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 (the “Notice”) describes how the FOLX Professionals, as an affiliated covered entity composed of multiple distinct medical groups including but not limited to Ampersex.VA PC, AS Medical of New York, P.C., Marsha Medical Group of CA, P.C., Marsha Medical Group of Kansas, P.A., Marsha Medical Group of NJ, P.C., and Marsha Medical Group, P.A. (collectively, “we” or “our”), may use and disclose your protected health information to carry out treatment, payment, or business operations and for other purposes that are permitted or required by law. “Protected health information” or “PHI” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical health or condition, treatment or payment for health care services.
This Notice also describes your rights with regard to your protected health information.
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION:
How do we typically use or share your protected health information? We typically use or share your protected health information in the following ways:
TREATMENT:
We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party. For example, your protected health information may be provided to any other health care provider with whom you have an existing treatment relationship to ensure the necessary information is accessible to diagnose or treat you.
PAYMENT:
Your protected health information may be used to bill or obtain payment for your health care services. For example, we may use your PHI in connection with processing payments for services provided to you.
HEALTH CARE OPERATIONS:
We may use or disclose protected health information in order to support the business activities of the FOLX Professionals. These activities include, but are not limited to, improving quality of care, providing information about treatment alternatives or other health-related benefits and services, development or maintaining and supporting computer systems, legal services, and conducting audits and compliance programs, including fraud, waste and abuse investigations.
OTHER USES AND DISCLOSURES:
We may use or disclose your protected health information in other ways – usually in ways that contribute to the public good. We have to meet conditions in the law before we can share your information for these purposes. For example, these situations may include the following uses and disclosures: as required by law; for public health purposes; for health care oversight purposes; for abuse or neglect reporting; pursuant to Food and Drug Administration requirements; in connection with legal proceedings; for law enforcement purposes; to coroners, funeral directors and organ donation agencies; for certain research purposes; to report certain criminal activities; for certain military activity and national security purposes; for workers’ compensation reporting; relating to certain inmate reporting; and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of the Health Insurance Portability and Accountability Act (“HIPAA”).
Other permitted and required uses and disclosures will be made only with your consent, authorization or opportunity to object unless permitted or required by law. We may restrict access to or disclosure of health information about you as required by other state and federal laws if those laws are more protective of your health information.
YOUR CHOICES:
For certain protected 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 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; or share information in a disaster relief situation. In these cases we never share your information unless you give us written permission: marketing purposes; sale of your information; most sharing of psychotherapy notes; and in the case of fundraising, we may contact you for fundraising efforts, but you can tell us not to contact you again.
YOUR RIGHTS:
When it comes to your protected health information, you have certain rights. Ask us how to make any of these requests.
You can get an electronic or paper copy of your medical record and other health information we have about you. We may require that you put your request in writing. 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.
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. 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.
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.
You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
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 make sure the person has this authority and can act for you before we take any action.
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.
OTHER INFORMATION:
We reserve the right to revise this Notice and to make the revised Notice effective for protected health information we already have about you as well as any information we receive in the future. You are entitled to a copy of the Notice currently in effect. Any significant changes to this Notice will be posted on the Platform.
Effective Date for this Notice: [insert original effective date]
Questions and complaints about this Notice or how we handle your protected health information should be directed to our HIPAA Privacy Officer at Privacy@folxhealth.com. If you are not satisfied with the manner in which a complaint is handled you may submit a formal complaint to the 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.