THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.Our Duty to Protect Your Protected Health Information (PHI) Identifiable information about your past, present, or future health, the provision of medical care, or payment for medical care is considered "Protected Health Information" (PHI). We are obligated to extend certain protections to your PHI and to provide you with this notice about privacy practices that explain how, when, and why we may use or disclose your PHI. Except in specific circumstances, we must use or disclose only the minimum necessary PHI to achieve the intended purpose of the use or disclosure. Additional copies of this notice are available in the waiting room or on our website https://espanol.raicesdebienestar.org/privacidad/.
How We May Use and Disclose Your Protected Health Information (PHI) We use and disclose PHI for a variety of reasons. We have a limited right to use and/or disclose your PHI for treatment, payment, and for our healthcare operations. For subsequent uses, we must have your written authorization unless the law permits or requires us to use or disclose without your authorization. If we disclose your PHI to an external entity to perform a function on our behalf, we must have an agreement from that entity that it will extend the same privacy protection to the information that we must apply to your PHI. However, the law states that we are allowed to make some disclosures without consent or authorization. Below, we describe and provide examples of our disclosures of your PHI.
Uses and Disclosures Related to Treatment, Payment, or Healthcare Operations- For treatment: We may disclose your PHI to doctors or other healthcare personnel who are involved in your medical care.
- For payment: We may disclose your PHI to bill and collect payment for your healthcare services.
- For healthcare operations: We may need to provide information to a government agency for its study. This is very unlikely, but if it were to occur, your name would be removed from what is sent.
Uses and Disclosures of PHI That Require Authorization For disclosure beyond treatment, payment, and operations purposes, we are required to have your written authorization unless the disclosure falls within one of the exceptions described below. The authorization may be revoked at any time to stop future disclosures, except to the extent that we have already acted on your authorization.
Uses and Disclosures of PHI from Mental Health Records That Do Not Require Consent- When required by law: We must disclose PHI to report suspected abuse, lawsuits, or other legal proceedings in which we have received a subpoena, and to government agencies that monitor HIPAA compliance.
- To prevent threats to health or safety: To prevent a serious threat to health or safety, we must disclose PHI as necessary to law enforcement or other persons who can reasonably mitigate the threat of harm.
- For specific government functions: We must disclose PHI of military personnel and veterans to government benefit programs related to eligibility and enrollment, Workers' Compensation programs, and for national security.
Your Rights Regarding Your Protected Health Information (PHI) You have the following rights related to your PHI:
- To request restrictions on disclosures: You have the right to request that we limit how we disclose your PHI. We will consider your request, but we are not legally required to accept it. To the extent that we agree, we will put the agreement in writing and adhere to it except in emergency situations. We cannot agree to limit disclosures required by law.
- To inspect and request a copy of PHI: Unless access to your records is restricted for clear and documented treatment reasons, you have the right to see your PHI upon written request. If you request copies of your PHI, a copying fee may be charged, depending on your circumstances. You have the right to choose which parts of your information you want to copy.
- To request the amendment of your PHI: If you believe there is an error or missing information in your PHI, you can request, in writing, that we correct the record. We will respond within 60 days. We may deny the request if we determine that the PHI is: 1. Correct and complete; 2. Not created by us; 3. Not permitted to be disclosed. Any denial will state the reasons for the denial.
- To know what disclosures have been made: You have the right to receive a list of when, to whom, for what purpose, and what content of your PHI has been disclosed, other than cases of disclosure: for treatment, payment, and operations; to you, your family, or in accordance with your written authorization. Your request can relate to disclosures going back seven years.
- Couples Counseling: Regarding couples counseling, confidentiality belongs to both parties. Information will not be disclosed unless a signed consent form is received from both parties.
Uses and disclosure of contact informationRaices de Bienestar understands that the privacy of your personal information is important. We will not share your personal data with any third party/affiliates without your direct consent. Opt-in for disclosure of contact information to third-parties may be done via email, verbal consent, and inbound SMS.
We may use and share information about you as we:
- Treat you
- Operate our organization
- Bill for your services
- Help with public health and safety issues
- Conduct research
- Comply with the law
- Address workers’ compensation, law enforcement, and other government requests
- Respond to lawsuits and legal actions
If you believe we have violated your privacy rights, you may file a complaint with our Clinic Manager, Eduardo Figueroa at privacy@raicesdebienestar.org. You may also file a written complaint with the Secretary of the U.S. Department of Health and Human Services. A complaint will not affect the quality of your care with us.
If you would like a copy of this document, you will have the opportunity to download your signed documents after completing the packet. You are encouraged to keep a copy for your records.