Effective Date: March 1, 2017
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires us to ask each of our patients to acknowledge receipt of our Notice of Privacy Practices. The Notice is published on this page. You acknowledge receipt of this notice by accepting terms and conditions for joining Eden Health.
Eden Health, Inc. and Eden Health Medical, P.C. (a New York professional corporation), together, designate themselves as a single Affiliated Covered Entity ("ACE") for purposes of compliance with the Health Insurance Portability and Accountability Act of 1996 ("HIPAA"). Each of the entities, sites, locations and care providers will follow the terms of this joint notice. In addition, the entities, sites, locations and care providers may share medical information with each other for treatment, payment, or health care operations related to the ACE. This designation may be amended from time-to-time to add new covered entities that are under common control with Eden Health, Inc.
1. YOUR RIGHTS
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you. To exercise a right listed below, please send a written request to either email@example.com or Eden Health, 108 Reade Street Suite 4F, New York, New York 10013.
a. Get an electronic or paper copy of your medical record. You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. We will provide a copy or a summary of your health information, usually within 30 days of your request.
b. Ask us to correct your medical record. You can ask us to correct health information about you that you think is incorrect or incomplete. We may say “no” to your request, but we'll tell you why in writing within 60 days.
c. Request confidential communications. You can ask us to contact you in a specific way (for example, home or office phone) or to send mail or email to a different address. We will say “yes” to all reasonable requests.
d. Ask us to limit what we use or share. You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care. If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
e. Get a list of those with whom we've shared information. You can ask for a list (accounting) of the times we've shared your health information for six years prior to the date you ask, who we shared it with, and why. We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make).
f. Get a copy of this privacy notice. You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
g. Choose someone to act for you. If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.
h. File a complaint if you feel your rights are violated. You can complain if you feel we have violated your rights by contacting us via email at firstname.lastname@example.org or via letter at Eden Health, 108 Reade Street Suite 4F, New York, New York 10013. You can file a complaint 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.
2. YOUR CHOICES
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, reach out to us via email@example.com. Tell us in writing what you want us to do, and we will follow your instructions. If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In these cases, you have both the right and choice to tell us to:
a. Share information with your family, close friends, or others involved in your care. To authorize the release of information to your family, close friends, or another individual involved in your care, please request a copy of our release form via email at firstname.lastname@example.org or in person at your next appointment with Eden Health.
b. Share information in a disaster relief situation.
In the following cases, we never share your information unless you give us written permission:
a. Substance abuse treatment records. We will never share substance abuse treatment records unless you expressly write to request that we do so.
b. Most sharing of psychotherapy notes. We will never share psychotherapy notes unless you expressly write to request that we do so.
In the following case, we never share your information:
a. We never sell or market your personal information.
3. OUR USES AND DISCLOSURES
We typically use or share your health information in the following ways:
To treat you. We can use your health information and share it with other professionals who are treating you, examples include but are not limited to:
To run our organization.
To bill for your services.
We may occasionally use or share your health information in the following ways:
We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We must meet many conditions in the law before we can share your information for these purposes. For more information see the link below.
a. Help with public health and safety issues. We can share health information about you for certain situations such as:
b. Do research We can use or share your information for health research.
c. Comply with the law. We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we're complying with federal privacy law.
d. Respond to organ and tissue donation requests. We can share health information about you with organ procurement organizations.
e. Work with a medical examiner or funeral director. We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
f. Address workers' compensation, law enforcement, and other government requests. We can use or share health information about you:
4. OUR RESPONSIBILITIES
For more information see the link below.
Changes to the Terms of this Notice
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available on the website and upon request.
Email and SMS Messaging
By utilizing our services or replying to our emails or SMS messages, you acknowledge that you are aware that email and SMS messaging are not secure methods of communication, and that you agree to the risks. If you would prefer not to exchange personal health information via email or SMS messaging, please notify us at email@example.com.
Questions and Complaints
If you have any questions about this Notice or would like an additional copy, please contact the Privacy Officer at firstname.lastname@example.org.
If you think that we may have violated your privacy rights or you disagree with a decision we made about access to your PHI, you may send a written complaint to the Privacy Officer at 108 Reade Street Suite 4F, New York, New York 10013.