Notice of Privacy Practices
Please review this Notice carefully
as it contains information about you personal medical information including information as to how this information can be used, to whom it can be disclosed to and how you can obtain access to this information.
Health Fitness Concepts RN, LLC (“HFC”) is committed to protecting the privacy of your identifiable health information. This information is known as “Protected Health Information” or “PHI.” PHI is information that individually identifies you. We create a record or get from you or from another health care provider, health plan, your employer, or a health care clearinghouse information that relates to: your past, present, or future physical or mental health or conditions, the provision of health care to you, or the past, present, or future payment for your health care.
How is HFC required to treat your PHI:
As Required by the Privacy Regulations Created as a Result of the Health Insurance Portability and Accountability Act of 1996-(HIPAA) Health Information Technology for Economic and Clinical Health Act (HITECH Act), and associated regulations and amendments, HFC is required to maintain the privacy of your PHI. We are also required to provide you with this Notice of our legal duties and privacy practices upon request. It describes our legal duties, privacy practices and your patient rights as determined by the Health Insurance Portability and Accountability Act (HIPAA) of 1996. We are required to follow the terms of this Notice currently in effect. We are required to notify affected individuals in the event of a breach involving unsecured protected health information. PHI is stored electronically and is subject to electronic disclosure.
How We May Use or Disclose Your PHI:
We use your PHI for treatment, payment, or healthcare operations purposes and for other purposes permitted or required by law. Not every use or disclosure is listed in this Notice, but all of our uses or disclosures of your health information will fall into one of the categories listed below. We need your written authorization to use or disclose your health information for any purpose not covered by one of the categories below. Subject to compliance with limited exceptions, we will not use or disclose psychotherapy notes, use or disclose your PHI for marketing purposes or sell your PHI, unless you have signed an authorization. You may revoke any authorization you sign at any time. If you revoke your authorization, we will no longer use or disclose your health information for the reasons stated in your authorization except to the extent we have already taken action based on your authorization.
The law permits us to use and disclose your health information for the following purposes:
We may disclose PHI to our business associates who perform functions on our behalf or provide us with services if the PHI is necessary for those functions or services. For example, we may use another company to do our billing, or to provide transcription or consulting services for us. All of our business associates are obligated, under contract with us, to protect the privacy and ensure the security of your PHI.
As Required by Law:
We will disclose PHI about you when required to do so by international, federal, state, or local law.
Law Enforcement Activities and Legal Proceedings:
We may also provide PHI to law enforcement officials, for example, in response to a warrant, investigative demand or similar legal process, or for officials to identify or locate a suspect, fugitive, material witness, or missing person. We may also disclose PHI to appropriate agencies if we reasonably believe an individual to be a victim of abuse, neglect or domestic violence. We may disclose your PHI as required to comply with a court or administrative order. We may disclose your PHI in response to a subpoena, discovery request or other legal process in the course of a judicial or administrative proceeding, but only if efforts have been made to tell you about the request or to obtain an order of protection for the requested information.
To Avert a Serious Threat to Health or Safety:
We may use and disclose PHI when necessary to prevent a serious threat to your health or safety or to the health or safety of others. But we will only disclose the information to someone who may be able to help prevent the threat.
We may disclose PHI for research purposes when an Institutional Review Board or privacy board has reviewed the research proposal and established protocols to ensure the privacy of your PHI and determined that the researcher does not need to obtain your authorization prior to using your PHI for research purposes.
HFC may use and disclose your PHI for activities necessary to support our healthcare operations, such as performing quality checks on our testing, internal audits, arranging for legal services or developing reference ranges for our tests.
We disclose your health information to authorized healthcare professionals who order tests or need access to your test results for treatment purposes.
HFC will use and disclose your PHI for purposes of billing and payment. For example, we may disclose your PHI to health plans or other payers to determine whether you are enrolled with the payer or eligible for health benefits or to obtain payment for our services. If you are insured under another person’s health insurance policy (for example, parent, spouse, domestic partner or a former spouse), we may also send invoices to the subscriber whose policy covers your health services.
Other Uses and Disclosures:
As permitted by HIPAA, we may disclose your PHI to: Public Health Authorities, The Food and Drug Administration, Health Oversight Agencies, Military Command Authorities, National Security and Intelligence Organizations, Correctional Institutions, Organ and Tissue Donation Organizations, Coroners, Medical Examiners and Funeral Directors, Workers Compensation Agents. We may also disclose relevant PHI to a family member, friend, or anyone else you designate in order for that person to be involved in your care or payment related to your care. We may also disclose PHI to those assisting in disaster relief efforts so that others can be notified about your condition, status and location.
For all of the above purposes, when state law is more restrictive than federal law, we are required to follow the more restrictive state law.
Your Rights Regarding your PHI:
Receive Test Information:
You have the right to access your PHI that we have created. You may receive your test results by contacting us at the contact information below to obtain the request form. If your request for your test information is denied, you may request that the denial be reviewed;
Amend Health Information:
You may request amendments to your PHI by making a written request. However, we may deny the request in some cases (such as if we determine the PHI is accurate). If we deny your request to change your PHI we will provide you with a written explanation of the reason for the denial and additional information regarding further actions that you may take;
Accounting of Disclosures:
ou have the right to receive a list of certain disclosures of your PHI made by HFC in the past six years from the date of your written request. Under the law, this does not include disclosures made for purposes of treatment, payment, or healthcare operations or certain other purposes.
Restrictions that may apply to your request:
You may request that we agree to restrictions on certain uses and disclosures of your PHI. We are not required to agree to your request, except for requests to limit disclosures to your health plan for purposes of payment or healthcare operations when you have paid us for the item or service covered by the request out-of-pocket and in full and when the uses or disclosures are not required by law.
Request Confidential Communications:
You have the right to request that we send your health information by alternative means or to an alternative address, and we will accommodate reasonable requests.
Your Right to Receive a Copy of this Notice:
You have the right to obtain a paper copy of this Notice upon request.
How to Exercise Your Rights:
You may write or send an email to us with your specific request, including requesting a form to complete to obtain a copy of your test results. HFC will consider your request and provide you a response.
If you believe your privacy rights have been violated, you have the right to file a complaint with us. You also have the right to file a complaint with the Secretary of the U.S. Department of Health and Human Services, Office for Civil Rights. . To file a complaint with the Secretary, mail it to email@example.com:
Secretary of the U.S.
Department of Health and Humans Services,
200 Independence Ave.,
S.W., Washington, D.C. 20201.
Call (202) 619-0257 (or toll free (877) 696-6775
or go to the website of the Office for Civil Rights, www.hhs.gov/ocr/hipaa/, for more information. HFC will not penalize you in any way for filing a complaint
To file a complaint with us, or should you have any questions about this Notice, send an email to us at firstname.lastname@example.org or write to us at the following address:
Health Fitness Concepts RN, LLC
45 Knollwood Rd.
Elmsford, NY 10523
You may also contact the Privacy Officer at 1-914-684-6064.
Note: We reserve the right to amend the terms of this Notice to reflect changes in our privacy practices, and to make the new terms and practices applicable to all PHI that we maintain about you, including PHI created or received prior to the effective date of the Notice revision. Our Notice is displayed on our website and a copy is available upon request.
Effective: Jan 1, 2016,