MEDHOME NOTICE OF PRIVACY PRACTICES
Effective Date: [Insert Date]
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.
I. OUR COMMITMENT TO YOUR PRIVACY
MedHome is committed to protecting the confidentiality of your health information. This Notice of Privacy Practices (NPP) applies to all protected health information (PHI) we create or receive. We are required by law to:
- Maintain the privacy of your PHI.
- Provide you with this Notice of our legal duties and privacy practices concerning your PHI.
- Notify you following a breach of your unsecured PHI.
- Abide by the terms of this Notice.
II. HOW WE MAY USE AND DISCLOSE YOUR PHI
MedHome may use and disclose your PHI without your written authorization for the following purposes:
1. Treatment
We may use and share your PHI to provide, coordinate, and manage your healthcare and related services.
- Example: Sharing your information with your physician, pharmacist, or medical supply provider involved in your care.
2. Payment
We may use and disclose your PHI to bill and receive payment for services we provide.
- Example: Providing your PHI to Medicare, Medicaid, or private health plans to verify coverage and process claims.
3. Health Care Operations
We may use and disclose your PHI for operational purposes, such as improving quality and managing business needs.
- Example: Quality assessments, staff performance reviews, and business planning.
III. USES AND DISCLOSURES REQUIRING YOUR OPPORTUNITY TO AGREE OR OBJECT
1. Individuals Involved in Your Care
We may share your PHI with family members or others involved in your care, unless you object.
2. Notification
We may disclose your PHI to notify a family member or representative about your location, condition, or death.
IV. USES AND DISCLOSURES REQUIRED OR PERMITTED BY LAW
We may use or disclose your PHI without your authorization for the following purposes:
- Required by Law: When mandated by federal, state, or local laws.
- Public Health Activities: Reporting disease, injury, or disability.
- Health Oversight Activities: Audits, investigations, or inspections.
- Judicial & Administrative Proceedings: In response to court orders or legal processes.
- Law Enforcement: For specific law enforcement purposes.
- Coroners, Medical Examiners & Funeral Directors: Identification or determining cause of death.
- To Prevent a Serious Threat: When necessary to prevent a serious and imminent threat to health or safety.
V. USES AND DISCLOSURES REQUIRING YOUR WRITTEN AUTHORIZATION
We will obtain your written authorization for any use or disclosure of your PHI not described in this Notice, including:
- Marketing: Most marketing activities.
- Sale of PHI: Any disclosure that involves the sale of PHI.
- Psychotherapy Notes: Most uses of psychotherapy notes.
You may revoke your authorization at any time in writing, except where we have already relied on it.
VI. YOUR RIGHTS REGARDING YOUR PHI
You may exercise the following rights by submitting a written request to our Privacy Officer:
1. Right to Inspect and Copy
You may request an electronic or paper copy of your PHI. Reasonable, cost-based fees may apply.
2. Right to Amend
You may request corrections to your PHI if you believe it is incorrect or incomplete.
3. Right to an Accounting of Disclosures
You may request a list of certain disclosures made in the past six (6) years.
4. Right to Request Restrictions
You may request restrictions on PHI use or disclosure. We are required to honor requests that restrict disclosures to a health plan when you pay out-of-pocket in full.
5. Right to Request Confidential Communications
You may request alternative communication methods (e.g., using a different address or phone number).
6. Right to a Paper Copy
You are entitled to a paper copy of this Notice, even if you previously agreed to electronic delivery.
VII. MEDHOME’S RESPONSIBILITIES
MedHome is committed to safeguarding your PHI with administrative, technical, and physical measures. We are required to:
- Provide you with this Notice.
- Train staff to protect your privacy.
- Follow the terms of this Notice.
We reserve the right to update this Notice at any time. Updated versions will be posted on our website: [Insert Website URL]
VIII. QUESTIONS AND COMPLAINTS
If you have questions, want to exercise your rights, or believe your privacy rights have been violated, please contact:
Privacy Officer Name: [Insert Name or Title]
Address: [Insert MedHome Address]
Phone: [Insert Phone Number]
Email: [Insert Email Address]
You may also file a complaint with the U.S. Department of Health and Human Services. MedHome will not retaliate against you for filing a complaint.