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EFFECTIVE APRIL 14, 2003
Under the Health Insurance
Portability and Accountability Act of 1996 ("HIPAA") we are
required to maintain the privacy of your protected health
information and provide you with notice of our legal duties and
privacy practices with respect to such protected health
information. We are required to abide by the terms of the notice
currently in effect. We reserve the right to change the terms of
our notice at any time and to make the new notice provisions
effective for all protected health information that we maintain.
In the event that we make a material revision to the terms of
our notice, you will receive a revised notice within 60 days of
such revision. If you should have any questions or require
further information, please contact our Privacy Officer at (541)
772-3062 or toll free at (800) 452-2558.
How We May Use or Disclose Your
Protected Health Information
Treatment
We may use or disclose your protected health information to
arrange for the provision of your medical treatment or services. For
example, the provider providing health care services to you will record
information in your record that is related to your treatment. This
information is necessary for us to perform certain functions that
include, but are not limited to, medical records reviews; to investigate
quality of care complaints; to perform quality improvement studies and
other functions, as HEALTH FUTURE is required under applicable law and
regulation.
Payment
We may use or disclose your protected health information in
order to process claims or make payment for covered services you receive
under your benefit plan. For example, your provider may submit a claim to
us for payment. The claim form will include information that identifies
you, your diagnosis, and treatment or supplies used in the course of
treatment.
Health Care Operations
We may use or disclose your protected health information for
health care operations. Health care operations include, but are not
limited to, quality assessment and improvement activities, underwriting,
premium rating, management, and general administrative activities. For
example, members of our quality improvement team may use information in
your health record to assess the quality of care that you receive and
determine how to continually improve the quality and effectiveness of
the services we provide in accordance with applicable state and federal
laws and regulations and applicable accreditation organization
requirements.
Business Associates
There may be instances where services are provided to our
organization through contracts with third-party "business associates."
Whenever a business associate arrangement involves the use or disclosure
of your protected health information, we will have a written contract
that requires the business associate to maintain the same high standards
of safeguarding your privacy that we require of our own employees and
affiliates.
Required by Law
We will disclose protected health information about you when
required to do so by federal, state, or local law.
Communication With Family or
Friends
Our service professionals, using their best judgment, may
disclose to a family member, other relative, close personal friend, or
any other person you identify, protected health information relevant to
that person's involvement in your care or payment related to your care.
Marketing
We may use or disclose your protected health information, as
necessary, to provide you with information about treatment alternatives
or other health-related benefits and services that may be of interest to
you.
Research
We may disclose information to researchers when their research
has been approved by an institutional review board that has reviewed the
research proposal and established protocols to ensure the privacy of
your protected information.
Coroners, Medical Examiners,
and Funeral Directors
We may disclose protected health information to a coroner or
medical examiner. We may also disclose protected health information to
funeral directors consistent with applicable law to carry out their
duties.
Organ Procurement
Organizations
Consistent with applicable law, we may disclose
protected health information to organ procurement organizations or other
entities engaged in the procurement, banking, or transplantation of
organs for the purpose of tissue donation or transplant.
Fundraising
We may contact you as part of a fundraising effort.
Public Health
As required by law, we may disclose your protected health
information to public health or legal authorities charged with
preventing or controlling disease, injury, or disability.
Food and Drug Administration (FDA)
We may disclose to the FDA protected health information
relative to adverse events with respect to food, supplements, product
and product defects, or post-marketing surveillance information to
enable product recalls, repairs, or replacement.
Workers' Compensation
We may disclose protected health information to the extent
authorized by and to the extent necessary to comply with laws relating
to workers' compensation or other similar programs established by law.
To Avert a Serious Threat to Health or Safety
Consistent with applicable federal and state laws, we may use
and disclose protected health information when necessary to prevent a
serious threat to your health and safety or the health and safety of the
public or another person.
Military and Veterans
If you are a member of the armed forces, we may disclose protected
health information about you as required by military command.
Health Oversight Activities
We may disclose protected health information to a health
oversight agency for activities authorized by law, including audits,
investigations, inspections, and licensure.
Protective Services for the
President, National Security, and Intelligence Activities
We may disclose protected health information about you to
authorized federal officials so they may provide protection to the
President, other authorized persons, or foreign heads of state or to
conduct special investigations, for intelligence, counterintelligence,
and other national security activities authorized by law.
Law Enforcement
We may disclose protected health information when requested by
a law enforcement official as part of law enforcement activities;
investigations of criminal conduct; in response to court orders; in
emergency circumstances; or when required to do so by law.
Inmates
We may disclose protected health information about an inmate of
a correctional institution or under the custody of a law enforcement
official to the correctional institution or law enforcement official.
Lawsuits and Disputes
We may disclose protected health information about you in
response to a subpoena, discovery request, or other lawful order from a
court.
Plan Sponsors
We may disclose protected health information about you to your
plan sponsor to carry out plan administration functions that the plan
sponsor performs upon certification by the plan sponsor that the plan
documents have been amended as set forth under HIPAA regulations.
Our Rights Regarding Your
Protected Health Information
The following describes your rights regarding the health
information we maintain about you. To exercise your rights, you must
submit your request in writing to our Privacy Officer at 300 South Park
Road, Hollywood, FL 33021.
Right to Request Restrictions
You have the right to request that we restrict uses or
disclosures of your protected health information to carry out treatment,
payment, health care operations, or communication with family or
friends. We are not required to agree to a restriction.
Right to Receive Confidential
Communications
You have the right to request that we send communications that
contain your protected health information by alternative means or to
alternative locations. We must accommodate your request if it is
reasonable and you clearly state that the disclosure of all or part of
that information could endanger you.
Right to Inspect and Copy
You have the right to inspect and copy protected health
information that we maintain about you in a designated record set. A
"designated record set" is a group of records that we maintain such as
enrollment, payment, and claims adjudication record systems. If copies
are requested or you agree to a summary or explanation of such
information, we may charge a reasonable cost-based fee for the costs of
copying, including labor and supply cost of copying; postage; and
preparation cost of an explanation or summary, if such is requested. We
may deny your request to inspect and copy in certain circumstances as
defined by law. If you are denied access to your protected health
information, you may request that the denial be reviewed.
Right to Amend
You have the right to have us amend your protected health
information for as long as we maintained such information. Your written
request must include the reason or reasons that support your request. We
may deny your request for an amendment if we determine that the record
that is the subject of the request was not created by us, is not
available for inspection as specified by law, or is accurate and
complete.
Right to Receive an Accounting
of Disclosures
You have the right to receive an accounting of disclosures of
your protected health information made by us in the six years prior to
the date the accounting is requested (or shorter period as requested).
This does not include disclosures made to carry out treatment, payment,
and health care operations; disclosures made to you; communications with
family and friends; for national security or intelligence purposes; to
correctional institutions or law enforcement officials; or disclosures
made prior to the HIPAA compliance date of April 14, 2003. Your first
request for accounting in any 12-month period shall be provided without
charge. A reasonable cost-based fee shall be imposed for each subsequent
request for accounting within the same 12-month period.
Right to Obtain a Paper Copy
You have the right to obtain a paper copy of this Notice of
Privacy Practices at any time.
How to File a Complaint if You
Believe Your Privacy Rights Have Been Violated
If you believe that your privacy rights have been violated, please
submit your complaint in writing to:
HEALTH FUTURE, LLC
Attn: Privacy Officer
777 Murphy Road
Medford, OR 97504
You may also file a complaint with the
Secretary of the Department of Health and Human Services. You can not be
retaliated against for filing a complaint.
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