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.
THIS NOTICE IS EFFECTIVE AS OF APRIL 14, 2003.
1. Purpose of this Privacy Notice.
At Mollen Immunization Clinics, our top priority is maintaining and improving the health of our patients. We do this, in part, by working closely with you, other health care practitioners who care for you, and with your insurance company or other third party payors who help pay the cost of your health care. In the process of providing you with care, we may need to use or disclose your health information to help us accomplish our mission. However, we are committed to safeguarding the privacy and confidentiality of your personal health information.
2. HIPAA and other laws protect your health information privacy.
The Health Insurance Portability and Accountability Act of 1996, or “HIPAA” is a federal law. One of its primary purposes is to make sure that information about your health is handled with special respect for your privacy. HIPAA contains numerous safeguards designed to protect your personal health information, called “protected health information.” In addition, there are state and federal laws which may provide additional privacy protection to health information about certain treatments or conditions. We are committed to maintaining the privacy of our patient’s protected health information to the extent required by applicable law.
HIPAA requires us to establish policies and procedures to insure that the privacy of your health information is maintained, and to provide you with this notice of our privacy practices to explain your rights, and our duties with respect to your health information. We are required to abide by the terms of this notice as currently in effect. However, the practices and policies described in this notice may be changed at any time and the changes can apply to information already held by Mollen Immunization Clinics at the time of change. If this notice is revised, a current copy will be made available to you upon request. The policy notice currently in effect also may be viewed on our website at any time by going to www.mollenimmunizationclinics.com
3. Mollen Immunization Clinics may use or disclose protected health information without your authorization for certain purposes or under limited circumstances.
Mollen Immunization Clinics must use information about you in many ways. If you think about how you receive health care, and all the things that must happen behind the scenes to maintain the quality of that care and get that care for paid for, you will see that your information is used in logical and necessary ways. In each of the areas described below, Mollen Immunization Clinics is not required to ask for your consent and will not ask for your consent to use or disclose your protected health information.
A. Uses of information for payment purposes.
i. To obtain payment for the health care services we provide.
Mollen Immunization Clinics will use and disclose your protected and health information in order to receive payment for your health care services. Information will be shared with your health plans or programs that provide health insurance coverage for you; information will be disclosed regarding treatment we provide to you so your health insurance plan can apply its terms and determine what it owes relating to any service received. In some cases information may be used to perform utilization review activities, including pre-authorization for certain procedures, concurrent case management and retrospective review to make sure health services are being used appropriately.
B. Uses of Information For Treatment Purposes.
i. If you need assistance.
Mollen Immunization Clinics is permitted to use your protected health information to help you obtain treatment. We may disclose information about you to your other health care providers, including doctors, nurses, technicians or hospital personnel, if they are involved with your care. For example, Mollen Immunization Clinics or one of its business associates might disclose information about your prescriptions to a pharmacist to determine if any medications you are prescribed may be incompatible.
ii. To tell you about special programs.
Mollen Immunization Clinics may contact you with information about treatment alternatives or other health-related benefits and services that may be of interest to you. For example, if you have identified a particular health problem, we may send you information that describes new treatments or procedures that may be right for you.
C. Uses of Information For Health Care Operations.
i. Quality control and improvement.
Mollen Immunization Clinics may collect patient data so we can evaluate and develop new or existing treatment and wellness programs, monitor quality of care delivery, and perform other activities related to the overall operation of Mollen Immunization Clinics.
ii. Legal and other services.
Your information may be used by Mollen Immunization Clinics in connection with professional services we obtain, such as legal services, audit functions, legal compliance, and detection of fraud or abuse.
D. When disclosure is required by law.
The HIPAA rules permit Mollen Immunization Clinics to disclose your private health information under certain circumstances when the disclosure is required by other laws or in furtherance of law enforcement efforts, including:
E. Other permitted disclosures Mollen Immunization Clinics may make without your consent.
- To a law enforcement official in response to a subpoena, court or administrative agency warrant or order; to identify or locate a suspect, fugitive, material witness or missing person; about a victim of a crime, in limited circumstances; and in an emergency, to report a crime, location of a victim of a crime or the identity of a person who committed a crime
- To an authorized federal official for intelligence, counterintelligence and other national security activities authorized by law
- If you are an inmate or in custody, to a law enforcement official
- In response to a discovery request in a civil proceeding
- In response to a summons issued by a court, grand jury, inspector or administrative body that can require production of information
- Pursuant to requirements of a federal, state or local public health authority
Mollen Immunization Clinics may use your protected health information for marketing in limited circumstances permitted by law. For example, we may use your name and address to communicate with you about a health related product or service that we provide. We may send you newsletters, communicate with you face-to-face, and send you promotional items of nominal value.
There are other special situations where Mollen Immunization Clinics may use your health information. Mostly, these are for public health purposes. We may disclose PHI to government officials in charge of collecting information to prevent or control disease, report injury or disability, to report reactions to medications or product defects or problems, or to notify a person who may have been exposed to a communicable disease or may be at risk of contracting or spreading a disease or condition.
Mollen Immunization Clinics may disclose protected health information to the government for oversight activities authorized by law, such as audits, investigations, inspections, licensure or disciplinary actions, and other proceedings, actions or activities necessary for monitoring the health care system, government programs, and compliance with civil rights laws.
Mollen Immunization Clinics may disclose protected health information to coroners, medical examiners, and funeral directors for the purpose of identifying a decedent, determining a cause of death, or otherwise as necessary to enable these parties to carry out their duties consistent with applicable law.
Mollen Immunization Clinics may release protected health information to determine your eligibility for workers’ compensation or similar programs.
Finally, if you are member of the armed forces, Mollen Immunization Clinics may release protected health information as required by the military.
F. Mollen Immunization Clinics uses or discloses only the “minimum necessary” information.
Mollen Immunization Clinics will normally use and/or disclose only the minimum amount of information that is necessary to perform certain activities. For example, if your insurance company calls with a question about treatment we provided to you in order to get your bill paid, we will only discuss information relevant to the payment of that bill. Or, if we call your home to remind you of an upcoming appointment, we will only leave messages regarding the date and time of your appointment.
However, this “minimum necessary” policy does not apply when you or another health care provider involved in you care requests information, when information disclosure is required by law or when you authorize the disclosure.
4. Other disclosures will not be made without your written authorization.
Mollen Immunization Clinics must obtain your specific written authorization to use or disclose your protected health information in any way not outlined in this notice. You may revoke your authorization in writing at any time. However, your revocation will not be effective to the extent we have already acted in reliance on the authorization.
5. Disclosure of HIV/AIDS status or disclosure of genetic information.
Many states have special laws that restrict when or how Mollen Immunization Clinics may disclose particularly sensitive health information without your prior written authorization. Such laws remain valid. Accordingly, Mollen Immunization Clinics will obtain your prior authorization before disclosing such information when applicable.
6. Your rights under HIPAA.
You may exercise any of the following rights by contacting the Mollen Immunization Clinics Privacy Officer identified below:
You have the right to ask Mollen Immunization Clinics to restrict the use and disclosure of your protected health information beyond the restrictions described in this notice. However, Mollen Immunization Clinics is not required to agree to your request.
You have the right to request confidential communications from us. We will accommodate any reasonable request for confidential communications by alternative means or at alternative locations.
You have the right to inspect and copy any protected health information maintained by us in a designated record set. This right does not apply to information compiled in reasonable anticipation of a legal or administrative proceeding. Your request to inspect or obtain copies of your protected health information must be in writing. If you request photocopies of protected health information, we will charge a reasonable cost-based fee that includes only the cost of copying, staff time to copy, postage, and preparing an explanation or summary of the requested information if you tell us in advance that you only want a summary. You may request copies of protected health information that we maintain in a format other than photocopies. We will respond in the format that you request if the protected health information is readily producible in that format. If you request a format other than photocopies, we may charge you a cost-based fee for providing the information in that format. If your request is denied, you have the right to have your request reviewed under most circumstances. You may get in touch with our Privacy Officer for more information about access.
You have the right to ask, in writing, that Mollen Immunization Clinics amend your health information maintained by us in a designated record set that you believe is incomplete or incorrect. Your written request must contain the reason(s) that you request the amendment. You will receive a response to your request. Your request may be denied by the us if the information was not created by Mollen Immunization Clinics, or if Mollen Immunization Clinics determines that the information is complete and correct.
You have the right to receive a list of how many times and to whom your protected health information has been disclosed by us during the six years prior to the date of your request. There are significant exceptions to this rule under federal regulations. For example, we do not have to give you a list of those disclosures made for treatment, payment or health care operations, and information we disclose to you or with your written authorization. Other exceptions exist. Furthermore, the list of disclosures only includes disclosures made on or after April 14, 2003.
You have the right to receive a paper copy of this notice upon your request.
You may make a complaint to us or to the Secretary of Health and Human Services if you feel we have violated your privacy rights. Mollen Immunization Clinics wants to hear from you if you have any questions, concerns or complaints about the privacy of your health information.
You may contact us by telephone, mail or e-mail:
Mollen Immunization Clinics, LLC
8328 E. Hartford Drive
Scottsdale, AZ 85255
You may also file a complaint with the Secretary of Health and Human Services at the following address:
7500 Security Boulevard
Baltimore, Maryland 21244
No one at Mollen Immunization Clinics will retaliate or take any action against you for filing a complaint.