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. We are required by law to give you this Notice of our duties and privacy practices and your rights. Snap Diagnostics considers personal information to be confidential. We protect the privacy of that information in accordance with federal and state privacy laws, as well as our own company privacy policies.
Uses and Disclosures of Health Information
Snap Diagnostics may use and disclose medical information about you for several different purposes including:
Treatment: Snap Diagnostics may use or disclose your protected health information to provide, coordinate or mange your health care and any related services. This includes the coordination or management of your health care with a third party. For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you. This may also include providing your protected health information to a durable medical equipment company (DME) that may provide care to you.
Payment: Snap Diagnostics may use and disclose your protected health information in order to bill and collect payment for the healthcare services provided to you from this office. We may disclose your medical information to another covered entity or health care provider for the payment activities of the entity that receives the information. For example, we may make contact with your health plan to verify your enrollment and your eligibility for benefits. A disclosure of certain information may also be required for any payments made by credit or debit card or any other electronic means.
Healthcare Operations: Snap Diagnostics may use and disclose your protected health information in connection to the business of healthcare, including performance improvement, quality of care assessment, and cost management. We may disclose your medical information to another covered entity for health care operations of the entity that receives the information in limited circumstances, if each entity either has or had a relationship to you.
Required by Law: Snap Diagnostics may use or disclose medical information about you when required by law such as in response to court or administrative orders, or under certain circumstances in response to subpoenas, discovery requests or other lawful processes. This office is required by Federal law to disclose your protected health information to the U.S. Department of Health and Human Service upon request for purpose of determining whether we are in compliance with the Federal Privacy Standards. We may disclose your health information when authorized by worker’s compensation or comparable laws.
Law Enforcement: Snap Diagnostics may disclose health information if a request is made by law enforcement officials. For example we may disclose your protected health information to identify or locate suspects, fugitives or witnesses, or victims of crime, to report deaths from crime, crimes on the premises, or in emergencies, the commission of a crime.
Public Health Activities: Snap Diagnostics may use or disclose your protected health information for public health activities such as reporting births, deaths, communicable diseases, injury or disability, ensuring the safety of drugs and medical devices, reporting child and sexual abuse, and for work place surveillance or work related illness and injury. We may disclose your protected health information to a health oversight agency for activities authorized by law such as audits, administrative or criminal investigations, inspections, licensure or disciplinary action and monitoring compliance with the law.
Abuse, Neglect, and Domestic Violence: Snap Diagnostics may disclose your protected health information to a government agency if we believe you are a victim of abuse, neglect, or domestic violence. If this office makes such a disclosure, we will inform you, except if there is a belief that informing you places you at further risk of additional harm.
Serious Threats to Health or Safety: Snap Diagnostics may use or disclose your protected health information when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of others. Under this situation, this office will only disclose health information to an agency or authority able to help prevent the threat.
Specialized Government Functions: Snap Diagnostics may disclose your protected health information if you are a member of the U.S. or foreign military and if required by the appropriate military command authorities. Furthermore, this office may disclose your health information to federal officials for intelligence and national security activities required by law. Additionally, this office may disclose your health information to correctional institutions or law enforcement officials if you are an inmate or under the custody of law enforcement officials.
Right to a Paper Copy of the Notice of Privacy Practices: You have the right to a paper copy of the Notice of Privacy Practices. You may ask Snap Diagnostics to give you a copy at any time. If you first obtain the Notice of Privacy Practices electronically, you may still request this office send you a paper copy.
Right to Request Restrictions: You have the right to request a restriction on the use and disclosure of your protected health information for purposes of treatment, payment, and health care operations. We are not required to grant any such request for restriction, but if the restrictions are granted they will be legally binding, except to the extent that disclosure has already occurred or if you are in need of emergency treatment and the information is needed to provide the emergency treatment.
Right to Inspect and Request a Copy of your Health Record: You have the right to inspect and obtain a copy of your health record. A fee may be charged to copy your record. If you are denied access to your health record for certain reasons the denial may be reviewable. Please contact our Privacy Officer for more information.
Right to Request an Amendment to your Health Record: You may make a written request to amend your protected health information. You must give us a reason for the amendment. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement. We will provide you with a copy of any such rebuttal. Please contact our Privacy Officer if you have any questions about amending your health record.
Right to Receive an Accounting of Disclosures: You have a right to an accounting of disclosures of your protected health information made for purposes other than for treatment, payment and healthcare operations and those disclosures you have authorized. If your health information is disclosed for multiple research purposes this medical practice will provide you with a description of the research for which your health information may have been disclosed and the researchers names and contact information. This Medical Practice may charge you for reasonable retrieval, report preparation and mailing costs incurred in responding to accounting requests in excess of the one free accounting report required by the Federal Privacy Standards. You will be advised in advance of the associated fees and given a chance to withdraw or amend a disclosure request. Please contact our Privacy Officer to obtain an Accounting and Disclosure Report.
Right to Confidential Communications: You have the right to request that confidential communications be made by alternate means (e.g. fax versus mail) or at alternate locations (alternate address or telephone number). Your request must be in writing. We will honor your request if it is reasonable. Please make this request in writing to our Privacy Officer.
Right to Provide an Authorization for Uses and Disclosures: You have the right to give authorization for uses and disclosures that are not identified by this Notice of Privacy Practices or are not permitted by applicable law. We will ask for your written authorization before using or disclosing personal information about you. Any authorization may be revoked at any time in writing and once an authorization has been revoked, we will not use or disclose your health information for the purposes detailed in the authorization. Please make this request in writing to our Privacy Officer.
Contact: To exercise any of the rights described above, or if you have any questions about this Notice, please contact our Privacy Officer at (847) 777-0000 or mail questions to the Snap Diagnostics at the address listed above. If you believe the privacy rights related to your protected health information have been violated you have the right to file a complaint with our Privacy Officer. You also have the right to file a complaint with the Secretary of the Department of Health and Human Services, Office of Civil Rights, U.S. Department of Health and Human Services, 200 Independence Avenue. S.W., Room 509F, HHH Building, Washington, D.C. 20201. There will be no retaliation for filing a complaint.
Changes to this Notice: We reserve the right to change this Notice. We reserve the right to make the revised or changed Notice effective for information we already have about you as well as any information we receive in the future. You are entitled to our Notice at any time upon request. You will be asked to acknowledge in writing your receipt of this Notice.
Document ID: QD-54880 Rev C