THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
This Notice of Privacy Practices (“NOTICE”) is provided to you pursuant to the Health Insurance Portability and Accountability Act of 1996, as amended, and its implementing regulations (“HIPAA”). This Notice is designed to inform you of how we may, under federal law, use or disclose your health information.
We understand that health information about you is personal, and we are committed to protecting the privacy of your information. As a patient of The Cusp, we maintain a record of the care you receive in a healthcare record so that we may provide you with quality care and to comply with various legal requirements. This Notice applies to the records of your care provided by The Cusp health care providers.
We are required by law to:
Maintain the privacy of your health information;
Give you this Notice of our legal duties and privacy practices with respect to your health information;
Notify you if you are affected by a breach of unsecured health information; and
Follow the terms of the Notice that is currently in effect.
The following people or groups will comply with this Notice:
Any health care professional authorized to enter information into your healthcare records maintained by The Cusp.
All workforce members of The Cusp.
We may use or disclose your protected health information to provide you with medical treatment or services, to obtain payment for our services or for certain uses that are necessary to operate our business.
we may use or disclose your health information to provide, coordinate or manage your care and any related services. This may also include coordinating or managing your care with a third party, or using a third party to assist us in providing such care to you.
we may use or disclose your health information to bill or obtain payment for our services. This may include releasing your health information to an insurance company to obtain payment for services.
we may use your health information for uses necessary to run our healthcare business, such as to conduct quality assessment activities, or arrange for legal services. This may include using your health information to (i) conduct internal audits and compliance programs to verify proper billing procedures or conduct fraud, waste and abuse investigations; (ii) improve quality of care; (iii) provide information about treatment alternatives or other health-related benefits and services; or (iv) obtain legal services.
We may also use or disclose your protected health information in the following situations without your authorization. These situations 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; for certain criminal activities; 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 the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of HIPAA. State laws may further restrict these disclosures.
Other uses and disclosures of your health information not described in this Notice will be made only with your authorization. We will obtain your written authorization for: (i) most uses and disclosures of psychotherapy notes; (ii) most uses and disclosures of health information for marketing purposes, as defined by HIPAA; and (iii) disclosures that constitute a sale of PHI, as defined by HIPAA. If you authorize us to use or disclose your health information for another purpose, you may revoke your authorization, in writing, at any time. Your revocation will be effective upon receipt, but will not be effective to the extent that we or others have acted in reliance upon the authorization.
You have the rights described below in regard to the health information that we maintain about you. You must submit a written request to exercise any of these rights. You may obtain forms for any of these purposes by contacting the Privacy Officer at the number or address below.
you have the right to inspect and get a copy of health information maintained by us and used in decisions about your care. This right does not apply to psychotherapy notes and certain other information. We may charge you a reasonable cost-based fee to cover copying, postage and/or preparation of a summary. We may deny your request in certain circumstances. You may request a licensed health care professional chosen by us to review a denial based on medical reasons; we will comply with this decision.
if you believe the health information we created for you is inaccurate or incomplete, you may ask us to amend it in writing. We cannot delete or destroy any information already included in your medical record. You must provide a reason for your request. We may deny your request if you ask to amend information that: (i) we did not create (unless the person or entity that created the information is not available to make the amendment); (ii) is not part of the health information we maintain; (iii) is not part of the information you are permitted by law to inspect and copy; or (iv) is accurate and complete.
you have the right to ask for a list or “accounting” of disclosures we have made of your health information. We are not required to list all disclosures, such as those you authorized or disclosures made for treatment, payment, health care operations and certain other purposes. You must state a time period, which may not be longer than 6 years or include dates before April 14, 2003. You may obtain one accounting in a 12-month period for free; we may charge you a reasonable fee for additional accountings of disclosures.
you have the right to request a restriction or limit how we use or disclose your health information. You must be specific in your request for restriction. We are not required to comply with your request, except when you request that we restrict disclosure of your health information to a health plan for a health care item or service for which you have paid out-of-pocket in full and the disclosure is for the purpose of carrying out payment or health care operations, and not otherwise required by law.
you have the right to request, in writing, that we contact you about medical issues in a certain way, such as by mail, or at alternative locations. You must specify how or where you wish to be contacted; we will try to accommodate reasonable requests.
you have the right to a paper or electronic copy of this Notice, which is posted and available on our website.
We reserve the right to change our privacy practices and update this Notice accordingly. We reserve the right to make the revised or changed Notice effective for all your health information, even if it was created prior to the change in the Notice. Revised Notices will be posted and available on our website.
If you believe any of your privacy rights have been violated, you may file a complaint with our Privacy Officer. You may also file a complaint with the Office for Civil Rights of the U.S. Department of Health and Human Services Rights by sending a letter to 200 Independence Avenue, S.W., Room 509F HHH Bldg., Washington, D.C. 20201, calling 1-877-696-6775, or visiting WWW.HHS.GOV/OCR/PRIVACY/HIPAA/COMPLAINTS/. WE WILL NOT TAKE ANY ACTION AGAINST YOU FOR FILING A COMPLAINT.
You may contact us about our privacy practices calling our Privacy Officer at firstname.lastname@example.org or writing to our Privacy Officer at:
680 2nd Street
San Francisco, CA 94107
This Notice is effective as of October 4, 2019.