Notice of Privacy Practices

Privacy Officer Name and Contact Information: Jessie Andersen, 716-664-5459

Effective Date of Notice: 2/1/2020

All medical information/treatment is provided through a medical services provider.

NOTICE OF PRIVACY PRACTICES

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Your Rights

You have the right to: 

• Get a copy of your paper or electronic medical record
• Correct your paper or electronic medical record
• Request confidential communication
• Ask us to limit the information we share
• Get a list of those with whom we’ve shared your information
• Get a copy of this privacy notice
• Choose someone to act for you
• File a complaint if you believe your privacy rights have been violated

Your Choices

You have some choices in the way that we use and share information as we: 

• Tell family and friends about your condition
• Provide disaster relief
• Provide mental health care
• Market our services and sell your information
• Raise funds

Uses and Disclosures

*All medical services are provided by a licensed medical professional. All medical information is kept confidential under HIPAA.

Your medical provider may use and share your information as they: 

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.  Get an electronic or paper copy of your medical record.

• You can ask to see or get an electronic or paper copy of your medical record and other health information a medical provider has about you. Ask us how to do this. 
• Your medical provider will provide a copy or a summary of your health information, usually within 30 days of your request. Your medical provider may charge a reasonable, cost-based fee.

Ask your provider to correct your medical record

• You can ask your medical provider to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
• Your medical provider may say “no” to your request, but they’ll tell you why in writing within 60 days.

Request confidential communications

• You can ask your medical provider to contact you in a specific way (for example, home or office phone) or to send mail to a different address. 
• They will say “yes” to all reasonable requests.

Ask your medical provider to limit what we use or share

• You can ask your medical provider not to use or share certain health information for treatment, payment, or our operations. your medical provider is not required to agree to your request, and they may say “no” if it would affect your care.
• If you pay for a service or health care item out-of-pocket in full, you can ask your medical provider not to share that information for the purpose of payment or our operations with your other health providers. your medical provider will say “yes” unless a law requires us to share that information.

Get a list of those with whom we’ve shared information

• You can ask for a list (accounting) of the times your medical provider has shared your health information for six years prior to the date you ask, who we shared it with, and why.
• We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). your medical provider will provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice

You can ask 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.

File a complaint if you feel your rights are violated

• You can complain if you feel your medical provider has violated your rights by contacting us.
• 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 your medical provider your choices about what we share. If you have a clear preference for how they share your information in the situations described below, talk to them. Tell them what you want them to do, and they will follow your instructions.

In these cases, you have both the right and choice to tell your medical provider to:

• Share information with your family, close friends, or others involved in your care
• Share information in a disaster relief situation
• Include your information in a hospital directory

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

In these cases, your medical provider never shares your information unless you give them written permission:

• Marketing purposes
• Sale of your information
• Most sharing of psychotherapy notes

In the case of fundraising:

• We may contact you for fundraising efforts, but you can tell us not to contact you again.

Uses and Disclosures

How do we typically use or share your health information? 

Your medical provider uses or share your health information in the following ways:

Treat you

They use your health information and share it with other professionals who are treating you.

Example: A doctor treating you for an injury asks another doctor about your overall health condition.

Run an organization

Your medical provider uses and share your health information to run our practice, improve your care, and contact you when necessary.

Example: Your medical provider uses health information about you to manage your treatment and services. 

Advertising & Promotion

For advertising and promotion, we may use your story and ultrasound images with all identifying information removed or de-identified to protect your privacy.  www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

Help with public health and safety issues

Your medical provider can share health information about you for certain situations such as: 

• Preventing disease
• Helping with product recalls
• Reporting adverse reactions to medications
• Reporting suspected abuse, neglect, or domestic violence
• Preventing or reducing a serious threat to anyone’s health or safety

Do research

Your medical provider can use or share your information for health research.

Comply with the law.

Your medical provider will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

Respond to organ and tissue donation requests.

Your medical provider can share health information about you with organ procurement organizations.

Work with a medical examiner or funeral director.

Your medical provider can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Address workers’ compensation, law enforcement, and other government requests

Your medical provider can use or share health information about you:

• For workers’ compensation claims
• For law enforcement purposes or with a law enforcement official
• With health oversight agencies for activities authorized by law
• For special government functions such as military, national security, and presidential protective services

Respond to lawsuits and legal actions

Your medical provider can share health information about you in response to a court or administrative order, or in response to a subpoena.

Responsibilities of your medical provider:

• Your medical provider is required by law to maintain the privacy and security of your protected health information.
• Your medical provider will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• Your medical provider must follow the duties and privacy practices described in this notice and give you a copy of it.
• Your medical provider will not use or share your information other than as described here unless you tell us we can in writing. If you tell your medical provider, they can, you may change your mind at any time. Let them know in writing if you change your mind.

For more information: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website.