Effective as of: March 28, 2024
Sprinter Medical West, PC (“Sprinter,”“we,” or “us”) is committed to protecting the privacy and security of your ProtectedHealth Information (i.e., “health information”) under the Health InsurancePortability and Accountability Act of 1996, as amended, and its implementing regulations (“HIPAA”). This notice describes your rights, as well as Sprinter’s rights and obligations, with respect to your health information under HIPAA.
YOUR RIGHTS
You have the right to:
• Get a copy of your paper or electronic medical record
• Correct your paper or electronic medical record
• Request confidential communications
• Ask us to limit the information we share
• Get a list of those with whom we’ve shared your information
• Get a copy of this privacy notice
• Choose someone to act for you
• File a complaint if you believe your privacy rights have been violated
YOUR CHOICES
You have some choices in the way that we use and share information as we:
• Tell family and friends about your condition
• Provide disaster relief
• Perform certain marketing activities (as defined by HIPAA)
• Use and disclose your information in other ways that require your written authorization
OUR USES AND DISCLOSURES
We may use and share your information as we:
• Treat you
• Run our organization
• Bill for your services
• Help with public health and safety issues
• Do research
• Comply with the law
• Address workers’ compensation, law enforcement, and other government requests
• Respond to lawsuits and legal actions
• Perform internal and external audits
YOUR RIGHTS
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you. To exercise any of these rights, please contact our Privacy Officer using the contact information provided at the end of this notice.
Get an electronic or paper copy of your medical record:
• You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you.
• We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee. Under limited circumstances, we may deny you access to certain records. If we deny your request, you may ask us to review the denial.
Ask us to correct your medical record
• You can ask us to correct health information about you that you think is incorrect or incomplete.
• We may say “no” to your request, but we’ll tell you why in writing within 60 days.
Request confidential communications
• You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
• We will say “yes” to all reasonable requests.
Ask us to limit what we use or share
• You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
• If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
Get a list of those with whom we’ve shared information
• You can ask for a list (i.e., an “accounting”) of the times we’ve shared your health information (i.e., “disclosures”) for six years prior to the date you ask, who we shared it with, and why.
• We will provide you with the accounting of disclosures you requested, but we will not include disclosures about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We will provide one accounting a year for free but may charge a reasonable, cost-based fee if you ask for another one within 12 months.
Get a copy of this privacy notice
• You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically.
Choose someone to act for you
• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
• We will take steps to verify the person has this authority and can act for you before we take any action.
File a complaint if you feel your privacy rights are violated
• You can complain if you feel we have violated your privacy rights by contacting us at privacy@sprinterhealth.com.
• 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 www.hhs.gov/ocr/privacy/hipaa/complaints/.
• We will not retaliate against you for filing a complaint.
YOUR CHOICES
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 information in the situations described below, talk to us. Tell us what you want us to do, and we will take steps to follow your instructions.
In these cases, you have both the right and choice to tell us to:
• Share information with your family, close friends, or others involved in your care
• Share information in a disaster relief situation
If you are not able to 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. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In these cases, we never share your information unless you give us written authorization:
• Marketing purposes (as defined by HIPAA)
• Sale of your information
OUR USES AND DISCLOSURES
How do we typically use or share your health information?
We typically use or share your health information in the following ways.
Treat you
We can use your health information and share it with other professionals who are treating you. We may also use your information to direct or recommend alternative treatments, therapies, health care providers, or settings of care to you or to describe a health-related product or service.
Example: A health care provider reviewing your diagnostic test results asks another one of your health care providers about your overall health condition.
Run our organization
We can use and share your health information to run our practice, improve your care, and contact you when necessary. We may also use and share your health information for other various “health care operations,” including internal administration and planning and various activities that improve the quality and cost effectiveness of the care that we deliver to you.
Example: We use health information about you to manage your treatment and services or monitor the quality of our health care services.
Bill for your services
We can use and share your health information to bill and get payment from health plans or other entities.
Example: We give information about you to your health insurance plan so it will pay for your services.
How else can we use or share your health information?
We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
Help with public health and safety issues
We can share health information about you for certain situations such as:
• Preventing or controlling disease, injury, or disability
• Helping with product recalls
• Reporting adverse reactions to medications
• Reporting suspected abuse, neglect, or domestic violence
• Preventing or reducing a serious threat to anyone’s health or safety
Do research
We can use or share your health information for health research purposes. We may make these research uses and disclosures of health information if (1) an institutional review board or privacy board has determined the research meets certain criteria, (2) under certain circumstances if the information is about patients who are deceased, or (3) by using a limited data set as described further below. In addition, in preparation for research when permitted by law, we may review health information to draft research protocols, identify or contact prospective research participants, or for similar purposes provided that legal conditions designed to protect your privacy are met. All other uses and disclosures of health information for research will require your written authorization.
To Create De-identified Information and Limited Data Sets
We may use health information to create de-identified health information and limited data sets. De-identified health information is health information that cannot reasonably be used to identify you. Once health information has been appropriately de-identified under HIPAA and other applicable law, we may use and share the de-identified health information for any purpose, such as to help advance medical care. Limited data sets consist of health information that does not include certain direct identifiers about you, such as your name or phone number. We may use and share limited data sets for purposes of research, health care operations, or public health activities as described in this notice after entering into a HIPAA-compliant agreement with the recipient.
Comply with the law
We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
Address workers’ compensation, law enforcement, and other government requests
We can use or share health information about you:
• For workers’ compensation claims
• For law enforcement purposes or with a law enforcement official
• With health oversight agencies for activities authorized by law
• For special government functions such as military, national security, and presidential protective services
Respond to lawsuits and legal actions
We can share health information about you in response to a court or administrative order, in response to a subpoena, or in the context of other judicial or administrative proceedings.
We may use health information to create de-identified health information and limited data sets. De-identified health information is health information that cannot reasonably be used to identify you. Once health information has been appropriately de-identified under HIPAA and other applicable law, we may use and share the de-identified health information for any purpose, such as to help advance medical care. Limited data sets consist of health information that does not include certain direct identifiers about you, such as your name or phone number. We may use and share limited data sets for purposes of research, health care operations, or public health activities as described in this notice after entering into a HIPAA-compliant agreement with the recipient.
OUR RESPONSIBILITIES
• 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 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. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
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, in our office, and on our website.
Contact the Privacy Offer at privacy@sprinterhealth.com if you have questions about this Notice of Privacy Practices.