Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW THIS INFORMATION CAREFULLY.
At Altura Centers for Health (ALTURA) we understand that health information about you and the health care you receive is personal. We are committed to protecting your personal health information. When you receive treatment and other health care services from us, we create a record of the services that you received. We need this record to provide you quality care and to comply with legal requirements. This notice tells you about the ways in which we may use and disclose the personal health information that we keep about you and the obligations that we have when we use and disclose your health information.
We are required by law to:
- Make sure that health information that identifies you is kept private in accordance with relevant law.
- Give you notice of our legal duties and privacy practices with respect to your personal health information.
- Follow the terms of the notice that is currently in effect for all of your personal health information.
How ALTURA May Use and Disclose Your Health Information
We may use and disclose your personal health information for these purposes:
ALTURA will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party that has already obtained your permission to have access to your protected health information. For example, we would disclose your protected health information, as necessary, to a home health agency that provides care to you. We will also disclose protected health information to physicians who may be treating you, when we have the necessary permission from you to disclose your protected health information. For example, your protected health information may be provided to a physician as a referral or in a consult to ensure that the physician has the necessary information to diagnose or treat you.
In addition, we may disclose your protected health information from time-to-time to another physician or health care provider (e.g., a specialist or laboratory) who, at the request of your physician, becomes involved in your care by providing assistance with your health care diagnosis or treatment to your physician.
We may use and disclose health information about you to bill and collect payment from you, your insurance company, including Medicaid and Medicare, or other third parties that may be available to reimburse us for some or all of your health care. For example, if you have health insurance, we may need to share information about treatment that you need to obtain your health plan’s prior approval or to determine whether your plan will cover the treatment.
If you paid out-of-pocket in full for a specific item or service, you have the right to ask that your Protected Health Information with respect to that item or service not be disclosed to a health plan for purposes of payment or health care operations.
For Health Care Operations
We may use or disclose, as-needed, your protected health information in order to support the business activities of ALTURA. These activities include, but are not limited to, quality assessment, employee reviews, licensing, and conducting or arranging for other business activities. For example, ALTURA may use a sign-in sheet at the front desk where you will be asked to sign your name. We may also call you by name in the waiting room when you are ready to be seen. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment.
We will share your protected health information with third party “business associates” that perform various activities (e.g., billing, transcription services) for the provider. Whenever an arrangement between our office and a business associate involves the use or disclosure of your protected health information, we will have a written contract that contains terms that will protect the privacy of your protected health information.
Health Related Services and Treatment Alternatives
We may use and disclose health information to tell you about health related services or recommend treatment options or alternatives that may be of interest to you. Please let us know if you do not wish us to contact you with this information, or if you wish to have us use a different address when sending this information to you.
Individuals Involved in Your Care or Payment for Your Care.
Unless you object, we may release health information about you to a friend or family member who is involved in your health care or the person who helps pay for your care.
Organ and Tissue Donation
If you are an organ donor, we may discuss health information about you with organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
As Required by Law
We will disclose health information about you when required to do so by federal, state or local law.
To Avert a Serious Threat to Health or Safety: We may use and disclose health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
Military and Veterans
When the appropriate conditions apply, we may use or disclose protected health information of individuals who are Armed Forces personnel (1) for activities deemed necessary by appropriate military command authorities; (2) for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits, or (3) to foreign military authority if you are a member of that foreign military service. We may also disclose your protected health information to authorized federal officials for conducting national security and intelligence activities, including for the provision of protective services to the President or others legally authorized.
We may release health information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
Public Health Activities
We may disclose health information about you for public health activities.
These activities generally include the following:
• To prevent or control disease, injury or disability.
• To report child abuse or neglect.
• To report reactions to medications or problems with products.
• 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.
• To notify people of recalls of products.
• To notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence.
We will only make this disclosure if you agree or when required or authorized by law.
Health Oversight Activities
We may disclose health information about you to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs and compliance with civil rights laws.
Lawsuits and Disputes
We may disclose health information about you in response to a court or administrative order. We may also disclose health information about you in response to a subpoena, discovery request or other lawful process that is not accompanied by a court or administrative order, but only if efforts have been made to tell you about the request or obtain an order protecting the information requested.
We may release health information about you if asked to do so by a law enforcement official:
• In response to a court order, subpoena, warrant, summons or similar process.
• To identify or locate a suspect, fugitive, material witness or missing person.
• Under certain limited circumstances, about the victim of a crime.
• About a death we believe may be the result of criminal conduct.
• About criminal conduct at the health center.
• In emergency circumstances to report a crime, the location of the crime or victims, or the identity, description or location of the person
who committed the crime.
Coroners, Health Examiners and Funeral Directors
We may release health information about our patients to a coroner or health examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release health information to funeral directors as may be necessary for them to carry out their duties.
If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may disclose to the institution health information necessary for your health and the safety of others.
You have certain rights with respect to your personal health information. This section of our notice describes your rights and how to exercise them:
Right to Inspect and Copy
You have the right to inspect and copy the personal health information in your medical and billing records, or in any other group of records that we maintain and use to make health care decisions about you. This right does not include the right to inspect and copy psychotherapy notes, although we may, at your request provide you with a summary of these notes.
To inspect and copy your personal health information, you must submit your request in writing to ALTURA. If you request a copy of the information, we may charge a fee for the copying and the mailing costs, and for any other costs associated with your request.
In certain, very limited circumstances, we may deny your request to inspect and copy. If your request is denied, you may request that the denial be reviewed. We will designate a licensed health care professional to review our decision. The person conducting the review will not be the same person who denied your request. We will comply with the outcome of this review.
Right to Amend
If you feel that the health information we maintain about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for any information that we maintain about you. To request an amendment, your request must be made in writing (legibly handwritten or typed), submitted to our Privacy Officer, and must be contained on one piece of paper. In addition, you must provide a reason that supports your request for an amendment.
We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
• Was not created by us, unless the person or organization that created the information is no longer available to make the amendment.
• Is not part of the health information kept by or for the Health Center.
• Is not part of the information which you would be permitted to inspect and copy, or
• Is accurate and complete.
• Any amendment we make to your health information will be disclosed to the health care professionals involved in your care and to others to carry out payment and health care operations, as previously described in this notice.
Right to Receive an Accounting of Disclosures
You have the right to receive an accounting of certain disclosures of your health information that we have made. Any accounting will not include all disclosures that we make.
For example, an accounting will not include disclosures:
• To carry out treatment, payment and health care operations as previously described in this notice.
• Pursuant to your written authorization.
• To a family member, other relative, or personal friend involved in your care or payment for your care when you have given permission to do so.
• To law enforcement officials.
To request an accounting of disclosures, you must submit your request in writing to our Privacy Officer. Your request must state a time period, which may not be more than six (6) years. The first list you request within a 12 month period will be free. For additional lists, we may charge you the costs of providing the lists. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred. We will mail you a list of disclosures in paper form within 30 days of your request, or notify you if we are unable to supply the list within that time period.
Right to Restrictions
You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your case or payment for your care, such as a family member or friend. For example, you may request that we not disclose information about you to a certain doctor or other health care professional, or that we not disclose information to your spouse about certain care that you received.
We are not required to agree to your request for restrictions if it is not feasible for us to comply with your request or if we believe that it will negatively impact our ability to care for you. However, if we do agree, we will comply with your request unless the information is needed to provide emergency treatment. To request a restriction, you must make your request in writing to our Privacy Officer. In your request, you must tell us what information you want to limit and to whom you want the limits to apply.
Right to Opt Out of Fundraising Communications
We may contact individuals to raise funds for the organization but the individual has a right to opt out of receiving such communications.
Your Written Authorization is Required for Other Uses and Disclosures
The following uses and disclosures of your Protected Health Information will be made only with your written authorization:
• Most uses and disclosures of psychotherapy notes;
• Uses and disclosures of Protected Health Information for marketing purposes; and
• Disclosures that constitute a sale of your Protected Health Information.
Other uses and disclosures of Protected Health Information not covered by this Notice or the laws that apply to us will be made only with your written authorization. If you do give us an authorization, you may revoke it at any time by submitting a written revocation to our Privacy Officer and we will no longer disclose Protected Health Information under the authorization. However, disclosure(s) that we made in reliance on your authorization before you revoked it will not be affected by the revocation.
Right to Get Notice of a Breach
You have the right to be notified upon a breach of any of your unsecured Protected Health Information.
Right to Receive Confidential Communication
You have the right to request that we communicate with you about health matters in a certain way. For example, you can ask that we only contact you by mail to a specified address. To request that we communicate with you in a certain way, you must make your request in writing. We will not ask you the reason for your request. Your request must specify how or where you wish to be contacted. We will accommodate all reasonable requests.
Right to a Copy of this Notice
You have the right to receive a paper copy of this notice at any time. To receive a copy, please request it at any of our health centers. You may also obtain a copy of this notice on our website at www.altura.org.
Changes to this Notice
We reserve the right to change this notice and to make the changed notice effective for all of the health information that we maintain about you. We will post a copy of our current notice in our facility. Our notice will indicate the effective date on the first page. We will also give you a copy of our current notice upon request.
If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. You may file a complaint by mailing, faxing or e-mailing us a written description of your complaint or by telling us about your complaint in person or over the telephone:
Privacy Officer • ALTURA Centers for Health
1201 N Cherry St • Tulare, CA 93274 (559) 685-4634 email@example.com
When filing a complaint, please describe what happened and give us the dates and names of anyone involved. Please also let us know how to contact you so that we can respond to your complaint. You will not be penalized for filling a complaint.
Other Uses and Disclosures of Your Protected Health Information
Other uses and disclosures of personal health information not covered by this notice or applicable law will be made only with your written authorization. If you give us your written authorization to use or disclose your personal health information, you may revoke your authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose your personal health information for the reason covered by your written authorization. You understand that we are unable to take back any uses and disclosures that we have already made with your authorization, and that we are required to retain our records of the care that we have provided to you.