TELEMEDICINE HIPAA NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
OUR LEGAL DUTY
Federal and state laws require us to maintain the privacy and security of your protected health information and to give you this Notice of Privacy Practices (“Notice”). We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. We are bound to follow these privacy practices from the effective date, until we replace this Notice.
Obria has safeguards to ensure client confidentiality. Information obtained by our staff about an individual receiving services may not be disclosed without the individual’s documented consent, except as required by law or as may be necessary to provide services to the individual, with appropriate safeguards for confidentiality. Information may otherwise be disclosed only in summary, statistical, or other form that does not identify the individual. We must maintain safeguards to ensure client confidentiality, with exceptions as required by law. Obria has the ability to bill third parties (through public or private insurance) for the cost of services without the application of discounts, and reasonable efforts must be made to collect charges without jeopardizing client confidentiality.
This Notice describes how health information about you may be used and disclosed and how you can access this information. PLEASE REVIEW THIS NOTICE CAREFULLY.
As required by law, this Notice provides you with information about your rights and our legal duties and privacy practices with respect to the privacy of PHI. This notice also discusses the uses and disclosures we will make of your PHI. We must comply with the provisions of this Notice as currently in effect, although we reserve the right to change the terms of this notice from time to time and to make the revised notice effective for all PHI we maintain.
By visiting the website or using our services, you agree that your personal information will be handled as described in this Notice. Your use of our website and services, and any dispute over privacy is subject to this Notice and our Terms of Service, including its applicable limitations on damages and the resolution of disputes. The Terms of Service are incorporated by reference into this Notice.
WHAT INFORMATION DO WE COLLECT ABOUT YOU AND WHY?
We may collect information about you directly from you and from third parties, as well as automatically through your use of our Site or Services.
With regard to your protected health information, you have the right to:
- Get a copy of your paper or electronic medical and claims record, if applicable, in most circumstances. Ask us how to do this. We may charge a reasonable, cost-based fee.
- Ask us to correct your health or claims records that you believe are inaccurate or incomplete. Ask us how to do this.
- Request confidential communication or a specific way for us to contact you. We will consider all reasonable requests.
- Ask us to limit the information we share for treatment, payment or our operations. We are not required to agree to your request, however, particularly if it would affect your care.
- We are required to provide confidential care to patients.
- Ask us not to share information with your health insurer about any service or health care item that you paid for out-of-pocket in full.
- Get a list of those with whom we have shared your information.
- You can request a paper copy of our current Notice from the Privacy Officer at [telephone], or you can access it on our website at http://obria.org/oregon/HIPAA-Notice or by contacting our Privacy Officer at (949)273-5040 or firstname.lastname@example.org. You can get a paper copy, even if you agreed to receive this Notice electronically.
- Choose someone to act for you. If you have given someone medical power of attorney or if someone is your legal guardian, such personal representative can exercise your rights and make choices about your health information. We will take reasonable actions to ensure any such person has this authority and can act for you before we take any action.
- A parent or other legal guardian will not be considered a minor’s personal representative when parental consent for care, such as family planning services, is not required under law.
- File a complaint if you believe your privacy rights have been violated or you have questions about this Notice, contact our Privacy Officer at the telephone number listed above. 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 hhs.gov/ocr/privacy/hipaa/complaints. We will not retaliate against you for filing a complaint.
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 health information in the situations described below, tell us what you want us to do, and we will follow your instructions. If you cannot 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 or need to lessen a serious and imminent threat to health or safety. You can tell us to:
- Share information with family, close friends, or others involved in payment for your care.
- Share information in a disaster relief situation.
- Contact you about fundraising efforts. We do not share or sell your information for any fundraising effort.
We will never share your information for marketing purposes unless you give us written permission. We never will sell your protected health information.
OUR USES AND DISCLOSURES
We may use or share your health information:
- Treat you. Example: We may share your health information with a healthcare provider who is treating you.
- Run our organization. Example: We may use your health information for quality improvement purposes.
- Bill and collect payment for our services. Example: We may send a bill to your health plan in order to collect payment.
- Administer your plan. Example: We may disclose your health information to your plan sponsor for plan administration, such as to provide statistics.
- Help with public health and safety issues.
- Do research.
- Comply with the law.
- Respond to organ and tissue donation requests and work with a medical examiner or funeral director.
- Address workers’ compensation, law enforcement, and other government requests.
- Respond to lawsuits and legal actions.
- Contact you about appointments.
- Tell you about health related benefits or services and your providers
- To create “de-identified” information that we can use for commercial purposes by removing information that would identify you as the source of the information.
USE OF TECHNOLOGY
We may use electronic software, services, and equipment, including without limitation email, video conferencing technology, cloud storage and servers, internet communication, cellular network, voicemail, facsimile, electronic health record, and related technology to share your protected health information with you or third parties subject to the rights and restrictions contained herein. In any event, certain unencrypted storage, forwarding, communications and transfers may not be confidential. We will take measures to safeguard the data transmitted, as well as ensure its integrity against intentional or unintentional breach or corruption. However, in very rare circumstances security protocols could fail, causing a breach of privacy or protected health information.
- We are required by law to maintain the privacy and security of your protected health information.
- We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
- We must follow the duties and privacy practices described in this Notice and give you a copy of it.
- We will not use or share your health information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
You are entitled to exercise any right provided to you by the laws of the State where you are receiving health care services, which are greater than those described above. If this Notice does not reference those greater rights, they shall be deemed incorporated into this Notice and will be afforded to you.
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, on our web site, and we will mail a copy to you.
Effective Date: _______________
Phone: (949) 273-5040
Fax: (657) 235-8040