THIS NOTICE DESCRIBES HOW WE MIGHT USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
MyFace2FaceMD™ is dedicated to maintaining the privacy of your protected health information (‘PHI’). PHI is information about you that may be used to identify you (such as your name, social security number or address), and that relates to: (a) your past, present or future physical or mental health or condition; (b) the provision of health care to you; or (c) your past, present, or future payment for the provision of health care. In conducting our business, MyFace2FaceMD™ will receive and create records containing your PHI. We are required by law to maintain the privacy of your PHI and to provide you with notice of its legal duties and privacy practices with respect to your PHI.
MyFace2FaceMD™ must abide by the terms of this Notice while it is in effect. This current Notice takes effect on January 2015 , and will remain in effect until MyFace2FaceMD™ replaces it. We reserve the right to change the terms of this Notice at any time, as long as the changes are in compliance with applicable law. If MyFace2FaceMD™ changes the terms of this Notice, the new terms will apply, effective at the time of posting, to all PHI that it maintains, including PHI that was created or received before such changes were made. If MyFace2FaceMD™ changes this Notice, it will post the new Notice on its Web site and will make the new Notice available upon request.
MyFace2FaceMD™ may use and disclose your PHI in the following ways:
You agree that MyFace2FaceMD™ is permitted to use and disclose your PHI for purposes of: (a) treatment; (b) payment; and (c) health care operations. Examples of such use are:
The occasion may arise where MyFace2FaceMD™ medical providers may be required to disclose your PHI to another physician or health care provider for purposes of a consultation or in connection with the provision of follow-up treatment.
In obtaining payment for our services, MyFace2FaceMD™ may use and disclose your PHI to your health insurer or health plan in connection with the processing and payment of claims and other charges.
MyFace2FaceMD™ may use and disclose your PHI in connection with its health care operations, such as providing customer services and conducting quality review assessments. MyFace2FaceMD™ will only disclose your PHI if and when it is absolutely necessary, and only to third parties who agree to maintain the confidentiality of your PHI on the same terms that are outlined in this Notice.
MyFace2FaceMD™ is permitted to use and disclose your PHI upon your written authorization, to the extent such use or disclosure is consistent with your authorization. You may revoke any such authorization at any time.
MyFace2FaceMD™ may use and disclose your PHI to the extent required by law.
The following categories describe unique circumstances in which MyFace2FaceMD™ may use or disclose your PHI:
MyFace2FaceMD™ may disclose your PHI as required by law to public health authorities or other governmental authorities for purposes including preventing and controlling disease, reporting child abuse or neglect, reporting domestic violence and reporting to the Food and Drug Administration regarding the quality, safety and effectiveness of a regulated product or activity. MyFace2FaceMD™ may, in certain circumstances disclose PHI to persons who have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition.
MyFace2FaceMD™ may disclose your PHI as authorized by, and to the extent necessary to comply with, workers’ compensation programs and other similar programs relating to work-related illnesses or injuries.
MyFace2FaceMD™ may disclose your PHI to a health oversight agency for authorized activities such as audits, investigations, inspections, licensing and disciplinary actions relating to the health care system or government benefit programs.
MyFace2FaceMD™ may disclose your PHI, in certain circumstances, as permitted by applicable law, in response to an order from a court or administrative agency, or in response to a subpoena or discovery request.
Under certain circumstances, MyFace2FaceMD™ may disclose your PHI to a law enforcement official, such as for purposes of identifying or locating a suspect, fugitive, material witness or missing person.
MyFace2FaceMD™ may, under certain circumstances, disclose PHI to coroners, medical examiners and funeral directors for purposes such as identification, determining the cause of death and fulfilling duties relating to decedents.
MyFace2FaceMD™ may, under certain circumstances, use or disclose PHI for the purposes of organ donation and transplantation.
MyFace2FaceMD™ may, under certain circumstances, use or disclose PHI if necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
In certain situations, MyFace2FaceMD™ may use and disclose PHI of persons who are, or were, in the Armed Forces for purposes such as ensuring proper execution of a military mission or determining entitlement to benefits. When required, MyFace2FaceMD™ may also disclose PHI to federal officials for intelligence and national security purposes.
You have the following rights regarding the PHI maintained by MyFace2FaceMD™:
You have the right to receive confidential communications of your PHI. At any time, you may request that MyFace2FaceMD™ communicate with you through alternate means or at an alternate location, and we will accommodate your reasonable requests. Any such request must be made in writing to MyFace2FaceMD™.
You have the right to request restrictions on certain uses and disclosures of PHI for treatment, payment or health care operations. You also have the right to request that MyFace2FaceMD™ restrict its disclosures of PHI to only certain individuals involved in your care or the payment of your care. Any such request must be made in writing to MyFace2FaceMD™. We are not required to comply with your request. However, if we agree to comply with your request, we will be bound by such agreement, except when otherwise required by law or in the event of an emergency.
You have the right to inspect and copy your PHI. You must submit your request in writing to MyFace2FaceMD™, and you will be responsible for any costs, including labor, associated with the copying and mailing of any such records. Under very limited circumstances, MyFace2FaceMD™ may deny your request to inspect and/or copy your PHI but will inform you of the reason for the denial, and you may request a review of the denial.
You have a right to request that MyFace2FaceMD™ amend your PHI if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is maintained by MyFace2FaceMD™. You must submit any such request in writing, and provide a reason to support the requested amendment. Under certain circumstances, MyFace2FaceMD™ may deny your request to amend your PHI, but will send you a written notice of the denial explaining the reason for the denial. You are entitled to submit a statement of disagreement for inclusion in your records.
You have a right to receive an accounting of all disclosures MyFace2FaceMD™ has made of your PHI. However, that right does not include disclosures made for treatment, payment or health care operations, disclosures made to you about your treatment, disclosures made pursuant to an authorization, and certain other disclosures. You must submit your request in writing to MyFace2FaceMD™ and you must specify the time period involved (which must be for a period of time less than six years from the date of the disclosure). Your first accounting will be free of charge. However, we may charge you for the costs involved in fulfilling any additional request made within a period of 12 months. MyFace2FaceMD™ will inform you of such costs in advance, so that you may withdraw or modify your request to save costs.
You have the right to be notified in the event that MyFace2FaceMD™ discovers a breach of unsecured PHI.
You have the right to obtain a paper copy of this Notice from MyFace2FaceMD™ at any time upon request. To obtain a paper copy of this notice, please contact us at (800)-311-6022.
You may complain to MyFace2FaceMD™ and to the Secretary of the Department of Health and Human Services if you believe that your privacy rights have been violated. To file a complaint with us, you must submit a statement in writing to: MyFace2FaceMD™ PO Box 882 Fletcher NC 28732.