Index Health is no longer accepting new patients.
Legal
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.
This Notice of Privacy Practices (“Notice”) describes how we may use and disclose your medical information (also known as “protected health information” under the Health Insurance Portability and Accountability Act (HIPAA)) to carry out treatment, payment and health care operations and for other purposes that are permitted or required by law. This Notice also describes your rights to access and control your medical information. References to “we,” “us,” “our,” or “our” means Ziemba Medical, P.C., the health care provider that provides you with care on behalf of Index Health, Inc.
Note that certain types of medical information may be subject to special confidentiality protections under applicable state or federal law. To the extent that any federal or state laws are more stringent than the provisions of this Notice, we will comply with the more stringent laws.
We are required by law to protect the privacy of your medical information and to provide you with this Notice. We are required to abide by the terms of this Notice, as currently in effect. We will let you know promptly if a breach occurs that may have compromised the privacy or security of your medical information. We may change the terms of this Notice at any time. The new notice will be effective for all medical information that we maintain at that time. Upon your request, we will provide you with any revised notice. You may request a revised version of this Notice by emailing us and requesting that a revised copy be sent to you via email or asking for one at the time of your next appointment.
Your medical information may be used and disclosed by our providers, personnel, and others who are involved in your care and treatment for the purpose of providing health care services to you. Your medical information may also be used and disclosed to pay your health care bills and to support our operations. The following are examples of the types of uses and disclosures of your medical information that we are permitted to make. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by us.
We will use and disclose your medical information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with another provider. For example, we may disclose your medical information to a provider to whom you have been referred to ensure that the provider has the necessary information to diagnose or treat you. As another example, we may disclose your medical information to another provider (e.g., a specialist or laboratory) who, at the request of your provider, becomes involved in your care.
Your medical information will be used and disclosed, as needed, to obtain payment for your health care services provided by us or by another provider. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we recommend for you such as: making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example, we may disclose to your health plan information about a treatment you are going to receive from us to obtain prior approval or to determine whether your plan will cover the treatment. As another example, we may provide basic information about you and your health plan to providers outside of our office office who are involved in your care, to assist them in obtaining payment for services they provide to you.
We may use or disclose, as needed, your medical information in order to support our business activities. These activities include, but are not limited to, quality assessment activities, employee review activities, training, licensing, and conducting or arranging for other business activities. For example, we may use your medical information to manage your treatment and services and to contact you about appointments or test results.
We may use or disclose your medical information in the following situations without your authorization or providing you the opportunity to agree or object. These situations include:
We may use and disclose your medical information, as necessary, to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
We may use and disclose your medical information to outside persons or entities that perform services on our behalf, such as auditing, legal, or transcription services. Such persons or entities are our “business associates.” Whenever an arrangement between us and our business associates involve the use or disclosure of your medical information, we must have a written contract that contains terms that will protect the privacy and security of your medical information.
We may disclose your medical information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. For example, we may disclose your medical information for the purpose of preventing or controlling disease, injury or disability.
We may disclose your medical information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), or in certain conditions in response to a subpoena, discovery request or other lawful process.
We may disclose your medical information as authorized to comply with workers’ compensation laws and other similar legally established programs.
We may disclose your medical information, if authorized or required by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.
We may disclose medical information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.
We may disclose your medical information to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your medical information if we believe that you have been a victim of abuse, neglect or domestic violence to the governmental entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.
We may disclose your medical information to a person or company required by the Food and Drug Administration for the purpose of quality, safety, or effectiveness of FDA-regulated products or activities, including to report adverse events, product defects or problems, biologic product deviations, to track products, to enable product recalls, to make repairs or replacements, or to conduct post marketing surveillance, as required.
We may also disclose certain medical information, so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include legal processes, limited information requests for identification and location purposes pertaining to victims of a crime, suspicion that death has occurred as a result of criminal conduct, in the event that a crime occurs on the premises of our practice, and medical emergency (not on our premises) and it is likely that a crime has occurred.
We may disclose your medical information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your medical information.
Consistent with applicable federal and state laws, we may disclose your medical information if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose medical information if it is necessary for law enforcement authorities to identify or apprehend an individual.
When the appropriate conditions apply, we may use or disclose medical information of individuals who are Armed Forces personnel: for activities deemed necessary by appropriate military command authorities; for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits, or to foreign military authority if you are a member of that foreign military services. We may also disclose your medical 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.
In some circumstances, medical information related to certain diseases or illnesses may be subject to other federal and state law restrictions that may limit or preclude some uses or disclosures described in this Notice. For example, there may be special restrictions on the use or disclosure HIV test results or status, mental health records, and alcohol and substance abuse treatment records.
We may use and disclose your medical information in the following instances. You have
the opportunity to agree or object to the use or disclosure of all or part of your medical information. If you are not present or able to agree or object to the use or disclosure of the medical information, then your provider may, using professional judgment, determine whether the disclosure is in your best interest.
Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your medical information that directly relates to that person’s involvement in your health care. If you are unable to 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. We may use or disclose medical information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death. Finally, we may use or disclose your medical information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.
Other uses and disclosures of your medical information will be made only with your written authorization, including: uses and disclosures of your medical information for marketing purposes, unless an exception applies; and disclosures that constitute the sale of your medical information. You may revoke this authorization in writing at any time. If you revoke your authorization, we will no longer use or disclose your medical information for the reasons covered by your written authorization. Please understand that we are unable to take back any disclosures already made pursuant to your authorization and prior to receiving your revocation.
The following is a description of your rights with respect to your medical information. To exercise your rights, please contact our Privacy Officer (via telephone at (561) 556-2656
or via email at privacyofficer@indexclinic.com)
If you have given someone medical power of attorney or if someone is your legal guardian or personal representative, that person can exercise your rights and make choices about your medical information.
You have the rights to:
You have the right to inspect and copy your medical information, with the exception of psychotherapy notes and certain other circumstances, such as when the information is compiled in anticipation of litigation or if providing such information will endanger your life or physical safety. You may obtain your medical record that contains medical and billing records and any other records that we use to make decisions about you. To the extent feasible, access or a copy of your medical information will be provided to you in the form or format that you request, including an electronic form or format if we maintain your medical information electronically. As permitted by federal or state law, we may charge you a reasonable fee for a copy of your records.
You have the right to request that we amend your medical information, for so long as we maintain this information, if you feel that the information we have about you is incorrect or incomplete. You must provide a reason to support your request for an amendment. We may deny your request if it is not in writing or if it does not include a reason supporting the request. In addition, we may deny your request if you ask us to amend information that:
You have the right to request a restriction of your medical information. This means you may ask us not to use or disclose any part of your medical information for the purposes of treatment, payment or health care operations. To request a restriction, you must submit your request in writing to our privacy officer’s email address listed above. We are not required to agree to your request unless you have paid for the services out of pocket in full and ask us not to disclose your medical information related solely to those services to your health plan for payment or health care operations purposes. If we agree to the requested restriction, we may not use or disclose your medical information in violation of that restriction unless it is needed to provide emergency treatment.
You have the right to receive an accounting of certain disclosures we have made, if any, of your medical information for the six (6) years prior to your request for the accounting. This right applies to disclosures for purposes other than treatment, payment or health care operations as described in this Notice. It excludes disclosures we may have made to you if you authorized us to make the disclosure, to family members or friends involved in your care, for notification purposes, for national security or intelligence, to law enforcement (as provided in the privacy rule) or correctional facilities, or as part of a limited data set disclosure. You may receive one (1) free accounting during a twelve (12) month period. If you request more than one (1) accounting you may be charged a fee. 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.
You have the right to request to receive confidential communications from us by alternative means or at an alternative location. We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. We will not request an explanation from you as to the basis for the request.
If you have given someone medical power of attorney or if someone is your legal guardian or personal representative, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.
You have the right to complain if you believe we have violated your rights. We will not retaliate against you for filing a complaint. You may either file a complaint:
