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.
Sunridge Medical Privacy Policy
This privacy policy is adopted to ensure that Sunridge Medical Wellness Centers (hereon referred to as SMWC) fully complies with all federal and state privacy protection laws and regulations, in particular, the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The protection of patient privacy is of utmost importance to SMWC. Violations of any of these provisions will result in disciplinary action which may include termination of employment and possible referral for criminal prosecution.
Privacy Policy Definitions
b. “Health Information” or “Protected Health Information” shall mean, certain Individually Identifiable Health Information, as defined in 45 C.F.R. § 164.501 of the Privacy Standards.
I. Information Collected
In the ordinary course of business, SMWC may receive personal information such as:
- Patient’s name, address, and telephone number;
- Information relating to treatment, diagnostic or other medical information concerning a patient;
- Patient’s insurance information and coverage;
In addition, other information will be gathered about a patient and we will create a record of the care and/or services provided to the patient by SMWC. Some of the information also may be provided to us by other individuals or organizations that are part of the patient’s care team – such as referring physician, other physicians, their health plan and family members, hospitals, or other health care providers.
II. How SMWC Will Use or Disclose Your Protected Health Information
b. Payment: SMWC will collect billing information from you such as your present address, social security number, date of birth, health insurance carrier, policy number, and other related billing information. SMWC may disclose to your health insurance provider, Medicare, Medicaid, or any other payor of health care claims the minimum amount necessary of your patient health care information in order to process your health insurance claim.
c. Regular Health Care Operations: SMWC will disclose your healthcare information to our physicians, medical assistants, nurses, x-ray technologists, billing clerks, administrative staff, and other employees involved in your healthcare treatment.
a. Notification and communication with Family: We may disclose your Protected Health Information to notify or assist in notifying a family member, your personal representative, or another person responsible for your care about your location, your general condition, or in the event of your death. If you are able and available to agree or object, we will give you the opportunity to object prior to making this notification. If you are unable or unavailable to agree or object, our health professionals will use their best judgment in communication with your family and others.
4. Voice Mail Message: It is the privacy policy of SMWC that a voice mail or answering machine message may be left at a patient’s home or another number the patient provides to SMWC regarding appointments, billing or payment issues, or other Protected Health Information, related to treatment, payment, or health care operations.
5. As Required by Law: It is the privacy policy of SMWC that we may use and disclose your Protected Health Information as required by law.
a. Public Health: As required by law, we may disclose your Protected Health Information to public health authorities for purposes related to preventing or controlling disease, injury or disability; reporting child 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.
b. Health Oversight Activities: We may disclose your Protected Health Information to health agencies during the course of audits, investigations, inspections, licensure, and other proceedings.
c. Judicial and Administrative Proceedings: We may disclose your Protected Health Information in the course of any administrative or judicial proceeding.
d. Law enforcement: We may disclose your Protected Health Information to a law enforcement official for purposes such as identifying or locating a suspect, fugitive, material witness, or missing person, complying with a court order or subpoena, and/or for other law enforcement purposes.
e. Deceased person information: We may disclose your Protected Health Information to coroners, medical examiners, and funeral directors.
f. Organ Donation: We may disclose your Protected Health Information to organizations involved in procuring, banking, or transplanting organs and tissues.
h. Public Safety: We may disclose your Protected Health Information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or the general public.
i. Specialized government functions: We may disclose your Protected Health Information for military, national security, and other purposes as made legal by government action.
III. Other Policies, Uses and Disclosures
2. Deceased Individuals: It is the policy of SMWC, that privacy protections extend to information concerning deceased individuals.
3. Restriction Requests: It is the policy of SMWC that serious consideration must be given to all requests for restrictions on the uses and disclosures of Protected Health Information as published in this privacy policy. You have the right to request restrictions on certain uses and disclosures of your Protected Health Information. SMWC is not required to agree to the restriction that you requested. If a particular restriction is agreed to, SMWC is bound by that restriction.
4. Minimum Necessary Disclosure: It is the policy of SMWC that it shall make reasonable efforts to limit the disclosure to the minimum amount of information needed to accomplish the purpose of the disclosure. It is also the policy of SMWC that all requests for Protected Health Information must be limited to the minimum amount of information needed to accomplish the purpose of the request.
6. Designation of Personal Representative: It is the policy of SMWC that access to protected health information must be granted to your designated personal representative as specified by you when such access is requested. This designation of a personal representative must be made in writing.
7. Confidential Communications Channels: It is the policy of SMWC that you have the right to receive your protected health information through a reasonable alternative means or at an alternative location. Confidential communication channels can be used within the reasonable capability of SMWC, (i.e. do not call me at work, call me at home) as requested by you.
8. Amendment of Incomplete or Incorrect Protected Health Information: It is the policy of SMWC that you have a right to request that SMWC amend your protected health information that is incorrect or incomplete. SMWC is not required to change your protected health information and will provide you with information about SMWC’s denial and how you can disagree with the denial. A request to amend your protected health information shall be made in writing to SMWC.
9. Accounting of Disclosures: It is the privacy policy of SMWC that an accounting of disclosures of Protected Health Information made by SWLC is given to you whenever such an accounting is requested in writing. You have a right to receive an accounting of disclosures of your Protected Health Information made by SMWC, except that SMWC does not have to account for the disclosures described in Section II (1) (a)(b)(c), of this Notice of Privacy Practices. Such written request for an accounting shall be made in writing to SMWC.
10. Complaints: It is the policy of SMWC that all complaints by employees, patients, providers, or other entities relating to Protected Health Information be investigated and resolved in a timely fashion. Complaints about this Notice of Privacy Practices or how SWMC handles your Protected Health Information should be directed to:
If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint to:
Department of Health and Human Services
Office of Civil Rights
Hubert H. Humphrey Bldg.
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201
IV. Changes to This Notice of Privacy Practices
SMWC reserves the right to amend this Notice of Privacy Practices at any time in the future and will provide a copy of such amendment to you upon request or upon your next visit. Until such an amendment is made, SMWC is required by law to comply with this Notice.
For answers or to make an appointment, call us toll-free at
800-923-7878
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