Effective Date: 05/01/2016
Yosemite Medical Clinic / Yosemite Emergency Medical Services
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
Yosemite Medical Clinic / Yosemite Emergency Medical Services respects your privacy. We maintain records containing your personal health information that are protected by law. This Notice of Privacy Practices explains how we may use or disclose your protected health information, your rights and our legal duties regarding your protected health information. In this Notice your protected health information is called your “Health Information”.
Our Duties Regarding Your Health Information
Yosemite Medical Clinic / Yosemite Emergency Medical Services is required by law to maintain the privacy of your Health Information and provide you with this Notice of our legal duties and privacy practices with respect to your Health Information. We reserve the right to change our privacy practices and the terms of this Notice and make the provisions of a revised Notice effective for all your Health Information we maintain. If we revise the Notice we will provide it to you when it is in effect by posting it in a clear and prominent location in our facility, having a copy available for you to request and take with you and posting it on our website if we maintain a website. We must follow the terms of the Notice that is in effect. You may request a copy of the Notice any time and we will give you a copy of the Notice that is in effect when you request it.
You may contact our Privacy Official if you have any questions or would like further information about the matters covered by this Notice. You will find our Privacy Official’s contact information at the end of this Notice.
How We May Use and Disclose Your Health Information
Use and Disclosure of Your Health Information for Treatment, Payment and Health Care Operations
We are permitted to use and disclose your Health Information for purposes of treatment, payment and health care operations.
- Treatment. We may use or disclose your Health Information to provide you with health care treatment or services. For example, we may use your Health Information to diagnose and treat you or we may disclose your Health Information to a health care provider you may be referred to so that provider has information needed to diagnose or treat you.
- Payment. We may use or disclose your Health Information to obtain payment or be reimbursed for the health care treatment and services we provide. For example, we may give your Health Information to your health plan so it can reimburse you or pay us. We may also provide your Health Information to your health plan to obtain prior approval for treatment or to determine whether your plan will cover the treatment.
- Health Care Operations. We may use or disclose your Health Information in connection with our health care operations which are ways we provide health care and manage our organization. For example, we may use or disclose your Health Information to evaluate our performance in providing health care to you and identify ways we may improve our service.
Use and Disclosure of Your Health Information Required or Permitted by Law
There are situations besides treatment, payment or health care operations where we may use or disclose some of your Health Information without first obtaining your written authorization. Any such use or disclosure will be limited to the Health Information required or permitted by law in the following situations.
- Public Health. We may disclose your Health Information to public health authorities that are authorized by law to collect or receive information to report vital information and prevent or control disease or injury. For example, we may report information about communicable diseases, child abuse or neglect, problems related to food, medications or medical devices or products and vital events such as births or deaths. We may also disclose your Health Information to a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition or findings concerning a work-related illness or injury or workplace related health issue to an employer. If we reasonably believe you are a victim of abuse, neglect, or domestic violence we may disclose your Health Information limited to requirements of law to a government authority, including a social service or protective services agency, authorized by law to receive reports of such abuse, neglect, or domestic violence.
- Health Oversight Activities. We may disclose your Health Information to a health oversight agency that includes, among others, an agency of the federal or state government authorized by law to monitor the health care system. Authorized health oversight activities include audits; civil, administrative, or criminal investigations; inspections; licensure or disciplinary actions; civil, administrative or other activities necessary for appropriate oversight of the health care system.
- Judicial and Administrative Proceedings. We may disclose your Health Information in the course of judicial or administrative proceedings. For example, we make a disclosure in response to a court or administrative order or subpoena.
- Law Enforcement Purposes. We may disclose your Health Information to a law enforcement official as required by law, in response to a law enforcement official’s lawful request to identify or locate a victim, suspect, fugitive, material witness or missing person or to report a crime that has occurred on our premises or that may have caused a need for emergency services.
- Required by Law. We may use or disclose your Health Information when required by state, federal or other law to correctional institutions, the Food and Drug Administration and authorized federal officials for the conduct of lawful national security activities and the provision of protective services to the President or other persons as required by federal law.
- Coroners, Medical Examiners and Funeral Directors. We may disclose your Health Information to coroners or medical examiners to identify a deceased person or to determine the cause of death and to funeral directors as necessary to carry out their duties.
- Organ Donation. We may disclose your Health Information to an organ procurement organization or other facility that participates in or makes a determination for the procurement, banking or transplantation of organs or tissues.
- Research. We may use or disclose your Health Information for research purposes under strict legal protection only if the use or disclosure has been reviewed and approved by a special Privacy Board or Institutional Review Board or if you authorize the use or disclosure.
- Disaster Relief Incidents. We may disclose your Health Information to a public or private entity authorized to assist in disaster relief efforts such as the American Red Cross. If you tell us you object, we will not make this use or disclosure unless we must do so to respond to an emergency situation.
- Persons Involved in Your Care. We may disclose your Health Information to persons involved in your health care or payment for health care including family members, your personal representative or another person identified by you unless you request a restriction on disclosure of your Health Information to such persons and we agree to restrict disclosure.
- Workers Compensation. We may use or disclose your Health Information to comply with worker's compensation laws.
- Avert a Serious Threat to Health or Safety. We may use or disclose your Health Information if we believe it is necessary to prevent or lessen a serious threat to the health or safety of a person or the public.
- School Immunization Records. We may disclose your Health Information to provide proof of your immunization to a school if you are an adult or emancipated minor and you agree; or if the Health Information is about a minor child and the child’s parent or guardian agrees.
- Military. If you are a member of the armed forces, we may release medical information about you to military authorities as authorized or required by law. We may also release medical information about foreign military personnel to the appropriate foreign military authority.
- Business Associates. We may use entities that are called Business Associates to perform work or services for us such as legal, accounting or financial services where the Business Associate may be required to create, receive, maintain or transmit your Health Information, but only if the Business Associate first agrees by written contract to safeguard your Health Information in accordance with the same standards we follow, and as is required by law.
- Fundraising. We may use limited Health Information such as your name, address and treatment dates to contact you for fundraising purposes to support our health care purposes and mission. You have the right to elect not to receive fundraising communications and if you receive a fundraising communication from us you will also receive simple instructions about how to stop receiving any more fundraising communications.
Use and Disclosure of Your Health Information Requiring Written Authorization
Your written authorization is required for the following uses and disclosures of your Health Information:
- Marketing. We will not use or disclose your Health Information for marketing purposes without your written authorization. Marketing is defined as a communication about a product or service related to your health care for which we receive payment from a third party.
- Sale of your Health Information. We will not use or disclose your Health Information in a way that is considered a sale of your Health Information without your written authorization. A sale of your Health Information is defined as an exchange where we, directly or indirectly, receive payment for your Health Information from the third party recipient of your Health Information.
- Psychotherapy Notes. If we maintain psychotherapy notes about you we will not disclose psychotherapy notes without your written authorization except in limited instances that are permitted or required by law.
All Other Uses and Disclosures of Your Health Information Require Written Authorization
Your written authorization is required for any other uses and disclosures of your Health Information that are not described in this Notice.
You May Revoke an Authorization in Writing at Any Time
You may revoke an authorization to use or disclose your Health Information at any time. Your revocation must be in writing and it will not affect uses or disclosures of your Health Information made in reliance on your authorization before its revocation. If the Authorization was obtained as a condition of obtaining insurance coverage, other law may provide the insurer with the right to contest a claim under the policy or the policy itself.
Your Rights Regarding Your Health Information
This section explains your rights and how you can make use of your rights regarding your Health Information.
1. Your Right to Our Notice of Privacy Practices
You have the right to obtain a paper copy of our current Notice of Privacy Practices. You have the right to receive an electronic copy of this Notice from our web site if we maintain one or, if you agree in writing, by email. You have the right to obtain a paper copy of this Notice at any time even if you have agreed to receive it electronically. You may ask our Privacy Official whose contact information is at the end of this Notice to provide you with a copy of our current Notice at any time.
2. Your Right to Request Restrictions of Use and Disclosure of Your Health Information
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 care or the payment for your care, such as a family member or friend.
To request a restriction, you must make your request in writing to our Privacy Official whose contact information is at the end of this Notice. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, only to you and your spouse. We are not required to agree to your request except in the limited circumstance described below. If we do agree, our agreement must be in writing, and we will comply with your request unless the information is needed to provide you emergency care.
We are required to agree to a request not to share your information with your health plan (health insurance provider) if the following conditions are met:
A. We are not otherwise required by law to share the information;
B. The information would be shared with your insurance company for payment purposes;
C. You pay the entire amount due for the health care item or service out of your own pocket or someone else pays the entire amount for you.
3. Your Right to Request Confidential Communications
You have the right to request that we communicate with you about your Health Information by alternative means or at an alternative location. For example, you can ask that we only contact you by telephone at work or by mail in a sealed envelope (not a post card). We will not ask you the reason for your request and we will accommodate all reasonable requests. If we are unable to communicate with you by the alternative means or at the alternative location you have requested we may attempt to communicate with you using any information we have. Your request must be in writing and given to our Privacy Official whose contact information is at the end of this Notice. You may use our request form if you like.
4. Your Right to Inspect and Copy your Health Information
You have the right to inspect and copy your Health Information we maintain that may be used to make decisions about your care for as long as we maintain those records. You may also request an electronic copy of your Health information if we maintain it electronically. Your request must be in writing and given to our Privacy Official whose contact information is at the end of this Notice. You may use our request form if you like. We may charge a reasonable, cost-based fee if you request a copy of your Health Information including costs of labor, supplies and postage. We will provide the access to your Health Information requested or, in some circumstances, we may deny part or all of the request. If we deny your request in whole or in part we will explain in writing why we denied the request and explain how you may request a review of our denial and how you may make a complaint to us and the Secretary of the U.S. Department of Health and Human Services concerning our denial.
5. Your Right to Request Amendment of your Health Information
If you believe your Health Information we maintain is incorrect or incomplete you have the right to request we amend that Health Information. Your request must be in writing and given to our Privacy Official whose contact information is at the end of this Notice. We will inform you of our action on your request including what we will do if we accept your request for amendment in whole or in part. If we deny all or part of your request for amendment we will provide you with the reasons for the denial and inform you of your additional rights regarding our denial including your right to complain to us and the Secretary of the U.S. Department of Health and Human Services.
6. Your Right to an Accounting of Disclosures of your Health Information
You have the right to receive an accounting of any disclosures of your Health Information we have made, other than disclosures relating to treatment, payment, health care operations and disclosures made to you or in accordance with your written authorization to make a disclosure. Your request must be in writing and given to our Privacy Official whose contact information is at the end of this Notice. You may use our request form if you like. You may request an accounting of disclosures for up to six (6) years prior to the date on which you make the request. We must provide you with the accounting in writing. The first accounting you request in any twelve (12) month period will be free of charge. We may charge you a reasonable, cost-based fee for any additional request for an accounting you make within the same twelve (12) month period and we will inform you in advance of the fee and provide you with an opportunity to withdraw or modify the request for another accounting in order to avoid or reduce the fee.
7. Your Right to Make a Complaint that Your Privacy Rights Have Been Violated
If you believe your privacy rights have been violated, you have the right to file a complaint with us and with the Secretary of the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint that your privacy rights have been violated. You may file a complaint with us by contacting the office of our Privacy Official listed below. Information about making a complaint to the Secretary is provided below.
Yosemite Medical Clinic / Yosemite Emergency Medical Services
For more information about the matters covered by this Notice, to make a request about any of your health information rights or to make a complaint that your privacy rights have been violated please contact our Privacy Official listed below. If you wish we will provide you with a form to make a complaint in writing to us. We will not retaliate against you for filing a complaint that your privacy rights have been violated.
Privacy Official of Yosemite Medical Clinic / Yosemite Emergency Medical Services
Telephone: (209) 372-0803
9000 Ahwahnee Drive,
Yosemite National Park, CA, 95389
Secretary, U. S. Department of Health and Human Services
You may make a complaint that your privacy rights have been violated to the Secretary of the U.S. Department of Health and Human Services. We will not retaliate against you for making a complaint to the Secretary that your privacy rights have been violated. The process to make a complaint to the Secretary is explained on the Internet at HHS.gov. A complaint to the Secretary must be filed within 180 days of when you first knew of the reasons you believe your health information privacy rights were violated although the 180-day period may be extended if you can show "good cause.”
You may file a Health Information Privacy Complaint with the Secretary online through the OCR Complaint Portal or obtain a Health Information Privacy Complaint Form Package to fill out, print and submit by mail, fax or email. If you prefer, you may submit a written complaint in your own format by mail or fax to the OCR office in your region or by email to OCRComplaint@hhs.gov.
If you have any questions about filing a complaint you may call the Department of Health and Human Services, Office for Civil Rights toll-free at 1-800-368-1019, TDD: 1-800-537-7697.