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.
Effective Date: February 2, 2023
This Notice of Privacy Practices (the “Notice”) describes how Mindbloom Medical, P.C., Mindbloom Provider Group, P.A., Mindbloom Medical Group of California, P.C., Mindbloom Medical NJ, P.C., and Mindbloom Medical KS, P.A. (“we” or “our”) may use and disclose your health information to carry out treatment, payment or business operations and for other purposes that are permitted or required by law. This Notice also describes your rights to access and control your health information.
Uses and disclosures of health information:
Your health information may be used and disclosed by our health care providers, our staff, and others outside of our office 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.
We will use and disclose your 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 health information may be provided to a health care provider to whom you have been referred to ensure the necessary information is accessible to diagnose or treat you.
Your health information may be used to bill or obtain payment for your health care services. This may include certain activities that your health insurance plan may undertake before it approves or pays for your services, such as: making a determination of eligibility or coverage for insurance benefits and reviewing services provided to you for medical necessity.
Health care operations:
We may use or disclose, as needed, your health information in order to support the business activities of this office. 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.
Uses and disclosures that do not require your authorization
We may use or disclose your health information in the following situations without your authorization: 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; for certain criminal investigations, proceedings, or actions; for certain military activity and national security purposes; for workers’ compensation reporting; 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 required by government agencies to determine compliance with applicable laws and regulations. State laws may further restrict these disclosures.
Uses and disclosures that require your authorization:
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. Without your authorization, we will not use or disclose your health information for marketing purposes. We will not sell your health information without your authorization. Your health information will not be used for fundraising. If you provide us with an authorization for certain uses and disclosures of your information, you may revoke such authorization, at any time, in writing, except to the extent that we have taken an action in reliance on the use or disclosure indicated in the authorization.
Your rights with respect to your health information:
You have the right to inspect and copy your health information.
You may request access to or an amendment of your health information.
You have the right to request a restriction on the use or disclosure of your health information. Your request must be in writing and state the specific restriction requested and to whom you want the restriction to apply. We may not agree to a restriction that you request, except if the requested restriction is on a disclosure to a health plan for a payment or health care operations purpose regarding a service that has been paid in full out-of-pocket.
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 health 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 health information that we have made, paper or electronic, except for certain disclosures which were pursuant to an authorization, for purposes of treatment, payment, healthcare operations (unless the information is maintained in an electronic health record); or for certain other purposes.
You have the right to obtain a paper copy of this Notice, upon request, even if you have previously requested its receipt electronically by e-mail.
Revisions to this notice:
We reserve the right to revise this Notice and to make the revised Notice effective for 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 our website. You then have the right to object or withdraw as provided in this Notice.
Breach of health information:
We will notify you if a reportable breach of your unsecured health information is discovered. Notification will include a brief description of how the breach occurred, the health information involved and contact information for you to ask questions.
Complaints about this Notice or how we handle your health information should be directed to our Privacy Officer at email@example.com. If you are not satisfied with the manner in which a complaint is handled you may submit a formal complaint to applicable state or federal agencies, including the Federal Trade Commission. 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 health information.. If you have any questions about this Notice, please contact us at firstname.lastname@example.org.