Privacy Practices of the Affiliated Medical Groups
MEDICAL INFORMATION PRIVACY NOTICE
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.
Effective Date: November 22, 2023
This Medical Information Privacy Notice (the “Notice”) describes the privacy practices of Mindbloom Medical, P.C.; Mindbloom Provider Group, P.A.; Mindbloom Medical Group of California, P.C.; Mindbloom Medical NJ, P.C.; Mindbloom Medical KS, P.A.; and the providers affiliated with these groups (collectively, “Groups,” “we,” “us,” or “our”) as they pertain to the use and disclosure of your Medical Information. Health information collected after you purchase any service through the Mindbloom website for purposes of intake and clinical evaluation, your treatment information, and all health records are identified in this Notice as “Medical Information.”
Mindbloom, Inc. is the management service organization for the independently owned professional practices and provides administrative, compliance, technology services to the practices—which includes operating the websites and mobile applications with links to this Notice. The providers who deliver services are independent professionals practicing subject to their state license regulations and within, or affiliated with, these groups (“Providers”).
Please note that the Health Insurance Portability and Accountability Act and applicable regulations (“HIPAA”) does not apply to us simply because there is health information involved, and HIPAA does not apply to your transactions or communications with our Providers or Groups. In addition, any Medical Information that you provide that is subject to specific protections under applicable state laws will be used and disclosed only in accordance with such applicable laws.
This Notice will tell you about the ways in which we may use and disclose your Medical Information, our obligations regarding that use and disclosure, and your rights to access and control that information.
Uses and Disclosures of Medical Information
Your Medical Information may be used and disclosed by our health care providers, our staff, and others that are involved in your care and treatment for the purpose of providing health care services to you, to support our business operations, to obtain payment for your care, and for any other reason authorized or required by law. Not every use or disclosure is listed in this Notice, but our uses or disclosures of your Medical Information will fall into one of the categories below:
Treatment: to provide, coordinate, or manage your health care and any related services, or send you reminders about your care. This includes the coordination or management of your health care with a third party.
Billing: to bill you or obtain payment for the health care services we have furnished to you.
Healthcare Business Operations: to support the general business activities of our medical practices. These activities include, but are not limited to, improving quality of care, customer service, care coordination, population-based activities related to improving health, evaluating practitioner performance, 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.
Uses and Disclosures Not Requiring Your Authorization
We may use or disclose your Medical Information in the following situations without your authorization: as required by law; to persons involved with your care when you are incapacitated or in an emergency; for public health purposes; for health care oversight purposes; for reporting victims of abuse, neglect or domestic violence; pursuant to regulatory requirements; in connection with legal proceedings; for law enforcement purposes; for workers’ compensation to the extent necessary to comply with workers compensation laws; to coroners, funeral directors and organ donation agencies to provide information regarding decedents; for certain research purposes; for certain criminal investigations, proceedings, or actions; for certain military activity and national security purposes; relating to certain inmate reporting; and other required uses and disclosures.
Under the law, we must make certain disclosures to you upon your request and when we’re required by government agencies to determine compliance with applicable laws and regulations. State laws may further restrict these disclosures. We do not share your Medical Information gathered by our clinicians or workforce members during your intake or treatment with third party analytics companies or for targeted advertising or marketing communications.
Uses and Disclosures Requiring Your Authorization
Except for the uses and disclosures described and limited as set forth in this Notice, we will use and disclose your Medical Information only with a written authorization from you. Your authorization must be signed by you or a designated representative and clearly state the rationale for disclosing the information and detail precisely the information you seek to be shared and to whom. This includes not selling your Medical Information to others, or using or disclosing your Medical Information for certain prohibited communications without your written authorization. Once you give us authorization to release your Medical Information, we cannot guarantee that the recipient to whom the information is provided will not disclose the information. You may take back or “revoke” your written authorization at any time in writing, except if we have already taken an action in reliance on the use or disclosure indicated in the authorization.
Certain federal and state laws may require special privacy protections that restrict the use and disclosure of certain Medical Information, including highly confidential information about you. If a use or disclosure of Medical Information is prohibited or materially limited by other laws that apply to us, it is our intent to meet the requirements of the more stringent law. Such laws may protect the following types of information: alcohol and substance abuse, biometric information, mental health, genetic information, reproductive health, prescriptions, sexually transmitted diseases, or communicable diseases.
Your Rights with Respect to Your Medical Information
You have the right to inspect and copy your Medical Information. We will deliver accessible medical records within a reasonable timeframe once we receive a request. The duration of accessibility may fluctuate depending on the type of data requested and complexity of the inquiry (e.g., a single record may be provided faster than historical records). We may charge you a reasonable fee for copies of your medical documents including costs associated with delivery.
You have the right to request a restriction on the use or disclosure of your Medical Information. Your request must be in writing and state the specific restriction requested and to whom you want the restriction to apply. We retain the right to not agree to a restriction that you request.
You have the right to request to receive confidential communications from us by alternative means or at an alternate location. We will comply with all reasonable requests submitted in writing which specify how or where you wish to receive these communications.
You have the right to request an amendment of your Medical Information. If we deny your request for amendment, you have the right to file a statement of disagreement with us. We may prepare a rebuttal to our statement and we will provide you with a copy of any such rebuttal.
You have the right to receive an accounting of certain disclosures of your Medical Information that we have made except for certain disclosures which were pursuant to an authorization, for purposes of treatment, payment, and healthcare business operations, or for certain other purposes.
Revisions to this Notice
We reserve the right to revise this Notice and to make the revised Notice effective for Medical 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 via the Mindbloom website. You then have the right to object or withdraw as provided in this Notice.
Breach of Medical Information & Security Review
We are required by law to maintain the privacy and security of your Medical Information. Our security and legal teams may review correspondence for specific accounts if we have a reason to believe that there is a security, legal, or fraud issue occurring with that specific account. We will notify you if a reportable breach of your unsecured Medical Information is discovered. Notification will include a brief description of how the breach occurred, the Medical Information involved, and contact information for you to ask questions.
For all inquiries, requests for records or special requests related to your Medical Information, please send a written request to: email@example.com or by postal mail to:
1317 Edgewater Dr #1583
Orlando, FL 32804
Complaints about this Notice or how we handle your Medical Information should be directed to firstname.lastname@example.org. If you are not satisfied with the way a complaint is handled you may submit a formal complaint to applicable state or federal agencies. We will not retaliate against you for filing a complaint.
We must follow the duties and privacy practices described in this Notice and will maintain the privacy of your Medical Information. If you have any questions about this Notice, please email email@example.com.