NOTICE OF HIPAA PRIVACY POLICIES FOR PATIENTS AND CLIENTS OF QUILTED HEALTH PROFESSIONAL SERVICES CORPORATION
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
Last modified: May 6th, 2021
This Notice describes how Quilted Health Professional Services Corporation and Journey Health, Inc. (d.b.a Quilted Health) when acting on behalf of the Professional Services Corporation may use and disclose health information about you (“Protected Health Information”) and how you can access this information.
Permissible Uses and Disclosures Without Your Written Authorization
Your protected health information may be used and disclosed by our healthcare 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 any other use authorized or required by law.
TREATMENT: We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. Uses and disclosures for treatment purposes include, but are not limited to, the types of uses and disclosures that follow. We may use your information to direct or recommend alternative treatments, therapies, healthcare providers, or settings of care to you or to describe a health-related product or service. We may use your information to obtain your medication history from your pharmacy/pharmacy benefits manager, health plans, and other healthcare providers. We may also disclose protected health information to a healthcare provider to whom you have been referred to ensure they have the necessary information to diagnose or treat you.
PAYMENT: Your protected 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 your protected health information to support our health care operations, which include internal administration, business planning, and activities that improve the quality and cost effectiveness of the care provided to you. We also may create and use de-identified data, in which information is removed from your protected health information so that you cannot be identified (“De-identified Data”), as authorized by law.
AS REQUIRED BY LAW: We may use and disclose your protected health information to the extent required by any applicable federal, state or local law.
UNIQUE CIRCUMSTANCES: We may use or disclose your protected health information in the following unique circumstances without your authorization: to assist in public health activities, such as disease tracking and reporting information about products under the under the U.S. Food and Drug Administration’s jurisdiction; to inform authorities to protect victims of abuse or neglect; for health care oversight purposes, such as investigations of fraud; in response to a legal order or other lawful process during a judicial or administrative proceeding; to law enforcement officials as required by law or in compliance with a court order; to coroners, funeral directors and organ donation agencies as authorized by law; for research purposes pursuant to a valid authorization from you or following institutional review board protocols; to avert a serious threat to health or safety; to assist in specialized government functions, such certain military activity and national security purposes; for workers’ compensation reporting; and other required uses and disclosures.
USES AND DISCLOSURES REQUIRING YOUR WRITTEN AUTHORIZATION
For any purpose other than described above, we only use or disclose your protected health information with your written authorization. We are prohibited from using or disclosing your protected health information for purposes that are considered marketing under the HIPAA privacy rule, including accepting payment from third parties in exchange for making communications about treatments, providers, products, or services, without your written authorization. We also will never sell your protected health information without your written authorization.
If you provide us with an authorization for certain uses and disclosures of your information, you may revoke such authorization at any time, except to the extent that we have taken an action in reliance on it, by contacting us at firstname.lastname@example.org
YOUR RIGHTS WITH RESPECT TO YOUR PROTECTED HEALTH INFORMATION
You have the following rights regarding the PHI maintained by the Professional Services Corporation:
- You have the right to inspect and copy your protected health information.
- You have the right to request and receive timely responses to your requests for protected health information. Unless otherwise protected by law we may not withhold this information from you.
- You may request access to or an amendment of your protected health information.
- You have the right to request a restriction on the use or disclosure of your protected health/personal information. Your request must be in writing to email@example.com and state the specific restriction requested and to whom you want the restriction to apply. If we agree to comply with your request, we will be bound by such agreement, except when otherwise required by law or in the event of an emergency.
- You have the right to request to receive confidential communications from us by alternative means or at an alternate location, and we will accommodate reasonable requests. You must submit your request in writing to firstname.lastname@example.org
- You have the right to request an amendment of your protected health information. If we deny your request for amendment, you have the right to file a statement of disagreement with us.
- You have the right to receive an accounting of certain disclosures of your protected health information that we have made for the prior six (6) years, except to the extent made for purposes of treatment, payment, healthcare operations, or certain other purposes (such as your authorization).
- You have the right to obtain a paper copy of this Notice, upon request, even if you have previously requested its receipt electronically by email.
- You have the right to file a complaint if you believe your privacy rights have been violated. You can file a written complaint with us at the address below, or with the U.S. 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.
BREACH OF HEALTH INFORMATION
You have the right to be notified in the event that we (or one of our business associates) discovers a breach of unsecured PHI.
REVISIONS TO THIS NOTICE
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 our website. You then have the right to object or withdraw as provided in this Notice.
Complaints about this Notice or how we handle your protected health information should be directed to our HIPAA Privacy Officer at email@example.com or in writing to the Attention of the Quilted Health Privacy Officer at 4311 11th Ave NE, 5th Floor, Seattle WA 98105.