NOTICE OF PRIVACY PRACTICE
PROTECTED HEALTH INFORMATION
At Sneeze & Snooze Clinic, PC. (dba SnoozeClinic.com), we value and protect your privacy. We thank you for the trust that you place in us and we want you to know that the Protected Health Information (“PHI”) you share with us will be treated with care.
This Notice describes how PHI about you may be used and disclosed, and how you can gain access to this information. Please review it carefully. PHI is information that may identify you and relates to your past, present or future physical or mental health or condition related to health care services. PHI includes the provision of health care products and services to you or payment for such services. This Notice describes how Snooze Clinic may use and disclose your PHI to carry out treatment, for payment, for health care operations and for other purposes permitted or required by law. This Notice also describes certain rights that you may have to access your PHI.
This Snooze Clinic Notice applies to all customers providing PHI. The notices applicable to any domain operated by Snooze Clinic can be found at the bottom of the domain and can be accessed by clicking the related link.
This Notice became effective on 12/01/2014
I. HOW WE MAY USE AND DISCLOSE YOUR PHI
Your PHI may be used and disclosed by Sneeze & Snooze Clinic’s staff and others outside of our offices who are involved in your care and treatment for the purpose of providing healthcare services to you. Your PHI may also be used and disclosed to pay your healthcare bills and to support the operations of Snooze Clinic. The following list, by way of example rather than limitation, explains certain uses and disclosures of your PHI that Snooze Clinic is permitted to make.
A. Uses and Disclosures of PHI that Do Not Require Your Prior Authorization
Except where prohibited by federal or state laws that require special privacy protections, we may use and disclose your PHI for treatment, payment, and health care operations without your prior authorization as follows:
- Treatment. We may use and disclose your PHI to provide and coordinate the treatment, medications, and services you receive. We may disclose PHI to pharmacists, doctors, nurses, technicians and other personnel involved in your health care. We may also disclose your PHI with other third parties, such as hospitals, other pharmacies, and other health care facilities and agencies to facilitate the provision of health care services, medications, equipment, and supplies you may need.
- Payment. We may use and disclose your PHI in order to obtain payment for the health care products and services that we provide to you and for other payment activities related to the services that we provide. For example, if we choose to process insurance claims, we may contact your insurer, pharmacy benefit manager, or other health care payor to determine whether it will pay for health care products and services you need and to determine the amount of your co-payment. We will bill you or if we choose, a third-party payor for the cost of health care products and services we provide to you. The information on or accompanying the bill may include information that identifies you, as well as information about the products or services that were provided to you or the medications you are taking. We may also disclose your PHI to other health care providers or HIPAA covered entities who may need it for their payment activities.
- Health Care Operations. We may use and disclose your PHI for our health care operations. Health care operations are activities necessary for us to operate our health care business. We may use your PHI to monitor the performance of the staff providing products or services to you. We may use your PHI as part of our efforts to continually improve the quality and effectiveness of the health care products and services we provide. We may also analyze PHI to improve the quality and efficiency of health care, for example, to assess and improve outcomes for health care conditions. We may also disclose your PHI to other HIPAA covered entities that have provided services to you so that they can improve the quality and effectiveness of the health care services that they provide. We may use your PHI to create de-identified data, which is stripped of your identifiable data and no longer identifies you.
We may also use and disclose your PHI without your prior authorization for the following purposes:
- As Required by Law. We will disclose your PHI when required to do so by federal, state or local law.
- Averting Serious Threats to Health or Safety. We may use and disclose your PHI when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
- Business Associates. We may contract with third parties to perform certain services for us, such as billing services, copy services, our consulting services. These third-party service providers, referred to as Business Associates, may need to access your PHI to perform services for us. They are required by law to protect your PHI and only use and disclose it as necessary to perform their services for us.
- Communications with Individuals Involved in Your Care or Payment for Your Care. We may disclose to a family member, another relative, close personal friend, or any other person you identify, PHI directly relevant to that person’s involvement in your care or payment related to your care. Additionally, we may disclose PHI to an individual who has the authority by law to make health care decisions for you, often designated as your “personal representative,” and treat him or her the same way we would treat you with respect to your PHI. We may use or disclose your PHI to notify or assist in notifying a family member, personal representative, or another person responsible for your care, regarding your location and general condition.
- Communicable Diseases. We may disclose or use your PHI to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and to comply with state-mandatory disease reporting, such as cancer registries.
- Coroners, Medical Examiners, and Funeral Directors. We may release your PHI to coroners or medical examiners so that they can carry out their duties. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also disclose PHI to funeral directors consistent with applicable law to enable them to carry out their duties.
- Correctional Institution. If you are or become an inmate of a correctional institution, we may disclose to the institution, or its agents, PHI necessary for your health and the health and safety of other individuals.
- Disaster Relief. We may use and disclose your PHI to organizations for purposes of disaster relief efforts.
- Food and Drug Administration (“FDA”). We may disclose to persons under the jurisdiction of the FDA, PHI relative to adverse events with respect to drugs, foods, supplements, products and product defects, or post-marketing surveillance information to enable product recalls, repairs, or replacement.
- Fundraising. As permitted by applicable law, we may contact you to provide you with information about our fundraising programs. You have the right to “opt-out” of receiving these communications and such fundraising materials will explain how you may request to opt-out of future communications if you do not want us to contact you further for fundraising efforts.
- Health Oversight Activities. We may disclose your PHI to an oversight agency for activities authorized by law. These oversight activities include audits, investigations, inspections, and credentialing, as necessary for licensure and for the government to monitor the health care system, government programs and compliance with civil rights laws.
- Law Enforcement. We may disclose your PHI for law enforcement purposes as required or permitted by law. We may disclose your PHI in response to a subpoena, administrative order, or court order, in response to a request from law enforcement, and to report limited information in certain circumstances.
- Military and Veterans. If you are a member of the armed forces, we may release PHI about you as required by military command authorities. We may also release PHI about foreign military personnel to the appropriate foreign military authority.
- National Security, Intelligence Activities, and Protective Services for the President and Others. We may release PHI about you to federal officials for intelligence, counterintelligence, protection of the President, and other national security activities authorized by law.
- Organ or Tissue Procurement Organizations. Consistent with applicable law, we may disclose your PHI to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.
- Public Health. We may disclose your PHI to public health or legal authorities charged with preventing or controlling disease, injury, or disability, including the FDA. In certain circumstances, we may also report work-related illnesses and injuries to employers for workplace safety purposes.
- Research. We may use your PHI to conduct research and we may disclose your PHI to researchers as authorized by law.
- Victims of Abuse or Neglect. We may disclose PHI about you to a government authority if we reasonably believe you are a victim of abuse or neglect. We will only disclose this type of information to the extent required by law, if you agree to the disclosure, or if the disclosure is allowed by law and we believe it is necessary to prevent serious harm to you or someone else.
- Worker’s Compensation. To the extent necessary to comply with the law, we may disclose your PHI to worker’s compensation or other similar programs established by law.
B. Uses and Disclosures of PHI That Do Require Your Authorization
As described above, Snooze Clinic will use your PHI and disclose it outside of Snooze Clinic for treatment, payment, healthcare operations and when permitted or required by law. Snooze Clinic will not disclose or sell your PHI for marketing purposes. In addition, certain disclosures of your psychotherapy notes, mental health records, and drug and alcohol abuse treatment records may require your prior written authorization. Some types of PHI, such as HIV information, genetic information, alcohol and/or substance abuse records, and mental health records may be subject to special confidentiality protections under applicable state or federal law and we will abide by these special protections.
II. YOUR RIGHTS REGARDING YOUR PHI
A. Right to Inspect and Copy
You have the right to inspect and obtain an electronic or paper copy of your PHI that may be used to make decisions about your care. This includes medical and billing records. To inspect and obtain a copy of your PHI, you must submit your request in writing to Snooze Clinic at doctorsCPAP@snoozeclinic.com. If you request a copy of the information, Snooze Clinic may charge a fee for the cost of copying, mailing or other supplies associated with your request. Snooze Clinic may deny your request to inspect and copy in some limited circumstances. If you are denied access to PHI, you may request that the denial be reviewed.
B. Right to Amend
You have a right to request an amendment of the PHI that Snooze Clinic has in its records. Your request for an amendment must be made in writing, including a reason for the request and submitted to Snooze Clinic at doctorsCPAP@snoozeclinic.com. Snooze Clinic may deny a request for an amendment if it is not in writing, does not include a reason to support the request or requests for amendment of information that: Was not created by Snooze Clinic; is not part of the PHI kept by Snooze Clinic; is not part of the information which you would be permitted to inspect and copy, or is accurate and complete. If a written request to amend is denied, Snooze Clinic will provide you with a written explanation of why it was denied.
C. Right to Receive Notification of any Breach
Individuals will receive notifications of his or her unsecured PHI that is breached.
D. Right to an Accounting of Disclosures
You have the right to request an accounting of disclosures. This is a list of disclosures Snooze Clinic has made of your PHI, excluding disclosures for treatment, payment, healthcare operations or disclosures you authorized in writing. To request an accounting of disclosures, submit your request in writing and include the specific time period (which may not be longer than six years) to Snooze Clinic at doctorsCPAP@snoozeclinic.com.
E. Right to Request Restrictions
You have the right to request a restriction on the ways your PHI is used or disclosed. To request a restriction, submit your request in writing to Snooze Clinic at doctorsCPAP@snoozeclinic.com. The request should include what information you want to limit, whether you want to limit use or disclosure, or both, and to whom you want the limits to apply. Snooze Clinic is not required to agree to the restrictions, except in the case where the disclosure is to a health plan for purposes of carrying out payment or health care operations, is not otherwise required by law, and the PHI pertains solely to a health care item or service for which you, or a person on your behalf, has paid in full.
F. Right to Request Confidential Communication
You have the right to request that Snooze Clinic communicates with you about health care matters in a certain way or at a certain location. For example, you can request that you are only contacted at work or at a specific address. Such requests should be made in writing to Snooze Clinic at doctorsCPAP@snoozeclinic.com and should specify how or where you wish to be contacted. Snooze Clinic will accommodate all reasonable requests. Please note if you choose to receive communications from us via e-mail or other electronic means, those may not be a secure means of communication and your PHI that may be contained in our e-mails to you will not be encrypted. This means that there is risk that your PHI in the e-mails may be intercepted and read by, or disclosed to, unauthorized third parties.
G. Right to a Paper Copy of This Notice
You have the right to a paper copy of this Notice of Privacy Practice, even if you have agreed to receive this Notice electronically. You may also find a copy of this Notice on the Snooze Clinic website at snoozeclinic.com.
H. Other Uses of PHI
Other uses and disclosures of your PHI not covered by this Notice or allowed by law will be made only with your written permission. If you provide permission to use or disclose PHI, you may revoke that permission, in writing, at any time. If you revoke your permission, Snooze Clinic will no longer use or disclose PHI about you for the reasons covered by your written authorization. Snooze Clinic is unable to take back any disclosures it may have already made with your permission.
I. Changes to This Notice of Privacy Practice
Snooze Clinic reserves the right to change this Notice at any time and to make the revised or changed Notice effective for PHI we already have about you, as well as any information we receive in the future. The revised Notice of Privacy Practice will be posted on Snooze Clinic’s website at snoozeclinic.com; you may also request that a revised copy be sent to you in the mail. Upon your written request, we will provide you with any historical Notice of Privacy Practice.
J. Questions or Complaints
If you believe Snooze Clinic has violated your privacy rights, you may file a complaint with Snooze Clinic or with the Secretary of the Department of Health and Human Services. You will not be penalized for filing a complaint. To file a complaint with Snooze Clinic, please submit a complaint in writing to Snooze Clinic at email@example.com.
If you have further questions about this Notice of Privacy Practice, please contact Snooze Clinic directly by emailing Snooze Clinic at firstname.lastname@example.org.