or disclose your PHI in the following situations without your authorization or providing you the opportunity to object.

• • Required by the Secretary of the Department of Health and Human Services: We may be required to disclose your PHI to the Secretary of the Department of Health and Human Services (“Secretary”) to investigate or determine our compliance with the requirements of the final rule on Standards for Privacy of Individually Identifiable Health Information.
    • Required By Law: We may use or disclose your PHI to the extent that the use or disclosure is otherwise required by federal, state or local law. Public Health: We may disclose your PHI for public health activities, such as disclosures to a public health authority or other government agency that is permitted by law to collect or receive the information (e.g., the Food and Drug Administration).
    • Health Oversight: We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.
    • Abuse or Neglect: If you have been a victim of abuse, neglect, or domestic violence, we may disclose your PHI to a government agency authorized to receive such information. In addition, we may disclose your PHI to a public health authority that is authorized by law to receive reports of child abuse or neglect.
    • Judicial and Administrative Proceedings: We may disclose your PHI in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), and, in certain circumstances, in response to a subpoena, discovery request or other lawful process.
    • Law Enforcement: We may disclose your PHI, so long as applicable legal requirements are met, for law enforcement purposes, such as providing information to the police about the victim of a crime.
    • Coroners and Funeral Directors: We may disclose your PHI to a coroner, medical examiner, or funeral director if it is needed to perform their legally authorized duties.
    • Organ Donation: If you are an organ donor, we may disclose your PHI to organ procurement organizations as necessary to facilitate organ donation or transplantation.
    • Research: Under certain circumstances, we may disclose your PHI to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your PHI.
    • Serious Threat to Health or Safety: We may disclose your PHI if we believe it is necessary to prevent a serious and imminent threat to the public health or safety and the disclosure is made to someone, we reasonably believe is able to prevent or lessen the threat.
    • Specialized Government Functions: When the appropriate conditions apply, we may disclose PHI for purposes related to military or national security concerns, such as for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits.
    • Workers’ Compensation: We may disclose your PHI as necessary to comply with workers’ compensation laws and other similar programs.
    • Inmates: We may use or disclose your PHI if you are an inmate of a correctional facility and we created or received your PHI in the course of providing care to you.
    • • Business Associates: We may disclose your PHI to persons who perform functions, activities or services to us or on our behalf that require the use or disclosure of PHI. To protect your health information, we require the business associate to appropriately safeguard your information.

[/vc_column_text][/vc_column][/vc_row]File a complaint if you feel your rights are violated

• • You can complain if you feel we have violated your rights by contacting us using the information in this notice.
  • 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 www.hhs.gov/ocr/privacy/hipaa/complaints/.
  • We will not retaliate against you for filing a complaint.

YOUR CHOICES

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

• • Share information with your family, close friends, or others involved in payment for your care
  • Share information in a disaster relief situation

 

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases, we never share your information unless you give us written permission:

• • Marketing purposes
  • Sale of your information

If you give such permission, you may later revoke it by sending written notice of revocation.

Routine Uses and Disclosures of Protected Health Information

We are permitted under federal law to use and disclose PHI, without your written authorization, for certain routine uses and disclosures, such as those made for treatment, payment, and the operation of our business. The following are examples of the types of routine uses and disclosures of PHI that we are permitted to make. While this list is not exhaustive, it should give you an idea of the routine uses and disclosures we are permitted to make.

For Treatment: We will use and disclose your PHI to provide, coordinate, or manage your treatment. We may disclose medical information about you to our physicians, to other health care providers treating you who are not part of Healthspan By Design, and to other personnel involved in your health care.

For Payment: Your PHI will be used, as needed, to obtain payment for the health care services we provide you. We may use and disclose medical information about your treatment and services to bill and collect payment from you.

For Health Care Operations: We may use or disclose your PHI in order to support the business activities of this medical practice. These activities may include, but are not limited quality assessment activities, practice accreditation, employee review activities, billing, and licensing, marketing, legal advice, accounting support and conducting or arranging for other business activities. For example, we may use or disclose your protected health information, as necessary, to contact you by mail to remind you of your appointment by reminder cards.

Other Uses and Disclosures That May Be Made Without Your Authorization

We may use or disclose your PHI in the following situations without your authorization or providing you the opportunity to object.

• • Required by the Secretary of the Department of Health and Human Services: We may be required to disclose your PHI to the Secretary of the Department of Health and Human Services (“Secretary”) to investigate or determine our compliance with the requirements of the final rule on Standards for Privacy of Individually Identifiable Health Information.
    • Required By Law: We may use or disclose your PHI to the extent that the use or disclosure is otherwise required by federal, state or local law. Public Health: We may disclose your PHI for public health activities, such as disclosures to a public health authority or other government agency that is permitted by law to collect or receive the information (e.g., the Food and Drug Administration).
    • Health Oversight: We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.
    • Abuse or Neglect: If you have been a victim of abuse, neglect, or domestic violence, we may disclose your PHI to a government agency authorized to receive such information. In addition, we may disclose your PHI to a public health authority that is authorized by law to receive reports of child abuse or neglect.
    • Judicial and Administrative Proceedings: We may disclose your PHI in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), and, in certain circumstances, in response to a subpoena, discovery request or other lawful process.
    • Law Enforcement: We may disclose your PHI, so long as applicable legal requirements are met, for law enforcement purposes, such as providing information to the police about the victim of a crime.
    • Coroners and Funeral Directors: We may disclose your PHI to a coroner, medical examiner, or funeral director if it is needed to perform their legally authorized duties.
    • Organ Donation: If you are an organ donor, we may disclose your PHI to organ procurement organizations as necessary to facilitate organ donation or transplantation.
    • Research: Under certain circumstances, we may disclose your PHI to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your PHI.
    • Serious Threat to Health or Safety: We may disclose your PHI if we believe it is necessary to prevent a serious and imminent threat to the public health or safety and the disclosure is made to someone, we reasonably believe is able to prevent or lessen the threat.
    • Specialized Government Functions: When the appropriate conditions apply, we may disclose PHI for purposes related to military or national security concerns, such as for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits.
    • Workers’ Compensation: We may disclose your PHI as necessary to comply with workers’ compensation laws and other similar programs.
    • Inmates: We may use or disclose your PHI if you are an inmate of a correctional facility and we created or received your PHI in the course of providing care to you.
    • • Business Associates: We may disclose your PHI to persons who perform functions, activities or services to us or on our behalf that require the use or disclosure of PHI. To protect your health information, we require the business associate to appropriately safeguard your information.

[/vc_column_text][/vc_column][/vc_row]

File a complaint if you feel your rights are violated

• • You can complain if you feel we have violated your rights by contacting us using the information in this notice.
  • 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 www.hhs.gov/ocr/privacy/hipaa/complaints/.
  • We will not retaliate against you for filing a complaint.

YOUR CHOICES

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

• • Share information with your family, close friends, or others involved in payment for your care
  • Share information in a disaster relief situation

 

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases, we never share your information unless you give us written permission:

• • Marketing purposes
  • Sale of your information

If you give such permission, you may later revoke it by sending written notice of revocation.

Routine Uses and Disclosures of Protected Health Information

We are permitted under federal law to use and disclose PHI, without your written authorization, for certain routine uses and disclosures, such as those made for treatment, payment, and the operation of our business. The following are examples of the types of routine uses and disclosures of PHI that we are permitted to make. While this list is not exhaustive, it should give you an idea of the routine uses and disclosures we are permitted to make.

For Treatment: We will use and disclose your PHI to provide, coordinate, or manage your treatment. We may disclose medical information about you to our physicians, to other health care providers treating you who are not part of Healthspan By Design, and to other personnel involved in your health care.

For Payment: Your PHI will be used, as needed, to obtain payment for the health care services we provide you. We may use and disclose medical information about your treatment and services to bill and collect payment from you.

For Health Care Operations: We may use or disclose your PHI in order to support the business activities of this medical practice. These activities may include, but are not limited quality assessment activities, practice accreditation, employee review activities, billing, and licensing, marketing, legal advice, accounting support and conducting or arranging for other business activities. For example, we may use or disclose your protected health information, as necessary, to contact you by mail to remind you of your appointment by reminder cards.

Other Uses and Disclosures That May Be Made Without Your Authorization

We may use or disclose your PHI in the following situations without your authorization or providing you the opportunity to object.

• • Required by the Secretary of the Department of Health and Human Services: We may be required to disclose your PHI to the Secretary of the Department of Health and Human Services (“Secretary”) to investigate or determine our compliance with the requirements of the final rule on Standards for Privacy of Individually Identifiable Health Information.
    • Required By Law: We may use or disclose your PHI to the extent that the use or disclosure is otherwise required by federal, state or local law. Public Health: We may disclose your PHI for public health activities, such as disclosures to a public health authority or other government agency that is permitted by law to collect or receive the information (e.g., the Food and Drug Administration).
    • Health Oversight: We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.
    • Abuse or Neglect: If you have been a victim of abuse, neglect, or domestic violence, we may disclose your PHI to a government agency authorized to receive such information. In addition, we may disclose your PHI to a public health authority that is authorized by law to receive reports of child abuse or neglect.
    • Judicial and Administrative Proceedings: We may disclose your PHI in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), and, in certain circumstances, in response to a subpoena, discovery request or other lawful process.
    • Law Enforcement: We may disclose your PHI, so long as applicable legal requirements are met, for law enforcement purposes, such as providing information to the police about the victim of a crime.
    • Coroners and Funeral Directors: We may disclose your PHI to a coroner, medical examiner, or funeral director if it is needed to perform their legally authorized duties.
    • Organ Donation: If you are an organ donor, we may disclose your PHI to organ procurement organizations as necessary to facilitate organ donation or transplantation.
    • Research: Under certain circumstances, we may disclose your PHI to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your PHI.
    • Serious Threat to Health or Safety: We may disclose your PHI if we believe it is necessary to prevent a serious and imminent threat to the public health or safety and the disclosure is made to someone, we reasonably believe is able to prevent or lessen the threat.
    • Specialized Government Functions: When the appropriate conditions apply, we may disclose PHI for purposes related to military or national security concerns, such as for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits.
    • Workers’ Compensation: We may disclose your PHI as necessary to comply with workers’ compensation laws and other similar programs.
    • Inmates: We may use or disclose your PHI if you are an inmate of a correctional facility and we created or received your PHI in the course of providing care to you.
    • • Business Associates: We may disclose your PHI to persons who perform functions, activities or services to us or on our behalf that require the use or disclosure of PHI. To protect your health information, we require the business associate to appropriately safeguard your information.

[/vc_column_text][/vc_column][/vc_row]Choose someone to act for you

• • If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
  • We will make sure the person has this authority and can act for you before we take any action.
  • You have the right to be notified if you are affected by a breach of unsecured PHI.

File a complaint if you feel your rights are violated

• • You can complain if you feel we have violated your rights by contacting us using the information in this notice.
  • 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 www.hhs.gov/ocr/privacy/hipaa/complaints/.
  • We will not retaliate against you for filing a complaint.

YOUR CHOICES

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

• • Share information with your family, close friends, or others involved in payment for your care
  • Share information in a disaster relief situation

 

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases, we never share your information unless you give us written permission:

• • Marketing purposes
  • Sale of your information

If you give such permission, you may later revoke it by sending written notice of revocation.

Routine Uses and Disclosures of Protected Health Information

We are permitted under federal law to use and disclose PHI, without your written authorization, for certain routine uses and disclosures, such as those made for treatment, payment, and the operation of our business. The following are examples of the types of routine uses and disclosures of PHI that we are permitted to make. While this list is not exhaustive, it should give you an idea of the routine uses and disclosures we are permitted to make.

For Treatment: We will use and disclose your PHI to provide, coordinate, or manage your treatment. We may disclose medical information about you to our physicians, to other health care providers treating you who are not part of Healthspan By Design, and to other personnel involved in your health care.

For Payment: Your PHI will be used, as needed, to obtain payment for the health care services we provide you. We may use and disclose medical information about your treatment and services to bill and collect payment from you.

For Health Care Operations: We may use or disclose your PHI in order to support the business activities of this medical practice. These activities may include, but are not limited quality assessment activities, practice accreditation, employee review activities, billing, and licensing, marketing, legal advice, accounting support and conducting or arranging for other business activities. For example, we may use or disclose your protected health information, as necessary, to contact you by mail to remind you of your appointment by reminder cards.

Other Uses and Disclosures That May Be Made Without Your Authorization

We may use or disclose your PHI in the following situations without your authorization or providing you the opportunity to object.

• • Required by the Secretary of the Department of Health and Human Services: We may be required to disclose your PHI to the Secretary of the Department of Health and Human Services (“Secretary”) to investigate or determine our compliance with the requirements of the final rule on Standards for Privacy of Individually Identifiable Health Information.
    • Required By Law: We may use or disclose your PHI to the extent that the use or disclosure is otherwise required by federal, state or local law. Public Health: We may disclose your PHI for public health activities, such as disclosures to a public health authority or other government agency that is permitted by law to collect or receive the information (e.g., the Food and Drug Administration).
    • Health Oversight: We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.
    • Abuse or Neglect: If you have been a victim of abuse, neglect, or domestic violence, we may disclose your PHI to a government agency authorized to receive such information. In addition, we may disclose your PHI to a public health authority that is authorized by law to receive reports of child abuse or neglect.
    • Judicial and Administrative Proceedings: We may disclose your PHI in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), and, in certain circumstances, in response to a subpoena, discovery request or other lawful process.
    • Law Enforcement: We may disclose your PHI, so long as applicable legal requirements are met, for law enforcement purposes, such as providing information to the police about the victim of a crime.
    • Coroners and Funeral Directors: We may disclose your PHI to a coroner, medical examiner, or funeral director if it is needed to perform their legally authorized duties.
    • Organ Donation: If you are an organ donor, we may disclose your PHI to organ procurement organizations as necessary to facilitate organ donation or transplantation.
    • Research: Under certain circumstances, we may disclose your PHI to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your PHI.
    • Serious Threat to Health or Safety: We may disclose your PHI if we believe it is necessary to prevent a serious and imminent threat to the public health or safety and the disclosure is made to someone, we reasonably believe is able to prevent or lessen the threat.
    • Specialized Government Functions: When the appropriate conditions apply, we may disclose PHI for purposes related to military or national security concerns, such as for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits.
    • Workers’ Compensation: We may disclose your PHI as necessary to comply with workers’ compensation laws and other similar programs.
    • Inmates: We may use or disclose your PHI if you are an inmate of a correctional facility and we created or received your PHI in the course of providing care to you.
    • • Business Associates: We may disclose your PHI to persons who perform functions, activities or services to us or on our behalf that require the use or disclosure of PHI. To protect your health information, we require the business associate to appropriately safeguard your information.

[/vc_column_text][/vc_column][/vc_row]

Choose someone to act for you

• • If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
  • We will make sure the person has this authority and can act for you before we take any action.
  • You have the right to be notified if you are affected by a breach of unsecured PHI.

File a complaint if you feel your rights are violated

• • You can complain if you feel we have violated your rights by contacting us using the information in this notice.
  • 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 www.hhs.gov/ocr/privacy/hipaa/complaints/.
  • We will not retaliate against you for filing a complaint.

YOUR CHOICES

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

• • Share information with your family, close friends, or others involved in payment for your care
  • Share information in a disaster relief situation

 

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases, we never share your information unless you give us written permission:

• • Marketing purposes
  • Sale of your information

If you give such permission, you may later revoke it by sending written notice of revocation.

Routine Uses and Disclosures of Protected Health Information

We are permitted under federal law to use and disclose PHI, without your written authorization, for certain routine uses and disclosures, such as those made for treatment, payment, and the operation of our business. The following are examples of the types of routine uses and disclosures of PHI that we are permitted to make. While this list is not exhaustive, it should give you an idea of the routine uses and disclosures we are permitted to make.

For Treatment: We will use and disclose your PHI to provide, coordinate, or manage your treatment. We may disclose medical information about you to our physicians, to other health care providers treating you who are not part of Healthspan By Design, and to other personnel involved in your health care.

For Payment: Your PHI will be used, as needed, to obtain payment for the health care services we provide you. We may use and disclose medical information about your treatment and services to bill and collect payment from you.

For Health Care Operations: We may use or disclose your PHI in order to support the business activities of this medical practice. These activities may include, but are not limited quality assessment activities, practice accreditation, employee review activities, billing, and licensing, marketing, legal advice, accounting support and conducting or arranging for other business activities. For example, we may use or disclose your protected health information, as necessary, to contact you by mail to remind you of your appointment by reminder cards.

Other Uses and Disclosures That May Be Made Without Your Authorization

We may use or disclose your PHI in the following situations without your authorization or providing you the opportunity to object.

• • Required by the Secretary of the Department of Health and Human Services: We may be required to disclose your PHI to the Secretary of the Department of Health and Human Services (“Secretary”) to investigate or determine our compliance with the requirements of the final rule on Standards for Privacy of Individually Identifiable Health Information.
    • Required By Law: We may use or disclose your PHI to the extent that the use or disclosure is otherwise required by federal, state or local law. Public Health: We may disclose your PHI for public health activities, such as disclosures to a public health authority or other government agency that is permitted by law to collect or receive the information (e.g., the Food and Drug Administration).
    • Health Oversight: We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.
    • Abuse or Neglect: If you have been a victim of abuse, neglect, or domestic violence, we may disclose your PHI to a government agency authorized to receive such information. In addition, we may disclose your PHI to a public health authority that is authorized by law to receive reports of child abuse or neglect.
    • Judicial and Administrative Proceedings: We may disclose your PHI in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), and, in certain circumstances, in response to a subpoena, discovery request or other lawful process.
    • Law Enforcement: We may disclose your PHI, so long as applicable legal requirements are met, for law enforcement purposes, such as providing information to the police about the victim of a crime.
    • Coroners and Funeral Directors: We may disclose your PHI to a coroner, medical examiner, or funeral director if it is needed to perform their legally authorized duties.
    • Organ Donation: If you are an organ donor, we may disclose your PHI to organ procurement organizations as necessary to facilitate organ donation or transplantation.
    • Research: Under certain circumstances, we may disclose your PHI to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your PHI.
    • Serious Threat to Health or Safety: We may disclose your PHI if we believe it is necessary to prevent a serious and imminent threat to the public health or safety and the disclosure is made to someone, we reasonably believe is able to prevent or lessen the threat.
    • Specialized Government Functions: When the appropriate conditions apply, we may disclose PHI for purposes related to military or national security concerns, such as for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits.
    • Workers’ Compensation: We may disclose your PHI as necessary to comply with workers’ compensation laws and other similar programs.
    • Inmates: We may use or disclose your PHI if you are an inmate of a correctional facility and we created or received your PHI in the course of providing care to you.
    • • Business Associates: We may disclose your PHI to persons who perform functions, activities or services to us or on our behalf that require the use or disclosure of PHI. To protect your health information, we require the business associate to appropriately safeguard your information.

[/vc_column_text][/vc_column][/vc_row]Get a copy of this privacy notice

• • You can contact us for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you

• • If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
  • We will make sure the person has this authority and can act for you before we take any action.
  • You have the right to be notified if you are affected by a breach of unsecured PHI.

File a complaint if you feel your rights are violated

• • You can complain if you feel we have violated your rights by contacting us using the information in this notice.
  • 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 www.hhs.gov/ocr/privacy/hipaa/complaints/.
  • We will not retaliate against you for filing a complaint.

YOUR CHOICES

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

• • Share information with your family, close friends, or others involved in payment for your care
  • Share information in a disaster relief situation

 

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases, we never share your information unless you give us written permission:

• • Marketing purposes
  • Sale of your information

If you give such permission, you may later revoke it by sending written notice of revocation.

Routine Uses and Disclosures of Protected Health Information

We are permitted under federal law to use and disclose PHI, without your written authorization, for certain routine uses and disclosures, such as those made for treatment, payment, and the operation of our business. The following are examples of the types of routine uses and disclosures of PHI that we are permitted to make. While this list is not exhaustive, it should give you an idea of the routine uses and disclosures we are permitted to make.

For Treatment: We will use and disclose your PHI to provide, coordinate, or manage your treatment. We may disclose medical information about you to our physicians, to other health care providers treating you who are not part of Healthspan By Design, and to other personnel involved in your health care.

For Payment: Your PHI will be used, as needed, to obtain payment for the health care services we provide you. We may use and disclose medical information about your treatment and services to bill and collect payment from you.

For Health Care Operations: We may use or disclose your PHI in order to support the business activities of this medical practice. These activities may include, but are not limited quality assessment activities, practice accreditation, employee review activities, billing, and licensing, marketing, legal advice, accounting support and conducting or arranging for other business activities. For example, we may use or disclose your protected health information, as necessary, to contact you by mail to remind you of your appointment by reminder cards.

Other Uses and Disclosures That May Be Made Without Your Authorization

We may use or disclose your PHI in the following situations without your authorization or providing you the opportunity to object.

• • Required by the Secretary of the Department of Health and Human Services: We may be required to disclose your PHI to the Secretary of the Department of Health and Human Services (“Secretary”) to investigate or determine our compliance with the requirements of the final rule on Standards for Privacy of Individually Identifiable Health Information.
    • Required By Law: We may use or disclose your PHI to the extent that the use or disclosure is otherwise required by federal, state or local law. Public Health: We may disclose your PHI for public health activities, such as disclosures to a public health authority or other government agency that is permitted by law to collect or receive the information (e.g., the Food and Drug Administration).
    • Health Oversight: We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.
    • Abuse or Neglect: If you have been a victim of abuse, neglect, or domestic violence, we may disclose your PHI to a government agency authorized to receive such information. In addition, we may disclose your PHI to a public health authority that is authorized by law to receive reports of child abuse or neglect.
    • Judicial and Administrative Proceedings: We may disclose your PHI in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), and, in certain circumstances, in response to a subpoena, discovery request or other lawful process.
    • Law Enforcement: We may disclose your PHI, so long as applicable legal requirements are met, for law enforcement purposes, such as providing information to the police about the victim of a crime.
    • Coroners and Funeral Directors: We may disclose your PHI to a coroner, medical examiner, or funeral director if it is needed to perform their legally authorized duties.
    • Organ Donation: If you are an organ donor, we may disclose your PHI to organ procurement organizations as necessary to facilitate organ donation or transplantation.
    • Research: Under certain circumstances, we may disclose your PHI to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your PHI.
    • Serious Threat to Health or Safety: We may disclose your PHI if we believe it is necessary to prevent a serious and imminent threat to the public health or safety and the disclosure is made to someone, we reasonably believe is able to prevent or lessen the threat.
    • Specialized Government Functions: When the appropriate conditions apply, we may disclose PHI for purposes related to military or national security concerns, such as for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits.
    • Workers’ Compensation: We may disclose your PHI as necessary to comply with workers’ compensation laws and other similar programs.
    • Inmates: We may use or disclose your PHI if you are an inmate of a correctional facility and we created or received your PHI in the course of providing care to you.
    • • Business Associates: We may disclose your PHI to persons who perform functions, activities or services to us or on our behalf that require the use or disclosure of PHI. To protect your health information, we require the business associate to appropriately safeguard your information.

[/vc_column_text][/vc_column][/vc_row]

Get a copy of this privacy notice

• • You can contact us for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you

• • If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
  • We will make sure the person has this authority and can act for you before we take any action.
  • You have the right to be notified if you are affected by a breach of unsecured PHI.

File a complaint if you feel your rights are violated

• • You can complain if you feel we have violated your rights by contacting us using the information in this notice.
  • 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 www.hhs.gov/ocr/privacy/hipaa/complaints/.
  • We will not retaliate against you for filing a complaint.

YOUR CHOICES

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

• • Share information with your family, close friends, or others involved in payment for your care
  • Share information in a disaster relief situation

 

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases, we never share your information unless you give us written permission:

• • Marketing purposes
  • Sale of your information

If you give such permission, you may later revoke it by sending written notice of revocation.

Routine Uses and Disclosures of Protected Health Information

We are permitted under federal law to use and disclose PHI, without your written authorization, for certain routine uses and disclosures, such as those made for treatment, payment, and the operation of our business. The following are examples of the types of routine uses and disclosures of PHI that we are permitted to make. While this list is not exhaustive, it should give you an idea of the routine uses and disclosures we are permitted to make.

For Treatment: We will use and disclose your PHI to provide, coordinate, or manage your treatment. We may disclose medical information about you to our physicians, to other health care providers treating you who are not part of Healthspan By Design, and to other personnel involved in your health care.

For Payment: Your PHI will be used, as needed, to obtain payment for the health care services we provide you. We may use and disclose medical information about your treatment and services to bill and collect payment from you.

For Health Care Operations: We may use or disclose your PHI in order to support the business activities of this medical practice. These activities may include, but are not limited quality assessment activities, practice accreditation, employee review activities, billing, and licensing, marketing, legal advice, accounting support and conducting or arranging for other business activities. For example, we may use or disclose your protected health information, as necessary, to contact you by mail to remind you of your appointment by reminder cards.

Other Uses and Disclosures That May Be Made Without Your Authorization

We may use or disclose your PHI in the following situations without your authorization or providing you the opportunity to object.

• • Required by the Secretary of the Department of Health and Human Services: We may be required to disclose your PHI to the Secretary of the Department of Health and Human Services (“Secretary”) to investigate or determine our compliance with the requirements of the final rule on Standards for Privacy of Individually Identifiable Health Information.
    • Required By Law: We may use or disclose your PHI to the extent that the use or disclosure is otherwise required by federal, state or local law. Public Health: We may disclose your PHI for public health activities, such as disclosures to a public health authority or other government agency that is permitted by law to collect or receive the information (e.g., the Food and Drug Administration).
    • Health Oversight: We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.
    • Abuse or Neglect: If you have been a victim of abuse, neglect, or domestic violence, we may disclose your PHI to a government agency authorized to receive such information. In addition, we may disclose your PHI to a public health authority that is authorized by law to receive reports of child abuse or neglect.
    • Judicial and Administrative Proceedings: We may disclose your PHI in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), and, in certain circumstances, in response to a subpoena, discovery request or other lawful process.
    • Law Enforcement: We may disclose your PHI, so long as applicable legal requirements are met, for law enforcement purposes, such as providing information to the police about the victim of a crime.
    • Coroners and Funeral Directors: We may disclose your PHI to a coroner, medical examiner, or funeral director if it is needed to perform their legally authorized duties.
    • Organ Donation: If you are an organ donor, we may disclose your PHI to organ procurement organizations as necessary to facilitate organ donation or transplantation.
    • Research: Under certain circumstances, we may disclose your PHI to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your PHI.
    • Serious Threat to Health or Safety: We may disclose your PHI if we believe it is necessary to prevent a serious and imminent threat to the public health or safety and the disclosure is made to someone, we reasonably believe is able to prevent or lessen the threat.
    • Specialized Government Functions: When the appropriate conditions apply, we may disclose PHI for purposes related to military or national security concerns, such as for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits.
    • Workers’ Compensation: We may disclose your PHI as necessary to comply with workers’ compensation laws and other similar programs.
    • Inmates: We may use or disclose your PHI if you are an inmate of a correctional facility and we created or received your PHI in the course of providing care to you.
    • • Business Associates: We may disclose your PHI to persons who perform functions, activities or services to us or on our behalf that require the use or disclosure of PHI. To protect your health information, we require the business associate to appropriately safeguard your information.

[/vc_column_text][/vc_column][/vc_row]Ask us to limit what we use or share

• • You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.

Get a copy of this privacy notice

• • You can contact us for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you

• • If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
  • We will make sure the person has this authority and can act for you before we take any action.
  • You have the right to be notified if you are affected by a breach of unsecured PHI.

File a complaint if you feel your rights are violated

• • You can complain if you feel we have violated your rights by contacting us using the information in this notice.
  • 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 www.hhs.gov/ocr/privacy/hipaa/complaints/.
  • We will not retaliate against you for filing a complaint.

YOUR CHOICES

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

• • Share information with your family, close friends, or others involved in payment for your care
  • Share information in a disaster relief situation

 

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases, we never share your information unless you give us written permission:

• • Marketing purposes
  • Sale of your information

If you give such permission, you may later revoke it by sending written notice of revocation.

Routine Uses and Disclosures of Protected Health Information

We are permitted under federal law to use and disclose PHI, without your written authorization, for certain routine uses and disclosures, such as those made for treatment, payment, and the operation of our business. The following are examples of the types of routine uses and disclosures of PHI that we are permitted to make. While this list is not exhaustive, it should give you an idea of the routine uses and disclosures we are permitted to make.

For Treatment: We will use and disclose your PHI to provide, coordinate, or manage your treatment. We may disclose medical information about you to our physicians, to other health care providers treating you who are not part of Healthspan By Design, and to other personnel involved in your health care.

For Payment: Your PHI will be used, as needed, to obtain payment for the health care services we provide you. We may use and disclose medical information about your treatment and services to bill and collect payment from you.

For Health Care Operations: We may use or disclose your PHI in order to support the business activities of this medical practice. These activities may include, but are not limited quality assessment activities, practice accreditation, employee review activities, billing, and licensing, marketing, legal advice, accounting support and conducting or arranging for other business activities. For example, we may use or disclose your protected health information, as necessary, to contact you by mail to remind you of your appointment by reminder cards.

Other Uses and Disclosures That May Be Made Without Your Authorization

We may use or disclose your PHI in the following situations without your authorization or providing you the opportunity to object.

• • Required by the Secretary of the Department of Health and Human Services: We may be required to disclose your PHI to the Secretary of the Department of Health and Human Services (“Secretary”) to investigate or determine our compliance with the requirements of the final rule on Standards for Privacy of Individually Identifiable Health Information.
    • Required By Law: We may use or disclose your PHI to the extent that the use or disclosure is otherwise required by federal, state or local law. Public Health: We may disclose your PHI for public health activities, such as disclosures to a public health authority or other government agency that is permitted by law to collect or receive the information (e.g., the Food and Drug Administration).
    • Health Oversight: We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.
    • Abuse or Neglect: If you have been a victim of abuse, neglect, or domestic violence, we may disclose your PHI to a government agency authorized to receive such information. In addition, we may disclose your PHI to a public health authority that is authorized by law to receive reports of child abuse or neglect.
    • Judicial and Administrative Proceedings: We may disclose your PHI in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), and, in certain circumstances, in response to a subpoena, discovery request or other lawful process.
    • Law Enforcement: We may disclose your PHI, so long as applicable legal requirements are met, for law enforcement purposes, such as providing information to the police about the victim of a crime.
    • Coroners and Funeral Directors: We may disclose your PHI to a coroner, medical examiner, or funeral director if it is needed to perform their legally authorized duties.
    • Organ Donation: If you are an organ donor, we may disclose your PHI to organ procurement organizations as necessary to facilitate organ donation or transplantation.
    • Research: Under certain circumstances, we may disclose your PHI to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your PHI.
    • Serious Threat to Health or Safety: We may disclose your PHI if we believe it is necessary to prevent a serious and imminent threat to the public health or safety and the disclosure is made to someone, we reasonably believe is able to prevent or lessen the threat.
    • Specialized Government Functions: When the appropriate conditions apply, we may disclose PHI for purposes related to military or national security concerns, such as for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits.
    • Workers’ Compensation: We may disclose your PHI as necessary to comply with workers’ compensation laws and other similar programs.
    • Inmates: We may use or disclose your PHI if you are an inmate of a correctional facility and we created or received your PHI in the course of providing care to you.
    • • Business Associates: We may disclose your PHI to persons who perform functions, activities or services to us or on our behalf that require the use or disclosure of PHI. To protect your health information, we require the business associate to appropriately safeguard your information.

[/vc_column_text][/vc_column][/vc_row]

Ask us to limit what we use or share

• • You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.

Get a copy of this privacy notice

• • You can contact us for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you

• • If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
  • We will make sure the person has this authority and can act for you before we take any action.
  • You have the right to be notified if you are affected by a breach of unsecured PHI.

File a complaint if you feel your rights are violated

• • You can complain if you feel we have violated your rights by contacting us using the information in this notice.
  • 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 www.hhs.gov/ocr/privacy/hipaa/complaints/.
  • We will not retaliate against you for filing a complaint.

YOUR CHOICES

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

• • Share information with your family, close friends, or others involved in payment for your care
  • Share information in a disaster relief situation

 

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases, we never share your information unless you give us written permission:

• • Marketing purposes
  • Sale of your information

If you give such permission, you may later revoke it by sending written notice of revocation.

Routine Uses and Disclosures of Protected Health Information

We are permitted under federal law to use and disclose PHI, without your written authorization, for certain routine uses and disclosures, such as those made for treatment, payment, and the operation of our business. The following are examples of the types of routine uses and disclosures of PHI that we are permitted to make. While this list is not exhaustive, it should give you an idea of the routine uses and disclosures we are permitted to make.

For Treatment: We will use and disclose your PHI to provide, coordinate, or manage your treatment. We may disclose medical information about you to our physicians, to other health care providers treating you who are not part of Healthspan By Design, and to other personnel involved in your health care.

For Payment: Your PHI will be used, as needed, to obtain payment for the health care services we provide you. We may use and disclose medical information about your treatment and services to bill and collect payment from you.

For Health Care Operations: We may use or disclose your PHI in order to support the business activities of this medical practice. These activities may include, but are not limited quality assessment activities, practice accreditation, employee review activities, billing, and licensing, marketing, legal advice, accounting support and conducting or arranging for other business activities. For example, we may use or disclose your protected health information, as necessary, to contact you by mail to remind you of your appointment by reminder cards.

Other Uses and Disclosures That May Be Made Without Your Authorization

We may use or disclose your PHI in the following situations without your authorization or providing you the opportunity to object.

• • Required by the Secretary of the Department of Health and Human Services: We may be required to disclose your PHI to the Secretary of the Department of Health and Human Services (“Secretary”) to investigate or determine our compliance with the requirements of the final rule on Standards for Privacy of Individually Identifiable Health Information.
    • Required By Law: We may use or disclose your PHI to the extent that the use or disclosure is otherwise required by federal, state or local law. Public Health: We may disclose your PHI for public health activities, such as disclosures to a public health authority or other government agency that is permitted by law to collect or receive the information (e.g., the Food and Drug Administration).
    • Health Oversight: We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.
    • Abuse or Neglect: If you have been a victim of abuse, neglect, or domestic violence, we may disclose your PHI to a government agency authorized to receive such information. In addition, we may disclose your PHI to a public health authority that is authorized by law to receive reports of child abuse or neglect.
    • Judicial and Administrative Proceedings: We may disclose your PHI in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), and, in certain circumstances, in response to a subpoena, discovery request or other lawful process.
    • Law Enforcement: We may disclose your PHI, so long as applicable legal requirements are met, for law enforcement purposes, such as providing information to the police about the victim of a crime.
    • Coroners and Funeral Directors: We may disclose your PHI to a coroner, medical examiner, or funeral director if it is needed to perform their legally authorized duties.
    • Organ Donation: If you are an organ donor, we may disclose your PHI to organ procurement organizations as necessary to facilitate organ donation or transplantation.
    • Research: Under certain circumstances, we may disclose your PHI to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your PHI.
    • Serious Threat to Health or Safety: We may disclose your PHI if we believe it is necessary to prevent a serious and imminent threat to the public health or safety and the disclosure is made to someone, we reasonably believe is able to prevent or lessen the threat.
    • Specialized Government Functions: When the appropriate conditions apply, we may disclose PHI for purposes related to military or national security concerns, such as for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits.
    • Workers’ Compensation: We may disclose your PHI as necessary to comply with workers’ compensation laws and other similar programs.
    • Inmates: We may use or disclose your PHI if you are an inmate of a correctional facility and we created or received your PHI in the course of providing care to you.
    • • Business Associates: We may disclose your PHI to persons who perform functions, activities or services to us or on our behalf that require the use or disclosure of PHI. To protect your health information, we require the business associate to appropriately safeguard your information.

[/vc_column_text][/vc_column][/vc_row]Request confidential communications

• • You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
  • We will consider all reasonable requests and must say “yes” if you tell us you would be in danger if we do not.

Ask us to limit what we use or share

• • You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.

Get a copy of this privacy notice

• • You can contact us for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you

• • If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
  • We will make sure the person has this authority and can act for you before we take any action.
  • You have the right to be notified if you are affected by a breach of unsecured PHI.

File a complaint if you feel your rights are violated

• • You can complain if you feel we have violated your rights by contacting us using the information in this notice.
  • 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 www.hhs.gov/ocr/privacy/hipaa/complaints/.
  • We will not retaliate against you for filing a complaint.

YOUR CHOICES

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

• • Share information with your family, close friends, or others involved in payment for your care
  • Share information in a disaster relief situation

 

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases, we never share your information unless you give us written permission:

• • Marketing purposes
  • Sale of your information

If you give such permission, you may later revoke it by sending written notice of revocation.

Routine Uses and Disclosures of Protected Health Information

We are permitted under federal law to use and disclose PHI, without your written authorization, for certain routine uses and disclosures, such as those made for treatment, payment, and the operation of our business. The following are examples of the types of routine uses and disclosures of PHI that we are permitted to make. While this list is not exhaustive, it should give you an idea of the routine uses and disclosures we are permitted to make.

For Treatment: We will use and disclose your PHI to provide, coordinate, or manage your treatment. We may disclose medical information about you to our physicians, to other health care providers treating you who are not part of Healthspan By Design, and to other personnel involved in your health care.

For Payment: Your PHI will be used, as needed, to obtain payment for the health care services we provide you. We may use and disclose medical information about your treatment and services to bill and collect payment from you.

For Health Care Operations: We may use or disclose your PHI in order to support the business activities of this medical practice. These activities may include, but are not limited quality assessment activities, practice accreditation, employee review activities, billing, and licensing, marketing, legal advice, accounting support and conducting or arranging for other business activities. For example, we may use or disclose your protected health information, as necessary, to contact you by mail to remind you of your appointment by reminder cards.

Other Uses and Disclosures That May Be Made Without Your Authorization

We may use or disclose your PHI in the following situations without your authorization or providing you the opportunity to object.

• • Required by the Secretary of the Department of Health and Human Services: We may be required to disclose your PHI to the Secretary of the Department of Health and Human Services (“Secretary”) to investigate or determine our compliance with the requirements of the final rule on Standards for Privacy of Individually Identifiable Health Information.
    • Required By Law: We may use or disclose your PHI to the extent that the use or disclosure is otherwise required by federal, state or local law. Public Health: We may disclose your PHI for public health activities, such as disclosures to a public health authority or other government agency that is permitted by law to collect or receive the information (e.g., the Food and Drug Administration).
    • Health Oversight: We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.
    • Abuse or Neglect: If you have been a victim of abuse, neglect, or domestic violence, we may disclose your PHI to a government agency authorized to receive such information. In addition, we may disclose your PHI to a public health authority that is authorized by law to receive reports of child abuse or neglect.
    • Judicial and Administrative Proceedings: We may disclose your PHI in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), and, in certain circumstances, in response to a subpoena, discovery request or other lawful process.
    • Law Enforcement: We may disclose your PHI, so long as applicable legal requirements are met, for law enforcement purposes, such as providing information to the police about the victim of a crime.
    • Coroners and Funeral Directors: We may disclose your PHI to a coroner, medical examiner, or funeral director if it is needed to perform their legally authorized duties.
    • Organ Donation: If you are an organ donor, we may disclose your PHI to organ procurement organizations as necessary to facilitate organ donation or transplantation.
    • Research: Under certain circumstances, we may disclose your PHI to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your PHI.
    • Serious Threat to Health or Safety: We may disclose your PHI if we believe it is necessary to prevent a serious and imminent threat to the public health or safety and the disclosure is made to someone, we reasonably believe is able to prevent or lessen the threat.
    • Specialized Government Functions: When the appropriate conditions apply, we may disclose PHI for purposes related to military or national security concerns, such as for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits.
    • Workers’ Compensation: We may disclose your PHI as necessary to comply with workers’ compensation laws and other similar programs.
    • Inmates: We may use or disclose your PHI if you are an inmate of a correctional facility and we created or received your PHI in the course of providing care to you.
    • • Business Associates: We may disclose your PHI to persons who perform functions, activities or services to us or on our behalf that require the use or disclosure of PHI. To protect your health information, we require the business associate to appropriately safeguard your information.

[/vc_column_text][/vc_column][/vc_row]

Request confidential communications

• • You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
  • We will consider all reasonable requests and must say “yes” if you tell us you would be in danger if we do not.

Ask us to limit what we use or share

• • You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.

Get a copy of this privacy notice

• • You can contact us for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you

• • If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
  • We will make sure the person has this authority and can act for you before we take any action.
  • You have the right to be notified if you are affected by a breach of unsecured PHI.

File a complaint if you feel your rights are violated

• • You can complain if you feel we have violated your rights by contacting us using the information in this notice.
  • 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 www.hhs.gov/ocr/privacy/hipaa/complaints/.
  • We will not retaliate against you for filing a complaint.

YOUR CHOICES

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

• • Share information with your family, close friends, or others involved in payment for your care
  • Share information in a disaster relief situation

 

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases, we never share your information unless you give us written permission:

• • Marketing purposes
  • Sale of your information

If you give such permission, you may later revoke it by sending written notice of revocation.

Routine Uses and Disclosures of Protected Health Information

We are permitted under federal law to use and disclose PHI, without your written authorization, for certain routine uses and disclosures, such as those made for treatment, payment, and the operation of our business. The following are examples of the types of routine uses and disclosures of PHI that we are permitted to make. While this list is not exhaustive, it should give you an idea of the routine uses and disclosures we are permitted to make.

For Treatment: We will use and disclose your PHI to provide, coordinate, or manage your treatment. We may disclose medical information about you to our physicians, to other health care providers treating you who are not part of Healthspan By Design, and to other personnel involved in your health care.

For Payment: Your PHI will be used, as needed, to obtain payment for the health care services we provide you. We may use and disclose medical information about your treatment and services to bill and collect payment from you.

For Health Care Operations: We may use or disclose your PHI in order to support the business activities of this medical practice. These activities may include, but are not limited quality assessment activities, practice accreditation, employee review activities, billing, and licensing, marketing, legal advice, accounting support and conducting or arranging for other business activities. For example, we may use or disclose your protected health information, as necessary, to contact you by mail to remind you of your appointment by reminder cards.

Other Uses and Disclosures That May Be Made Without Your Authorization

We may use or disclose your PHI in the following situations without your authorization or providing you the opportunity to object.

• • Required by the Secretary of the Department of Health and Human Services: We may be required to disclose your PHI to the Secretary of the Department of Health and Human Services (“Secretary”) to investigate or determine our compliance with the requirements of the final rule on Standards for Privacy of Individually Identifiable Health Information.
    • Required By Law: We may use or disclose your PHI to the extent that the use or disclosure is otherwise required by federal, state or local law. Public Health: We may disclose your PHI for public health activities, such as disclosures to a public health authority or other government agency that is permitted by law to collect or receive the information (e.g., the Food and Drug Administration).
    • Health Oversight: We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.
    • Abuse or Neglect: If you have been a victim of abuse, neglect, or domestic violence, we may disclose your PHI to a government agency authorized to receive such information. In addition, we may disclose your PHI to a public health authority that is authorized by law to receive reports of child abuse or neglect.
    • Judicial and Administrative Proceedings: We may disclose your PHI in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), and, in certain circumstances, in response to a subpoena, discovery request or other lawful process.
    • Law Enforcement: We may disclose your PHI, so long as applicable legal requirements are met, for law enforcement purposes, such as providing information to the police about the victim of a crime.
    • Coroners and Funeral Directors: We may disclose your PHI to a coroner, medical examiner, or funeral director if it is needed to perform their legally authorized duties.
    • Organ Donation: If you are an organ donor, we may disclose your PHI to organ procurement organizations as necessary to facilitate organ donation or transplantation.
    • Research: Under certain circumstances, we may disclose your PHI to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your PHI.
    • Serious Threat to Health or Safety: We may disclose your PHI if we believe it is necessary to prevent a serious and imminent threat to the public health or safety and the disclosure is made to someone, we reasonably believe is able to prevent or lessen the threat.
    • Specialized Government Functions: When the appropriate conditions apply, we may disclose PHI for purposes related to military or national security concerns, such as for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits.
    • Workers’ Compensation: We may disclose your PHI as necessary to comply with workers’ compensation laws and other similar programs.
    • Inmates: We may use or disclose your PHI if you are an inmate of a correctional facility and we created or received your PHI in the course of providing care to you.
    • • Business Associates: We may disclose your PHI to persons who perform functions, activities or services to us or on our behalf that require the use or disclosure of PHI. To protect your health information, we require the business associate to appropriately safeguard your information.

[/vc_column_text][/vc_column][/vc_row]Ask us to correct your health records

• • You can ask us to correct your health records if you think they are incorrect or incomplete.
  • We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Request confidential communications

• • You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
  • We will consider all reasonable requests and must say “yes” if you tell us you would be in danger if we do not.

Ask us to limit what we use or share

• • You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.

Get a copy of this privacy notice

• • You can contact us for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you

• • If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
  • We will make sure the person has this authority and can act for you before we take any action.
  • You have the right to be notified if you are affected by a breach of unsecured PHI.

File a complaint if you feel your rights are violated

• • You can complain if you feel we have violated your rights by contacting us using the information in this notice.
  • 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 www.hhs.gov/ocr/privacy/hipaa/complaints/.
  • We will not retaliate against you for filing a complaint.

YOUR CHOICES

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

• • Share information with your family, close friends, or others involved in payment for your care
  • Share information in a disaster relief situation

 

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases, we never share your information unless you give us written permission:

• • Marketing purposes
  • Sale of your information

If you give such permission, you may later revoke it by sending written notice of revocation.

Routine Uses and Disclosures of Protected Health Information

We are permitted under federal law to use and disclose PHI, without your written authorization, for certain routine uses and disclosures, such as those made for treatment, payment, and the operation of our business. The following are examples of the types of routine uses and disclosures of PHI that we are permitted to make. While this list is not exhaustive, it should give you an idea of the routine uses and disclosures we are permitted to make.

For Treatment: We will use and disclose your PHI to provide, coordinate, or manage your treatment. We may disclose medical information about you to our physicians, to other health care providers treating you who are not part of Healthspan By Design, and to other personnel involved in your health care.

For Payment: Your PHI will be used, as needed, to obtain payment for the health care services we provide you. We may use and disclose medical information about your treatment and services to bill and collect payment from you.

For Health Care Operations: We may use or disclose your PHI in order to support the business activities of this medical practice. These activities may include, but are not limited quality assessment activities, practice accreditation, employee review activities, billing, and licensing, marketing, legal advice, accounting support and conducting or arranging for other business activities. For example, we may use or disclose your protected health information, as necessary, to contact you by mail to remind you of your appointment by reminder cards.

Other Uses and Disclosures That May Be Made Without Your Authorization

We may use or disclose your PHI in the following situations without your authorization or providing you the opportunity to object.

• • Required by the Secretary of the Department of Health and Human Services: We may be required to disclose your PHI to the Secretary of the Department of Health and Human Services (“Secretary”) to investigate or determine our compliance with the requirements of the final rule on Standards for Privacy of Individually Identifiable Health Information.
    • Required By Law: We may use or disclose your PHI to the extent that the use or disclosure is otherwise required by federal, state or local law. Public Health: We may disclose your PHI for public health activities, such as disclosures to a public health authority or other government agency that is permitted by law to collect or receive the information (e.g., the Food and Drug Administration).
    • Health Oversight: We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.
    • Abuse or Neglect: If you have been a victim of abuse, neglect, or domestic violence, we may disclose your PHI to a government agency authorized to receive such information. In addition, we may disclose your PHI to a public health authority that is authorized by law to receive reports of child abuse or neglect.
    • Judicial and Administrative Proceedings: We may disclose your PHI in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), and, in certain circumstances, in response to a subpoena, discovery request or other lawful process.
    • Law Enforcement: We may disclose your PHI, so long as applicable legal requirements are met, for law enforcement purposes, such as providing information to the police about the victim of a crime.
    • Coroners and Funeral Directors: We may disclose your PHI to a coroner, medical examiner, or funeral director if it is needed to perform their legally authorized duties.
    • Organ Donation: If you are an organ donor, we may disclose your PHI to organ procurement organizations as necessary to facilitate organ donation or transplantation.
    • Research: Under certain circumstances, we may disclose your PHI to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your PHI.
    • Serious Threat to Health or Safety: We may disclose your PHI if we believe it is necessary to prevent a serious and imminent threat to the public health or safety and the disclosure is made to someone, we reasonably believe is able to prevent or lessen the threat.
    • Specialized Government Functions: When the appropriate conditions apply, we may disclose PHI for purposes related to military or national security concerns, such as for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits.
    • Workers’ Compensation: We may disclose your PHI as necessary to comply with workers’ compensation laws and other similar programs.
    • Inmates: We may use or disclose your PHI if you are an inmate of a correctional facility and we created or received your PHI in the course of providing care to you.
    • • Business Associates: We may disclose your PHI to persons who perform functions, activities or services to us or on our behalf that require the use or disclosure of PHI. To protect your health information, we require the business associate to appropriately safeguard your information.

[/vc_column_text][/vc_column][/vc_row]

Ask us to correct your health records

• • You can ask us to correct your health records if you think they are incorrect or incomplete.
  • We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Request confidential communications

• • You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
  • We will consider all reasonable requests and must say “yes” if you tell us you would be in danger if we do not.

Ask us to limit what we use or share

• • You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.

Get a copy of this privacy notice

• • You can contact us for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you

• • If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
  • We will make sure the person has this authority and can act for you before we take any action.
  • You have the right to be notified if you are affected by a breach of unsecured PHI.

File a complaint if you feel your rights are violated

• • You can complain if you feel we have violated your rights by contacting us using the information in this notice.
  • 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 www.hhs.gov/ocr/privacy/hipaa/complaints/.
  • We will not retaliate against you for filing a complaint.

YOUR CHOICES

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

• • Share information with your family, close friends, or others involved in payment for your care
  • Share information in a disaster relief situation

 

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases, we never share your information unless you give us written permission:

• • Marketing purposes
  • Sale of your information

If you give such permission, you may later revoke it by sending written notice of revocation.

Routine Uses and Disclosures of Protected Health Information

We are permitted under federal law to use and disclose PHI, without your written authorization, for certain routine uses and disclosures, such as those made for treatment, payment, and the operation of our business. The following are examples of the types of routine uses and disclosures of PHI that we are permitted to make. While this list is not exhaustive, it should give you an idea of the routine uses and disclosures we are permitted to make.

For Treatment: We will use and disclose your PHI to provide, coordinate, or manage your treatment. We may disclose medical information about you to our physicians, to other health care providers treating you who are not part of Healthspan By Design, and to other personnel involved in your health care.

For Payment: Your PHI will be used, as needed, to obtain payment for the health care services we provide you. We may use and disclose medical information about your treatment and services to bill and collect payment from you.

For Health Care Operations: We may use or disclose your PHI in order to support the business activities of this medical practice. These activities may include, but are not limited quality assessment activities, practice accreditation, employee review activities, billing, and licensing, marketing, legal advice, accounting support and conducting or arranging for other business activities. For example, we may use or disclose your protected health information, as necessary, to contact you by mail to remind you of your appointment by reminder cards.

Other Uses and Disclosures That May Be Made Without Your Authorization

We may use or disclose your PHI in the following situations without your authorization or providing you the opportunity to object.

• • Required by the Secretary of the Department of Health and Human Services: We may be required to disclose your PHI to the Secretary of the Department of Health and Human Services (“Secretary”) to investigate or determine our compliance with the requirements of the final rule on Standards for Privacy of Individually Identifiable Health Information.
    • Required By Law: We may use or disclose your PHI to the extent that the use or disclosure is otherwise required by federal, state or local law. Public Health: We may disclose your PHI for public health activities, such as disclosures to a public health authority or other government agency that is permitted by law to collect or receive the information (e.g., the Food and Drug Administration).
    • Health Oversight: We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.
    • Abuse or Neglect: If you have been a victim of abuse, neglect, or domestic violence, we may disclose your PHI to a government agency authorized to receive such information. In addition, we may disclose your PHI to a public health authority that is authorized by law to receive reports of child abuse or neglect.
    • Judicial and Administrative Proceedings: We may disclose your PHI in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), and, in certain circumstances, in response to a subpoena, discovery request or other lawful process.
    • Law Enforcement: We may disclose your PHI, so long as applicable legal requirements are met, for law enforcement purposes, such as providing information to the police about the victim of a crime.
    • Coroners and Funeral Directors: We may disclose your PHI to a coroner, medical examiner, or funeral director if it is needed to perform their legally authorized duties.
    • Organ Donation: If you are an organ donor, we may disclose your PHI to organ procurement organizations as necessary to facilitate organ donation or transplantation.
    • Research: Under certain circumstances, we may disclose your PHI to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your PHI.
    • Serious Threat to Health or Safety: We may disclose your PHI if we believe it is necessary to prevent a serious and imminent threat to the public health or safety and the disclosure is made to someone, we reasonably believe is able to prevent or lessen the threat.
    • Specialized Government Functions: When the appropriate conditions apply, we may disclose PHI for purposes related to military or national security concerns, such as for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits.
    • Workers’ Compensation: We may disclose your PHI as necessary to comply with workers’ compensation laws and other similar programs.
    • Inmates: We may use or disclose your PHI if you are an inmate of a correctional facility and we created or received your PHI in the course of providing care to you.
    • • Business Associates: We may disclose your PHI to persons who perform functions, activities or services to us or on our behalf that require the use or disclosure of PHI. To protect your health information, we require the business associate to appropriately safeguard your information.

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