NOTICE OF PRIVACY PRACTICES
This Notice of Privacy Practices (“Notice”) describes how we, Premier Health and Affiliated Covered Entities may use and disclose your protected health information (“PHI”), as well as how you obtain access to such PHI. This Notice also describes your rights with respect to your PHI. We are required by HIPAA to provide this Notice to you. Please review it carefully.
HOW WE MAY USE AND DISCLOSE YOUR PHI
We may use and disclose PHI without your prior authorization for purposes of Treatment, Payment or Healthcare Operations. Note that some categories of information, such as HIV/AIDS information, genetic information, and information of state Medicaid recipients may be subject to more stringent confidentiality protections under applicable state or federal laws, and we will abide by these special protections.
USES AND DISCLOSURES OF PHI THAT DO NOT REQUIRE YOUR PRIOR AUTHORIZATION
The following are the primary circumstances under which we may use and disclose your PHI without a signed Authorization:
Treatment. We may use or disclose PHI as necessary to treat you or perform services in connection with your treatment or to allow another covered entity or healthcare provider to treat you. For example, we may disclose PHI to your pharmacist for dispensing prescription medications or to a specialist physician, or other health care providers or facility to help coordinate your care and make sure that everyone who is involved in your care has the information that they need about you to meet your health care needs.
Payment. We may use or disclose your PHI as necessary to receive reimbursement or compensation for services provided. We may contact an insurer to get payment authorization for services provided, and we are permitted to use PHI to bill you for the cost of the services provided. For example, we may need to release medical or other information about you to your insurance to process claims for health care services we have rendered. We may also disclose PHI as necessary for another covered entity’s payment activities.
Healthcare Operations. We may use or disclose PHI for healthcare operations, such as use in your health records, to provide appointment reminders or for our own internal quality and other business purposes. For example, we may use your PHI to review our services and to evaluate the performance of our staff. We may use your PHI as part of our efforts to continually improve the quality and effectiveness of the health care products and services we provide. We may also use your PHI for strategic planning, claims reporting and in developing and testing our information systems and programs.
Appointment Reminders. We may use and disclose your PHI to contact you as a reminder that you have an appointment for treatment or medical care.
Fundraising Activities. We may use your PHI to contact you in an effort to raise money for Premier Health and its operations. In making these communications we will only use or disclose limited information about you, including: your demographic information (name, address, other contact information, age, gender, and date of birth); dates of health care provided to you; department of service; your treating physician; whether you had a positive or negative outcome; and your health insurance status. If you do not want us to contact you for fundraising efforts, you have the right to opt-out of receiving such communications.
Individuals Involved in Your Care or Payment for Your Care. We may release PHI about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. We may also tell your family or friends your condition and that you are in the facility. In addition, we may disclose medical information about you to
Research. Under certain circumstances, we may use and disclose your PHI for research purposes. You will not be the subject of research without your prior written and informed consent. Unless otherwise described in the consent, your identity and your health information will remain private during and after the research. All research projects must comply with state and federal regulations.
As Required By Law. We will disclose your PHI when required to do so by federal, state or local law
To Avert a Serious Threat to Health or Safety. We may use and disclose your PHI when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
Organ and Tissue Donation. We may release your medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
Military and Veterans. If you are a member of the armed forces, we may release your PHI as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority.
Workers’ Compensation. We may release your PHI as authorized by applicable law to the extent necessary to comply with workers’ compensation laws or laws related to similar programs. These programs provide benefits for work-related injuries or illness.
Public Health Activities. We may disclose medical information about you for public health activities. These activities generally include the following: (i) to prevent or control disease, injury or disability; (ii) to report births and deaths; (iii) to report child abuse or neglect; (iv) to report reactions to medications or problems with products; (v) to notify people of recalls of products they may be using; (vi) to notify a person who may have been exposed to a disease or may be atrisk for contracting or spreading a disease or condition; (vii) to notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence (We will only make this disclosure if you agree or when required or authorized by law).
Health Oversight Activities. We may disclose your PHI to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
Law Enforcement. We may disclose your PHI if asked to do so by a law enforcement official: (i) In response to a court order, subpoena, warrant, summons or similar process; (ii) To identify or locate a suspect, fugitive, material witness, or missing person; (iii) About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement; (iv) About a death we believe may be the result of criminal conduct; (v) About criminal conduct at the facility; and (vi) In emergency circumstances, not occurring on the premises, to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.
Coroners, Medical Examiners and Funeral Directors. We may disclose your PHI to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release PHI to funeral directors as necessary to carry out their duties.
National Security and Intelligence Activities. We may disclose your PHI to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
Protective Services for the President and Others. We may disclose your PHI to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.
Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official, if necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
Third Parties. We may disclose your PHI to third parties with whom we contract to perform services on our behalf. If we disclose your information to these entities, we will have an agreement with them to safeguard the privacy and security of the information and to not further use or disclose the information. For instance, we may contract with a company that provides billing or health care management services.
OTHER USES OF MEDICAL INFORMATION
Other uses and disclosures of your PHI not covered by this Notice or the laws that apply to us will be made only with your written permission, including but not limited to (i) most uses and disclosures of psychotherapy notes; (ii) uses and disclosures involving mental health records or drug and alcohol treatment records, (iii) most uses and disclosures of your medical information for marketing purposes; and (iv) disclosures that constitute the sale of your medical information. If you provide us permission to use or disclose your PHI, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose your PHI for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.
YOUR HEALTH INFORMATION RIGHTS
You must submit your specific request in writing on the Written Specific Request to Exercise My Patient Rights form. All requests will be reviewed and considered within the timeframes required under HIPAA. Under certain circumstances, we may deny your request. If this occurs, you have the right to have the denial reviewed.
Right to Inspect and Copy. You have the right to inspect and copy the PHI that we maintain about you. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. . If we maintain this information electronically, you have the right to receive a copy of such information in an electronic format. Additionally, you have the right to ask us to send a copy of your PHI to other individuals or entities that you designate.
Right to Request an Amendment. If you feel that PHI maintained about you is incorrect or incomplete, you may request that we amend it. We are obligated to review any such request, but are not obligated to agree to it. Specifically, we may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that: (i) was not created by us, unless the person or entity that created the information is no longer available to make the amendment; (ii) is not part of the medical information kept by or for the facility; (iii) is not part of the information which you would be permitted to inspect and copy; or (iv) is accurate and complete.
Right to Accounting of Disclosures. You have the right to request an accounting of disclosures. This is a list of when, what, to whom, and why we disclosed medical information about you. To request this list or accounting of disclosures, you must submit your request in writing on the form described above. Your request must state a time period, within the six (6) years immediately preceding the request. Your request should indicate in what form you want the list (for example, on paper, electronically). The first list you request within a 12-month period will be free of charge. For additional requests in the same 12-month period, we may charge you a reasonable cost-based fee for providing you with the list. 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.
Right to Request Restrictions. You have the right to request a restriction or limitation on our use or disclose of your PHI for treatment, payment or health care operations. You also have the right to request a limitation on the PHI we disclose about you to someone who is involved in your care or the payment for your care. If we agree, we will comply with your request unless the information is needed to provide emergency treatment. We are not required to agree to the restrictions, unless your request is that we not disclose information to a health plan for payment or health care operations activities when you have paid for the services that are the subject of the information out-of-pocket in full.
Right to Request Confidential Communications. You have the right to request that we communicate with you about your health matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. Please note that if you choose to receive communications from us via email or other electronic means, those may not be a secure means of communication and your PHI that may be contained in our emails to you will not be encrypted.
Right to a Paper Copy of This Notice. You have the right to a paper copy of this Notice even if you have agreed to receive the Notice electronically. You may ask us to give you a copy of this Notice at any time. You may also obtain a copy of this Notice on our website.
Notification of a Breach. You have the right to be notified following a breach of your unsecured PHI, and we will notify you in accordance with applicable law.
CHANGES TO THIS NOTICE
We are required to follow the terms of this Notice or any change to it that is in effect. We reserve the right to change our practices and this Notice and to make the new Notice effective for all PHI we maintain. If we make a material change to this Notice, we will post the revised notice at the facility where you receive services and on our website and make the revised notice available upon request.
A patient who believes that we have violated his or her privacy rights may file a complaint with the Privacy Officer listed below. You may also file a complaint with the U.S. Department of Health and Human Services Office of Civil Rights, 200 Independence Avenue, S. W., Washington, DC 20201. We will promptly investigate any complaints in an effort to resolve the matter. We may not penalize or retaliate against you for filing such a complaint.
Privacy Officer Contact
10319 Jefferson Hwy Baton Rouge, LA 70809
Puerto Rico Contact
Blvd. del Rio Avenue, Ramal 3
Boulevard del Rio Office Plaza
Torre 3, Local A
Humacao, PR 00791
Revised November 2015
This Notice of Privacy Practices covers an Affiliated Covered Entity (“ACE”). When this Notice refers to the Premier Health ACE, it is referring to Premier Health and each of the following subsidiaries and affiliates: [Convenient Care, Lake After Hours, Total Occupational Medicine, Lake Urgent Care, Lourdes After Hours, Rapides Urgent Care, Lake Charles Urgent Care, Total Urgent Care, Lake Urgent Care Northshore, IU Health Urgent Care, St. Vincent’s Urgent Care, Premier Medical Center, Family Physicians Urgent Care, LCMC Health Urgent Care, St. Francis Urgent Care, Freedom Urgent Care]. Each of the Premier Health subsidiaries or affiliates listed above is a covered entity under HIPAA. Pursuant to 45 C.F.R. § 164.105(b), each of the Premier Health subsidiaries or affiliates hereby designates itself as a single covered entity for purposes of compliance with HIPAA. This designation may be amended from time-to-time to add new covered entities that are under the common control and ownership of Premier Health. To obtain a list of the most current listing of these entities, please contact the Privacy Officer. “ACE” amended December 2017.