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. THIS NOTICE OF PRIVACY PRACTICES IS PROVIDED ON BEHALF OF THE FOLLOWING:
Introduction
We are committed to protecting the privacy of your protected health information (“PHI”) that is in our possession, and only using and disclosing your PHI as permitted by applicable laws and regulations. PHI is any information that we possess, use, and disclose that identifies you and relates to your past, current, or future physical and mental health condition or illness and the health care products and services that have been provided to you. This Notice of Privacy Practices (“Notice”) has been created to help you understand our legal duties under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) to protect your PHI and how we may use and disclose your PHI. We will mainly use and disclose your PHI in relation to the health care products and services that we provide you. Specifically, we will use and disclose your PHI as necessary to provide service to you and other health care operations and activities as described later in this Notice. This Notice also describes the legal rights that you have related to your PHI that is in our possession. We take the matters described in this Notice very seriously because of our relationship with you and the requirement that we comply with this Notice. Your PHI will only be used and disclosed as described in this Notice. Should a need for use and disclosure of your PHI occur that is not described in this Notice, we will obtain your written authorization before the use and disclosure. At some future time, it may be necessary for us to revise this Notice. If such becomes necessary, we will post the revised Notice on our website and if you request, provide a written Notice to you.
Your Rights With Respect To Your PHI
HIPAA provides you with several rights related to your PHI. These rights are summarized below. If you would like more information about any of these, please contact our Privacy Officer at the address or telephone numbers indicated in this Notice.
1. You have the right to receive this written Notice of Privacy Practices describing how we will protect your PHI and your rights related to PHI. You are entitled to request this written Notice at any time.
2. You have the right to request a limitation on our use and disclosure of your PHI. But please be aware that we may not be able to agree to your requested limitation if it results in our not being able to provide health care products and services to you or if we are required to use and disclose the PHI under federal or state law. CloudTop Health, Inc intends to honor requests by you not to disclose PHI to your health plan if the PHI relates solely to an item or service for which you have already paid in full. All requests for limitation on the use and disclosure of your PHI must be submitted in writing, using a form that we will provide, to our Privacy Officer. The address and telephone numbers for our Privacy Officer are listed at the end of this Notice.
3. You have the right to review or receive photocopies of our records that contain your PHI, to the extent that these records are part of a “designated record set” as defined by HIPAA. We will be pleased to allow you to review such records at no charge during normal business hours. However, we may charge you $0.10 per page for photocopies of the records, together with any expenses for mailing, special courier, faxing, and supplies necessary to fulfill your request for records. If we are unable to provide our records to you, we will provide you a written explanation of why we are not able to provide the records. Depending on the reason, you may submit a written request for us to reconsider. All requests to review or receive photocopies of our records that contain your PHI must be submitted in writing, using a form that we will provide, to our Privacy Officer. The address and telephone number for our Privacy Officer are listed at the end of this Notice.
4. You have the right to request changes in the content of your PHI contained in our records where you believe the content is incomplete, inaccurate, or for some other reason needs to be changed. We may not be able to agree to your requested change if we no longer have the records or if the requested change would cause your PHI to become inaccurate. If we are not able to agree to your requested change, we will notify you in writing as to why we are not able to agree. You will then have the right to submit to us a written statement of disagreement, to which we may elect to further respond in writing to you. All requests for changes to your PHI in our records must be submitted in writing, using a form that we will provide, to our Privacy Officer. The address and telephone number for our Privacy Officer are included in this Notice.
5. You have the right to request that we communicate with you about your PHI in a confidential manner and only to locations (such as a post office box) or by particular means (such as personal cellular telephone) specified by you. All requests for confidential communications must be submitted in writing, using a form that we will provide. The address and telephone number for our organization is included on the first page of this Notice.
6. You have the right to obtain an accounting of some of our disclosures of your PHI. By an accounting, we mean a written record of these disclosures.Other disclosures of your PHI that are not required to be included in the accounting are disclosures made directly to you or that you have authorized, made to family, friends, and others who assist you or are involved with your care (caregivers) and made for other purposes allowed by HIPAA. Please consult with our Privacy Officer, at the address or telephone number indicated in this Notice, for more information on the disclosures not required to be including in the accounting. The period of time for which we are required to provide the accounting is the six-year period immediately prior to the date of your request for the accounting. However, your request for an accounting can be for a shorter period of time. For disclosures by our business associates, we may provide you with a list of those business associates, in which case you may request an accounting of disclosures from them. You may obtain from us, without charge, one accounting during a 12-month period. However, if you request additional accountings during the same 12-month period, we may charge you $0.10 per page for printing or photocopying of the accounting, together with any expenses for mailing, special courier, faxing, and supplies necessary to fulfilling your request for the accounting. If it becomes necessary for us to charge you for an accounting, we will notify you in advance and allow you to withdraw or modify your request for the accounting. All requests for an accounting of our disclosures of your PHI must be submitted in writing, using a form that we will provide, to our Privacy Officer. The address and telephone number for our Privacy Officer is listed in this Notice.
7. We are obligated to notify you if a breach occurs that may have compromised the privacy or security of your PHI.
8. You have the right to file a complaint if you believe that we have violated your rights as described above and to not fear retaliation or adverse action by us against you for exercising your right. You can file the complaint with us directly or with the United States Department of Health and Human Services (“HHS”). Please be assured that we will work with you to resolve any complaint that you contact us to discuss. IF YOU HAVE QUESTIONS ABOUT ANY OF YOUR RIGHTS AS DESCRIBED ABOVE, PLEASE CONTACT OUR PRIVACY OFFICER AT THE ADDRESS OR TELEPHONE NUMBER INDICATED IN THIS NOTICE.
You may visit the following website for information on filing a complaint with the United States Department of Health and Human Services: http://www.hhs.gov/ocr/
Ways That We May Use and Disclose Your PHI
HIPAA requires that this Notice tell you how we may use and disclose your PHI including, in some instances, uses and disclosures that are permitted without your authorization. These uses and disclosures are summarized below, but if you would like more information about any of these please contact our Privacy Officer at the addresses or telephone numbers indicated at the end of this Notice.
1. Health care operations. Generally, HIPAA defines health care operations as those activities necessary and related to our providing of health care products and services to you. These activities include, but may not be limited to, the following:
A. Conducting quality assessment and improvement activities, case management and care coordination, and contacting of health care providers and patients with information about treatment alternatives and related functions that do not include treatment.
B. Conducting or arranging for medical review, legal services, and auditing functions, including fraud and abuse detection and compliance programs.
C. General administrative activities, including, but not limited to, activities relating to implementation of and compliance with the requirements of HIPAA. We will use and disclose your PHI to carry out the above activities as necessary or required, and especially to monitor and improve the quality of the health care products and services that are provided to you by us and other health care professionals.
2. Business associates. The nature of the healthcare system is such that we may not be able to provide health care products and services to you without the involvement of other businesses or persons. Depending on what these other businesses or persons do for us, they may become business associates as defined by HIPAA. In many situations, it will be necessary for us to provide your PHI to these business associates so that they can carry out the activities that we need to have performed in order to provide you with health care products and services. Contracts have or will be submitted to the business associates to whom we provide your PHI so that they can carry out their activities on our behalf. Very importantly to you, these contracts require our business associates to give us their assurance that they, like us, will protect the privacy of your PHI. Examples of business associates services include quality improvement, legal, data analysis/aggregation, and accounting.
3. Disclosures of your PHI. In providing health care products and services to you, we may find it necessary to communicate with businesses and individuals not already described above. In addition to communicating with these businesses and individuals, we may also communicate with you directly, as well as others who assist you with your health care, commonly referred to as caregivers. We will disclose your PHI to these caregivers, or appropriate others, as we believe necessary and appropriate for your health care.
4. Federal and state government agencies. We may disclose your PHI to federal and state government agencies for a variety of purposes, most of which are directed at monitoring health care quality and safety, and government programs related to health care and our compliance with laws applicable to health care. For example, the United States Drug Enforcement Administration (“DEA”) monitors the distribution and usage of controlled substances, while the United States Food and Drug Administration (“FDA”) monitors adverse drug events. We may disclose your PHI to such agencies where required by the agency so that the agency can carry out its required activities. Related to this, some private businesses, such as the manufacturers of medications and medical devices, are legally required to conduct post-marketing surveillance in order to ensure the safety of their products. Disclosing your PHI for such surveillance may be necessary. Our disclosures to federal and state government agencies will take place only as permitted by HIPAA or other applicable laws.
5. Federal and state government health care insurance programs. If you apply for and receive benefits from federal and state healthcare programs, such as Medicare, Medicaid, Tricare or Champus, your PHI may be disclosed to the agency granting these benefits. If you are employed by a business that is required to carry workers-compensation insurance, and you are injured in such a way that the workers-compensation plan covers your health care, it may be necessary to disclose your PHI to the workers-compensation plan. Such plans have a right to conduct audits, inspections, and investigations of our activities and your activities, and where required, we will disclose your PHI for these activities.
6. Law enforcement and/or health oversight activities. A number of federal, state, and local government agencies are charged with enforcing the health care and drug laws, and other laws in relation to the health care products and services that we may provide to you. These agencies may engage in a number of activities designed to monitor and improve federal and state health care programs and systems, government benefit programs, and government regulatory programs, including inspections, audits and investigations of our activities and the health care products and services that we provide to our patients. At any time that we are required by federal or state laws, or by court order, subpoena or other legal mandate, to disclose your PHI, we will do so as necessary. Additionally, as permitted by HIPAA, disclosures to law enforcement can include information for identification and location purposes (e.g., suspect or missing person); information regarding a person who is or is suspected to be a crime victim; in situations where the death of an individual may have resulted from criminal conduct; or to a coroner or medical examiner for the purpose of identification or determining cause of death.
7. Legal disputes. Lawsuits and other legal disputes may involve your PHI that we possess. In the event that you are involved in a lawsuit or other legal proceeding, whether as a plaintiff or a defendant, and without regard to the basis for the lawsuit, such as medical malpractice or divorce, we will disclose your PHI when required to comply with a court order, subpoena, discovery proceeding, such as a deposition, or other legal mandate served upon us.
8. Disclosures for the benefit of you and others. A variety of events could occur where we would use and disclose your PHI for your benefit and to prevent or reduce the risk of harm to you. Finally, we may disclose your PHI where necessary to protect the health and safety of others.
9. Disclosures for national security and intelligence. We are legally required to disclose your PHI where necessary for national security activities and intelligence and counterintelligence activities. Disclosures related to this may also include those where required in relation to the protection of the President of the United States. Any disclosure for these purposes would be made only to authorized government officials.
10. Disclosures if you are in the military or a veteran. We may use or disclose PHI of individuals who are Armed Forces personnel: (1) for activities deemed necessary by appropriate military command authorities; or (2) for the purpose of a determination by the Department of Veteran Affairs of eligibility for benefits. This includes any branch of the Armed Forces and whether on active or reserve status as required by the U.S. Military. If you are a veteran, we may release your PHI, particularly if you are receiving health care products and services from Veterans Services or the Veterans Administration. Any disclosure for these purposes would be made only to authorized government officials.
11. Marketing. We may only use and/or disclose your PHI for marketing activities if we obtain from you prior written authorization. For this purpose, “marketing” activities generally include communications to you that encourage you to purchase or use a product or service and, potentially, communications to you in the context of treatment and health care operations where we receive remuneration (monies) from a third party for making the communication. We may provide refill reminders or communicate with you about a drug or biologic that is currently prescribed to you so long as any payment we receive for making the communication is reasonably related to our cost of making the communication.
12. Other types of disclosures. This last category of disclosures includes a variety of disclosures that we may make in accordance with HIPAA. We may be required to disclose your PHI if you are placed into the custody of a federal or state correctional system, if necessary to protect the health and safety of you and others. We may disclose your PHI to a person who, under law, has the authority to represent you in making health care decisions. Your PHI may be “de-identified” so that your PHI is changed by removing certain information (e.g., your name, address) so that it does not identify you. Also, health care is an area where much research is being conducted, and as permitted by HIPAA we may disclose your PHI for purposes of a research project, and we may use or disclose de-identified information for a variety of purposes, including but not limited to research, analysis or other health-related studies. We may disclose your PHI to organizations that manage organ transplantation programs as permitted by HIPAA. We will not make any disclosure of PHI that is a sale of PHI without your authorization.
IF YOU HAVE QUESTIONS ABOUT WAYS THAT WE MAY USE AND DISCLOSE YOUR PHI AS DESCRIBED ABOVE, PLEASE CONTACT OUR PRIVACY OFFICER AT THE ADDRESS OR TELEPHONE NUMBER INDICATED IN THIS NOTICE.
Uses and Disclosures Not Contained in this Notice.
If a use and disclosure of your PHI is not contained in this Notice, then we will obtain you or your authorized representative’s written authorization before the use and disclosure. You may have the right to refuse to authorize the use and disclosure, or if you grant the authorization, to revoke the authorization at any time, except to the extent CloudTop Health, Inc has taken an action in reliance on the authorization. If such authorization is requested, we will provide you with a form that describes the proposed use and disclosure and your rights related to the requested authorization.
Conclusion
HIPAA requires that we give you this Notice of Privacy Practices and make a good faith effort to obtain your written acknowledgment that you were given this Notice. Upon giving you this Notice, you will be asked to sign a document acknowledging that you received this Notice. We appreciate your cooperation in reviewing this Notice and in giving us your written acknowledgment.
HIPAA requires that this Notice, at a minimum, cover the following three areas:
1. How we will use and disclose your protected health information;
2. Your rights with respect to your protected health information; and
3. Our legal duties to protect the confidentiality of your protected health information and to notify you if a breach occurs that may have compromised the privacy or security of your protected health information.
In preparing this Notice, we made every effort to comply with this HIPAA requirement. Also, we want to advise you that in addition to the privacy and other rights given to you by HIPAA, our state may from time to time enact laws that also provide you privacy and other rights in relation to your health care and your protected health information.
If you have any questions or want more information concerning your privacy rights under HIPAA or under the laws of our state or concerning our privacy practices, please consult our Privacy Officer: by phone at (813) 999-0898 or by mail at PO Box 10253 Tampa, FL 33679. Also, you should contact our Privacy Officer if you wish to file a complaint about our privacy practices or if you believe we have violated any of your rights as described in this Notice.
Effective Date: August 1, 2019
Revised September 4, 2019
CLOUDTOP HEALTH, INC
PO BOX 10253
Tampa, FL 33679
TELEPHONE (813) 999-0898 FAX (888) 286-3058