Last modified: January 11, 2023
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.
WHO WILL FOLLOW THIS NOTICE:
The privacy practices described in this notice will be followed by Blossom Q Health, Inc. and its affiliated entities, including Equal Health (collectively “Equal Health”).
Equal Health is dedicated to maintaining the privacy of your identifiable health information. In conducting our business, we will create and maintain records regarding you and the treatment and services we provide to you, and we will maintain records of treatment provided to you by others. We are required by law to maintain the confidentiality of health information that identifies you. We also are required by law to provide you with this notice of our legal duties and privacy practices concerning your identifiable health information. By law, we must follow the terms of the Notice of Privacy Practices that we have in effect at the time.
To summarize, this notice provides you with the following information:
How we may use and disclose your identifiable health information.
Our obligations concerning the use and disclosure of your identifiable health information.
Your privacy rights as to your identifiable health information.
The terms of this notice apply to all records containing your identifiable health information that are created and/or retained by Equal Health. We reserve the right to revise or amend our Notice of Privacy Practice. Any revision or amendment to this notice will be effective for all records our organization has created or maintained in the past, and for any records we may create in the future.
Please direct any questions or concerns regarding this policy to firstname.lastname@example.org.
We may use and disclose your information in the following ways:
Treatment: We will use or disclose health information about you to provide you with medical treatment and other services at Equal Health. We may disclose health information about you to other health care providers, including doctors, nurses, technicians, dentists, mental health professionals, therapists, or other persons who are involved in your care at Equal Health. Different departments of Equal Health also may share health information about you to coordinate your care and provide you with related services. We may also disclose health information about you to people outside Equal Health who may be involved in your medical care. Your confidential information may also be released to other health care providers in the event you need emergency care.
Payment. We may use and disclose your identifiable health information to bill and collect payment for the services and supplies you receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment to determine if your insurer will cover or pay for your supplies and/or services. Although, please note that We do not accept any health insurance currently. We may also use and disclose your identifiable health information to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your identifiable health information to bill you directly for services and supplies.
Health Care Operations. We may use and disclose health information about you for our day-to-day health care operations. This is necessary to ensure that all patients receive quality care. For example, we may use health information for satisfaction surveys, quality assessment, and improvement activities and for developing and evaluating clinical protocols. We may also combine health information about many patients to help determine what additional services we should offer, what services should be discontinued, and whether certain new treatments are effective. Health information about you may be used by our corporate office for business development and planning, cost management analyses, insurance claims management, risk management activities, and in developing and testing information systems and programs. We may also use and disclose information for professional review, performance evaluation and for training programs. Other aspects of health care operations that may require use and disclosure of your health information include accreditation, certification, licensing and credentialing activities, review and auditing, including compliance reviews, medical reviews, legal services and compliance programs. Your health information may be used and disclosed for the business management and general activities of Equal Health, including resolution of internal grievances, customer service, and due diligence in connection with a sale or transfer of Equal Health.
Business Associates. There are some services provided at Equal Health through contracts with business associates. Examples include medical directors, outside attorneys and a copy service we use when making copies of your health record. When these services are contracted, we may disclose your health information so that they can perform the job we’ve asked them to do and bill you or your third-party payer for services rendered. If we do disclose your information to a business associate, we will have a written agreement with them to ensure that our business associate also protects the privacy of your health information.
Appointment Reminders, Health-Related Benefits and Services. We may use your identifiable health information to inform you of health-related benefits or services that may be of interest to you, provide appointment reminders, provide reminders of outstanding orders for diagnostic testing, and provide information and reminders related to prescription and refills of medications .
Disclosures Required by Law. We will use and disclose your identifiable health information when we are required to do so by federal, state, or local laws.
Organized Healthcare. We will disclose health information about you to our healthcare affiliates who interact and cooperate to provide treatment to you. These participants include a variety of providers such as physicians (e.g., MD, DO, podiatrist, dentist, optometrist), therapists (e.g., physical therapist, occupational therapist, speech therapist, behavioral health counselors/therapists), portable radiology units, clinical labs, hospice caregivers, pharmacies, psychologists, social workers, advanced practice providers, registered nurses, case managers, and suppliers (e.g., prosthetic, orthotics). Providers in these organized health care arrangements will share protected health information with each other as necessary to carry out treatment, payment or health care operations relating to your treatment.
USE AND DISCLOSURE OF YOUR IDENTIFIABLE HEALTH INFORMATION IN CERTAIN SPECIAL CIRCUMSTANCES
The following categories describe unique scenarios in which we may use or disclose your
identifiable health information:
Public Health Activities. We may disclose your identifiable health information to public health authorities that are authorized by law to collect information for the purpose of:
Maintaining vital records, such as births and deaths
Reporting child abuse or neglect
Preventing or controlling disease, injury, or disability
Reporting certain communicable diseases (e.g., positive HIV test results) to applicable public health authorities
Notifying a person regarding a potential exposure to a communicable disease
Notifying a person regarding a potential risk for spreading or contracting a disease or condition
Reporting reactions to drugs or problems with products or devices
Notifying individuals if a product or device they may be using has been recalled
Notifying appropriate government agency(ies) and authority(ies) regarding the potential abuse or neglect of an adult resident(including domestic violence); however, we will only disclose this information if the resident agrees or we are required or authorized by law to disclose this information
Health Oversight Activities. We may disclose your health information to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure, and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.
Emergencies. We may use or disclose your health information if you need emergency treatment or if we are required by law to treat you but are unable to obtain your general written consent. If this happens, we will try to obtain your general written consent as soon as we reasonably can after we treat you.
Lawsuits and Similar Proceedings. We may use and disclose your identifiable health information in response to a court or administrative order if you are involved in a lawsuit or similar proceeding. We also may disclose your identifiable health in response to a discovery request, subpoena, or other lawful process by another party involved in a dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.
Law Enforcement. We may release identifiable health information if asked to do so by a law enforcement official:
Regarding a crime victim in certain situations, if we are unable to obtain the person’s agreement
Concerning a death, we believe might have resulted from criminal conduct
Regarding criminal conduct in our offices
In response to a warrant, summons, court order, subpoena, or similar legal process
To identify/locate a suspect, material witness, fugitive, or missing person
In an emergency, to report a crime (including the location or victim(s) of the crime, or the description, identity, or location of the perpetrator)
Serious Threats to Health or Safety. We may use and disclose your identifiable health information when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.
Data Breach Notification Purposes. We may use or disclose your health information to provide legally required notices of unauthorized access to or disclosure of your health information.
Coroners, Medical Examiners and Funeral Directors. We may disclose health information to a coroner or medical examiner. We may also disclose medical information to funeral directors consistent with applicable law to carry out their duties.
Organ and Tissue Donation. If you are an organ donor, we may use or release health information to organizations that handle organ procurement or other entities engaged in procurement, banking or transportation of organs, eyes or tissues to facilitate organ, eye or tissue donation and transplantation.
Workers’ Compensation. We may release health information for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
Military and Veterans. If you are a member of the armed forces, we may release health information about you as required by military command authorities. We may also release health information about foreign military personnel to the appropriate military authority.
Research. Under certain circumstances, we may use and disclose health information for research. For example, a research project may involve comparing the health of patients who received one treatment to those who received another, for the same condition. Before we use or disclose health information for research, the project will go through a special approval process. Even without special approval, we may permit researchers to look at records to help them identify patients who may be included in their research project or for other similar purposes, as long as they do not remove or take a copy of any health information.
YOUR RIGHTS REGARDING YOUR IDENTIFIABLE HEALTH INFORMATION
Confidential Communications. You have the right to request that we communicate with you about your health and related issues in a particular manner or at a certain location. To request a type of confidential communication, you must make a written request to us, specifying the requested method of contact or location where you wish to be contacted. We will accommodate reasonable requests. You do not need to give a reason for your request.
Requesting Restrictions. You have the right to request a restriction in our use or disclosure of your identifiable health information for treatment, payment, or health care operations. Additionally, you have the right to request we limit our disclosure of your identifiable health care information to individuals involved in your care or the payment for your care, such as family members and friends. We are not required to agree to your request except as otherwise required by law; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you. To request a restriction in our use or disclosure of your identifiable health information, you must make your request in writing to us. Your request must describe in clear and concise fashion: (a) the information you wish restricted; (b) whether you are requesting to limit our use, disclosure, or both; and (c) to whom you want the limits to apply. If you or another third party has paid for services out of pocket in full, you may restrict disclosure to any and all recipients.
Inspection and Copies. With some exceptions, you have the right to inspect and obtain a copy of the identifiable health information that may be used to make decisions about you, including resident medical records and billing records. You must submit your request in writing to us to inspect and/or obtain a copy of your identifiable health information. We will respond to your request for inspection of records within 10 days. We ordinarily will respond to a request for copies within 30 days if the information is located within our facility and within 60 days if it is located off site at another facility. We may charge a fee for the costs of copying, mailing, labor, and supplies associated with your request. We may deny your request to inspect and/or copy your records in certain limited circumstances; however, you may request a review of our denial.
Electronic Format. You have the right to receive your health information in electronic format if it is kept in such form.
Amendment. You may ask us to amend your health information if you believe it to be incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for us. To request an amendment, your request must be made in and submitted to us in writing. You must provide us with a reason that supports your request for amendment. We will deny your request if you fail to submit your request (and the reason supporting your request) in writing. Also, we may deny your request if you ask us to amend information that is: (a) accurate and correct; (b) not part of the identifiable health information kept by or for us; (c) not part of the identifiable health information which you would be permitted to inspect and copy; (d) not created by us, unless the individual or entity that created the information is not available to amend the information. If your request to amend is denied, you will have the right to have certain information related to your requested amendment included in your records. Their rights will be explained to you in the written denial notice.
Accounting of Disclosures. All our patients have the right to request an “accounting of disclosures.” An “accounting of disclosures” is a list of certain disclosures we have made of your identifiable health information. To obtain an accounting of disclosures, you must submit your request in writing to Equal Health. All requests for an “accounting of disclosures” must state a time period which may not be longer than six years and cannot include dates before April 14, 2003. The first accounting you request within a 12-month period will be provided free of charge, but you may be charged for the cost of providing additional accountings. We will notify you of the cost involved, and you may choose to withdraw or modify your request at that time.
Sale of Health Information. We may not sell your health information without your specific authorization. However, we may disclose health information for public health purposes, for treatment and payment for health care, for the sale, transfer, merger or consolidation of all or part of our business and for related due diligence. We may also provide health information to a business associate in connection with the business associate’s performance of activities for us, to a resident or beneficiary upon request, and as required by law.
Use of Health Information for Marketing Purposes. We must obtain authorization to use or disclose your health information for marketing purposes if we receive financial remuneration from a third party whose product or service is being promoted.
Fundraising. We may use limited health information, including department of service information, identity of the treating physician, and health insurance status as part of our fundraising efforts. You may request to opt out of receiving future fundraising communications.
Psychotherapy Notes. Most uses and disclosures of your psychotherapy notes, if we maintain or record such notes, will only be made after we obtain authorization from you.
Right to a Paper Copy of this Notice. You are entitled to receive a paper copy of our Notice of Privacy Practices. You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this notice, contact our office.
Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with us or with the Department of Health and Human Services Office of Civil Rights. All complaints must be in writing. To file a complaint with us, please direct to Equal Health, c/o Savita Singh-Varma at 650 Ponce de Leon Ave, Suite 300, Atlanta, Georgia 30308. You will not be penalized or retaliated against for filing a complaint.
Right to Provide an Authorization for Other Uses and Disclosures. We will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your identifiable health information may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your identifiable health information for the reasons described in the authorization. Please note that we are unable to take back any disclosures we have already made with your permission, and we are required to retain records of your care.
Notification of Breach. If your health information has been compromised, we must notify you within sixty (60) days of the breach.
Any other uses and disclosures of your health information not described in this Notice of Privacy Practices will be made only with appropriate authorization. We reserve the right to change the terms of this Notice and to make the new Notice provisions effective for all protected health information that we maintain.