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. 

If you have any questions about this notice, please contact the Vida Medical Clinic. 

OUR OBLIGATIONS: 

We are required by law to:  

• Maintain the privacy of protected health information (PHI)    

• Give you this notice of our legal duties and privacy practices regarding PHI about you 

• Follow the terms of our notice that is currently in effect 

 
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION: 

The following describes how we may use and disclose PHI that identifies you.   Except for the purposes described below, we will use and disclose PHI only with your written permission.  You may revoke such permission at any time by writing to our Privacy Officer.    

For Treatment.  We may use and disclose PHI for your treatment and to provide you with treatment-related health care services.  For example, we may disclose PHI to doctors, nurses, technicians, or other personnel, including people outside our office, who are involved in your medical care and need the information to provide you with medical care.    

For Health Care Operations.  We may use and disclose PHI for health care operations purposes.  These uses and disclosures are necessary to ensure that all of our patients receive quality care and operate and manage our office.  For example, we may use and disclose information to ensure the obstetrical or gynecological care you receive is of the highest quality.  We also may share information with other entities that have a relationship with you (for example, your health plan) for their health care operation activities.     

Appointment Reminders, Treatment Alternatives, and Health-Related Benefits and Services. We may use and disclose PHI to contact you to remind you that you have an appointment with us. We may also use and disclose PHI to tell you about treatment alternatives or health-related benefits and services that may be of interest to you.   

Individuals Involved in Your Care or Payment for Your Care.  When appropriate, we may share PHI with a person who is involved in your medical care or payment for your care, such as your family or a close friend.  We also may notify your family about your location or general condition or disclose such information to an entity assisting in a disaster relief effort.   

SPECIAL SITUATIONS: 

As Required by Law.  We will disclose PHI when required by federal, state, or local law. 

To Avert a Serious Threat to Health or Safety.  We may use and disclose PHI when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Disclosures, however, will be made only to someone who may be able to help prevent the threat.   

Business Associates.  We may disclose PHI to our business associates who perform functions on our behalf or provide us with services if the information is necessary for such functions or services.  For example, we may use another company to perform billing services on our behalf.  All of our business associates are obligated to protect the privacy of your information. They are not allowed to use or disclose any information other than as specified in our contract. 

Organ and Tissue Donation. If you are an organ donor, we may use or release PHI to organizations that handle organ procurement or other entities engaged in the procurement, banking, or transportation of organs, eyes, or tissues to facilitate organ, eye, or tissue donation and transplantation.  

Military and Veterans.  If you are a member of the armed forces, we may release PHI as required by military command authorities.  We also may release PHI to the appropriate foreign military authority if you are a member of a foreign military.  

Workers’ Compensation.  We may release PHI for workers’ compensation or similar programs.  These programs provide benefits for work-related injuries or illnesses.   

Public Health Risks.  We may disclose PHI for public health activities.  These activities generally include disclosures to prevent or control disease, injury, or disability; report births and deaths; report child abuse or neglect; report reactions to medications or problems with products; notify people of recalls of products they may be using; a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and 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 PHI to a health oversight agency for activities authorized by law. These oversight activities include audits, investigations, inspections, and licensure. The government must monitor the health care system, government programs, and compliance with civil rights laws through these activities. 

Data Breach Notification Purposes.  We may use or disclose your PHI to provide legally required notices of unauthorized access to or disclosure of your health information. 

Lawsuits and Disputes.  If you are involved in a lawsuit or a dispute, we may disclose PHI in response to a court or administrative order.  We also may disclose PHI in response to a subpoena, discovery request, or other lawful process by someone involved in the dispute, but only if efforts have been made to tell you about the request or obtain an order protecting the information requested.   

Law Enforcement.  We may release PHI if asked by a law enforcement official if the information is: (1) in response to a court order, subpoena, warrant, summons, or similar process; (2) limited information to identify or locate a suspect, fugitive, material witness, or missing person; (3) about the victim of a crime even if, under certain very limited circumstances, we are unable to obtain the person’s agreement; (4) about a death we believe may be the result of criminal conduct; (5) about criminal conduct on our premises; and (6) in an emergency 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, Medical Examiners, and Funeral Directors.  We may release PHI to a coroner or medical examiner.  This may be necessary, for example, to identify a deceased person or determine the cause of death.  We also may release PHI to funeral directors as necessary for their duties.   

National Security and Intelligence Activities.  We may release PHI to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.   

Protective Services for the President and Others. We may disclose PHI to authorized federal officials so they may protect the President, other authorized persons, or foreign heads of state or conduct special investigations.   

Inmates or Individuals in Custody.  If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release PHI to the correctional institution or law enforcement official.  This release would be necessary: (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution. 

USES AND DISCLOSURES THAT REQUIRE US TO GIVE YOU AN OPPORTUNITY TO OBJECT: 

Individuals Involved in Your Care or Payment for Your Care. Unless you object, we may disclose to a member of your family, a relative, a close friend, or any other person you identify your PHI that directly relates to that person’s involvement in your health care. If you cannot agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. 

Disaster Relief.  We may disclose your PHI to disaster relief organizations that seek your Protected PHI to coordinate your care or notify family and friends of your location or condition in a disaster.  We will provide you with an opportunity to agree or object to such a disclosure whenever we can do so practically. 

YOUR WRITTEN AUTHORIZATION IS REQUIRED FOR OTHER USES AND DISCLOSURES: 

The following uses and disclosures of your PHI will be made only with your written authorization: 

1. Uses and disclosures of PHI for marketing purposes; and 
2. Disclosures that constitute a sale of your PHI 
3. Disclosures when it is sought to investigate or impose liability on individuals, healthcare providers, or others who seek, obtain, provide, or facilitate reproductive health care that is lawful under the circumstances in which such health care is provided or to identify persons for such activities.  

Other uses and disclosures of PHI not covered by this notice or the laws that apply to us will be made only with your written authorization.  If you give us authorization, you may revoke it at any time by submitting a written revocation to our Privacy Officer, and we will no longer disclose PHI under the authorization.  However, the disclosure that we made based on your authorization before you revoked it will not be affected by the revocation.   

YOUR RIGHTS: 

You have the following rights regarding PHI we have about you: 

Right to Inspect and Copy.  You have a right to inspect and copy PHI that may be used to make decisions about your care or payment for your care.  This includes medical and billing records other than psychotherapy notes.  To inspect and copy this PHI, you must make your request in writing to Vida Medical Clinic.  We have up to 15 days to make your PHI available to you, and we may charge you a reasonable fee for the costs of copying, mailing, or other supplies associated with your request.  We may not charge you a fee if you need the information for a claim for benefits under the Social Security Act or any other state or federal needs-based benefit program.  We may deny your request in certain limited circumstances.  If we do deny your request, you have the right to have the denial reviewed by a licensed healthcare professional who was not directly involved in the denial of your request, and we will comply with the outcome of the review. 

Right to an Electronic Copy of Electronic Medical Records. If your PHI is maintained in an electronic format (an electronic medical record or an electronic health record), you have the right to request that an electronic copy of your record be given to you or transmitted to another individual or entity.  We will make every effort to provide access to your PHI in the form or format you request if it is readily producible in such form or format.  If the PHI is not readily producible in the form or format you request, your record will be provided in either our standard electronic format or, if you do not want this form or format, a readable hard copy form.  We may charge you a reasonable, cost-based fee for the labor of transmitting the electronic medical record. 

Right to Get Notice of a Breach. You have the right to be notified when your unsecured PHI is breached. 

Right to Amend.  If you feel that the PHI we have is incorrect or incomplete, you may ask us to amend it.  You have the right to request an amendment for as long as the information is kept by or for our office.  To request an amendment, you must make your request in writing to Vida Medical Clinic.   

Right to an Accounting of Disclosures.  You have the right to request a list of certain disclosures we made of PHI for purposes other than treatment, payment, and health care operations for which you provided written authorization.  To request an accounting of disclosures, you must make your request in writing to Vida Medical Clinic.  

Right to Request Restrictions.  You have the right to request a restriction or limitation on the PHI we use or disclose for treatment, payment, or health care operations.  You also have the right to request a limit on the PHI we disclose to someone involved in your care or the payment for your care, like a family member or friend.  For example, you could ask that we not share information about a particular diagnosis or treatment with your spouse.  To request a restriction, you must make your request in writing to Vida Medical Clinic. We are not required to agree to your request unless you ask us to restrict the use and disclosure of your PHI to a health plan for payment or health care operation purposes. Such information you wish to restrict pertains solely to a health care item or service you have paid us “out-of-pocket” in full. If we agree, we will comply with your request unless the information is needed to provide emergency treatment. 

Right to Request Confidential Communications.  You have the right to request that we communicate with you about medical matters in a certain way or location.  For example, you can ask that we only contact you by mail or at work.  To request confidential communications, you must make your request in writing to Vida Medical Clinic. Your request must specify how or where you wish to be contacted.  We will accommodate reasonable requests.  

Right to a Paper Copy of This Notice.  You have the right to a paper copy of this notice.  You may ask us to give you a copy of this notice at any time.  Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy.   

CHANGES TO THIS NOTICE: 

We reserve the right to change this notice and make the new notice apply to the PHI we already have and any information we receive in the future.  We will post a copy of our current notice at our office.  The notice will contain the effective date on the first page, in the top right-hand corner. 

COMPLAINTS: 

If you believe your privacy rights have been violated, you may file a complaint with Vida Medical Clinic or with the Secretary of the Department of Health and Human Services.  Contact Vida Medical Clinic’s Privacy Officer to file a complaint with our office.  All complaints must be made in writing.  You will not be penalized for filing a complaint.