Notice of Privacy Practices
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. ANY REFERENCES IN THIS DOCUMENT TO MEDICAL PRACTICE, MEDICAL RECORDS, MEDICAL SERVICES, ETC. APPLY ALSO TO PSYCHOTHERAPY.
Privacy Officer: Director of Clinical Operations – firstname.lastname@example.org or call 866.968.6342
Backpack Medical Group of KS PA (“Backpack Healthcare”) understands the importance of privacy and is committed to maintaining the confidentiality of your medical information. Backpack Healthcare makes a record of the medical care we provide and may receive such records from others. Backpack Healthcare uses these records to provide or enable other health care providers to provide quality medical care, to obtain payment for services provided to you as allowed by your health plan and to enable Backpack Healthcare to meet professional and legal obligations to properly operate this medical practice. Backpack Healthcare is required by law to maintain the privacy of protected health information, to provide individuals with notice of our legal duties and privacy practices with respect to protected health information, and to notify affected individuals following a breach of unsecured protected health information. This notice describes how Backpack Healthcare may use and disclose your medical information. It also describes your rights and our legal obligations with respect to your medical information.
How We May Use or Disclose Your Health Information
Backpack Healthcare collects health information about you and maintains it electronically in an electronic medical records system. This is your medical record. The medical record is the property of Backpack Healthcare, but the information in the medical record belongs to you. Applicable law permits us to use or disclose your health information for the following purposes:
- Treatment. We use medical information about you to provide your medical care. We disclose medical information to our employees and others who are involved in providing the care you need. For example, we may share your medical information with other physicians or other health care providers who may provide services that we do not provide. We may also share this information with a pharmacist who needs it to dispense a prescription to you, or a laboratory that performs a test. We may also disclose medical information to members of your family or other parties who can help you when you are sick or injured, or after you die.
- Payment. We use and disclose medical information about you to obtain payment for the services we provide. For example, we give your health plan the information it requires to reimburse us for services provided to you. We may also disclose information to other health care providers to assist them in obtaining payment for services they have provided to you.
- Care Operations. We may use and disclose medical information about you to operate Backpack Healthcare. For example, we may use and disclose this information to review and improve the quality of care we provide, or the competence and qualifications of our professional staff. We may use and disclose this information to obtain your health plan’s authorization for services or referrals. We may also use and disclose this information as necessary for medical reviews, legal services and audits, including fraud and abuse detection and compliance program and business planning and management. We may also share your medical information with our “business associates,” such as our billing service provider that performs administrative services for us. We have a written contract with each of these business associates that contains terms requiring them and their subcontractors to protect the confidentiality and security of your protected health information. We may also share your information with other health care providers, health care clearinghouses or health plans that have a relationship with you, when they request this information to help them with their quality assessment and improvement activities, their patient-safety activities, their population-based efforts to improve health or reduce health care costs, their protocol development, case management or care coordination activities, their review of competence, qualifications and performance of health care professionals, their training programs, their accreditation, certification or licensing activities, their health care fraud and abuse detection and compliance efforts, etc.
- Appointment Reminders. We may use and disclose medical information to contact and remind you about appointments. If you are not home, we may leave this information on your answering machine or in a message left with the person answering the phone.
- Notification and Communication With Family. You have the ability to sign release of information forms to permit us to disclose your information to approved parties. These releases must be signed before we contact such approved parties.
- Marketing. Provided we do not receive any payment for making these communications, we may contact you to give you information about products or services related to your treatment, case management or care coordination, or to direct or recommend other treatments, therapies, health care providers or settings of care that may be of interest to you. We may similarly describe products or services we provide and tell you which health plans we participate in. We will not otherwise use or disclose your medical information for marketing purposes.
- Sale of Health Information. We will not sell your health information without your prior written authorization. If you provide prior written authorization, the authorization will disclose that we will receive compensation for your health information. We will stop any future sales of your information to the extent that you revoke your authorization.
- Required by Law. We will use and disclose your health information when required by law, but we will limit our use or disclosure to the minimum amount necessary. When the law requires us to report abuse, neglect or domestic violence, or respond to judicial or administrative proceedings or to law enforcement officials, we will further comply with the requirement set forth below concerning those activities.
- Public Health. We may, and are sometimes required by law, to disclose your health information to public health authorities for purposes related to: preventing or controlling disease, injury or disability; reporting child, elder or dependent adult abuse or neglect; reporting domestic violence; reporting to the Food and Drug Administration problems with products and reactions to medications; and reporting disease or infection exposure.
- Health Oversight Activities. We may, and are sometimes required by law, to disclose your health information to health oversight agencies during audits, investigations, inspections, licensure and other proceedings, subject to the limitations imposed by law.
- Judicial and Administrative Proceedings. We may, and are sometimes required by law, to disclose your health information in the course of any administrative or judicial proceeding to the extent expressly authorized by a court or administrative order. We may also disclose information about you in response to a subpoena, discovery request or other lawful process if reasonable efforts have been made to notify you of the request and you have not objected, or if your objections have been resolved by a court or administrative order.
- Public Safety. We may, and are sometimes required by law, to disclose your health information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a person or the general public.
- Workers’ Compensation. We may disclose your health information as necessary to comply with workers’ compensation laws. For example, to the extent your care is covered by workers’ compensation, we may make periodic reports to your employer about your condition. We are also required by law to report cases of occupational injury or occupational illness to the employer or workers’ compensation insurer.
- Change of Ownership. If Backpack Healthcare is sold or merged with another organization, your health information/ record will become the property of the new owner, although you will maintain the right to request that copies of your health information be transferred to another provider.
- Breach Notification. In the case of a breach of unsecured protected health information, we will notify you as required by law. If you have provided us with a current email address, we may use email to communicate information related to the breach. In some circumstances, our business associate may provide the notification. We may also provide notification by other methods as appropriate.
- Psychotherapy Notes. We will not use or disclose your psychotherapy notes without your prior written authorization except for the following. To the extent you revoke an authorization to use or disclose your psychotherapy notes, we will stop using or disclosing these notes, unless otherwise permitted or required by law:
- Use by the originator of the notes for your treatment
- For training our staff, students and other trainees,
- To defend ourselves if you sue us or bring some other legal proceeding,
- If the law requires us to disclose the information to you or the Secretary of U.S. Department of Health and Human Services or for some other reason,
- In response to health oversight activities concerning your psychotherapist,
- To avert a serious and imminent threat to health or safety, or
- To the coroner or medical examiner after you die.
- Research. We may disclose your health information to researchers conducting research with respect to which your written authorization is not required as approved by an Institutional Review Board or privacy board, in compliance with governing law.
When We May Not Use or Disclose Your Health Information
Except as described in this Notice, we will, consistent with its legal obligations, not use or disclose health information which identifies you without your written authorization. If you authorize us to use or disclose your health information for another purpose, you may revoke your authorization in writing at any time.
Your Health Information Rights
- Right to Request Special Privacy Protections. You have the right to request restrictions on certain uses and disclosures of your health information by a written request specifying what information you want to limit, and what limitations on our use or disclosure of that information you wish to have imposed. If you tell us not to disclose information to your commercial health plan concerning health care items or services for which you paid for in full out-of-pocket, we will abide by your request, unless we must disclose the information for treatment or legal reasons. We reserve the right to accept or reject any other request and will notify you of our decision.
- Right to Request Confidential Communications. You have the right to request that you receive your health information in a specific way or at a specific location. For example, you may ask that we send information to a particular email account or to your work address. We will comply with all reasonable requests submitted in writing which specify how or where you wish to receive these communications.
- Right to Inspect and Copy. You have the right to inspect and copy your health information, with limited exceptions. To access your medical information, you must submit a written request detailing what information you want access to, whether you want to inspect it or obtain a copy of it, and if you want a copy, your preferred form and format. We will provide copies in your requested form and format if it is readily producible, or we will provide you with an alternative format you find acceptable, or if we can’t agree and we maintain the record in an electronic format, your choice of a readable electronic or hardcopy format. We will also send a copy to any recipient you designate in writing. We will charge a reasonable fee which covers our costs for labor, supplies, postage, and if requested and agreed to in advance, the cost of preparing an explanation or summary. We may deny your request under limited circumstances. If we deny your request to access your child’s records or the records of an incapacitated adult you are representing because we believe allowing access would be reasonably likely to cause substantial harm to the patient, you will have a right to appeal our decision. If we deny your request to access your psychotherapy notes, you will have the right to have them transferred to another mental health professional.
- Right to Amend or Supplement. You have a right to request that we amend your health information that you believe is incorrect or incomplete. You must make a request to amend in writing and include the reasons you believe the information is inaccurate or incomplete. We are not required to amend your health information and will provide you with information about our denial and how you can disagree with the denial. We may deny your request if we do not have the information, if we did not create the information (unless the person or entity that created the information is no longer available to make the amendment), if you would not be permitted to inspect or copy the information at issue, or if the information is accurate and complete as is. If we deny your request, you may submit a written statement of your disagreement with that decision, and we may, in turn, prepare a written rebuttal. All information related to any request to amend will be maintained and disclosed in conjunction with any subsequent disclosure of the disputed information.
- Right to Receive an Accounting of Disclosures. Upon request, you may obtain an accounting of certain disclosures of your protected health information made by us during any period prior to the date of your request provided such period does not exceed six years. If you request an accounting more than once during a twelve-month period, we may charge you a reasonable fee for the accounting statement.
- Right to Obtain a Paper Copy of this Notice of Privacy Practices. Upon request, you may obtain a paper copy of this Notice, even if you agreed to receive such notice electronically.
Changes to this Notice of Privacy Practices
We reserve the right to amend this Notice at any time in the future. Until such amendment is made, we are required by law to comply with the terms of this Notice currently in effect. After an amendment is made, the revised Notice will apply to all protected health information that we maintain, regardless of when it was created or received. The revised Notice will be made available to you upon request.
This Notice is effective on January, 30th 2024.
Complaints about this Notice or how we handle your health information should be directed to our Privacy Officer listed at the top of this Notice. If you are not satisfied with the way this office handles a complaint, you may submit a formal complaint by using the form from the website below: The complaint form may be found at www.hhs.gov/ocr/privacy/hipaa/complaints/hipcomplaint.pdf. You will not be retaliated against in any way for filing a complaint.