Notice on Privacy Practices
Dated: October 21, 2019
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THE INFORMATION. PLEASE REVIEW IT CAREFULLY.
The Health Insurance Portability & Accountability Act of 1996 (HIPAA) requires confidentiality for all medical records and other individually identifiable health information in our possession. This Notice is to inform you of the uses and disclosures of confidential information that may be made by Aiwa Health, Inc. (d/b/a Probably Genetic)(“Probably Genetic”), and of your individual rights and Probably Genetic’s legal duties with respect to confidential information under HIPAA.
Our Pledge Regarding Medical Information
- We understand that information about you and your health is personal.
- We are committed to protecting information about you.
WHAT IS PROTECTED HEALTH INFORMATION (PHI)
PHI It is individually identifiable health information which is collected from an individual and (1) Is created or received by a health care provider, health plan, health plan provider, employer, or health care clearinghouse; and (2) relates to the past, present or future physical or mental health or condition of an individual; the provision of health care to an individual; or the past, present or future payment for the provision of health care to an individual; and (a) that identifies the individual; or (b) where there is a reasonable basis to believe the information can be used to identify the individual.
WAYS IN WHICH WE WAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION
We may use and disclose at our discretion your health information for each of the following purposes only. The following categories describe different ways that we use and disclose information. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
Disclosure at Your Request
We may disclose information when requested by you. This disclosure at your request may require a written authorization by you.
We may disclose information for providing, coordinating or managing treatment and related services.
We may use and disclose information about you so that the treatment and services you receive may be billed to and payment may be collected from you or a third party. For example, we may need to give information about treatment you received to your health plan so it will pay us or reimburse you for the treatment.
Health Care Operations
We may use and disclose information about you for our health care operations. These uses and disclosures are necessary to run our company and make sure that you receive quality care. For example, your de-identified data may be used for quality improvements to current products.
Incidental Uses and Disclosures
There are certain incidental uses or disclosures of your health information that occur while we are providing services to you or conducting our business. For example, other individuals waiting in the same area may hear your name called. We will make reasonable efforts to limit these incidental uses and disclosures.
Members of Our Workforce
It is our policy to allow members of our workforce to share certain of your health information with one another to the extent necessary to permit them to perform their legitimate functions. At the same time, we will work with and train our workforce members to ensure that there are no unnecessary or extraneous communications that will violate your rights to have the confidentiality of your health information maintained.
Probably Genetic contracts with certain individuals or entities to provide services on its behalf. Examples include data processing/data exchange, quality assurance, genetic counseling services or medical sign-offs for testing orders. We may disclose your health information to a business associate, only as necessary, to allow the business associate to perform its functions on behalf of Probably Genetic. We will have a contract with our business associates that obligate them to maintain the confidentiality of your health information.
We may use or disclose information about you to inform you about appointments.
Family Members or Others You Designate
We may disclose your information with your family member or others you designate as a care giver so long as the information is limited to information directly relevant to that person’s involvement in your care. We will not disclose your information if you specifically request that we do not.
As Required by Law
We will disclose information about you when required to do so by federal, state or local law. These include providing legally-required notices of unauthorized access, acquisition, or disclosure of your PHI.
We may conduct studies that may involve your current care or that involve reviews of your medical history or records. We generally ask for your written authorization before using your health information or sharing it with others to conduct research. Under limited circumstances when your identity has been removed and data aggregated, we may use your health information without your authorization. Aggregate data is information that has been stripped of your name and contact information and combined with information of others so that you cannot reasonably be identified as an individual. In most of these situations, we must comply with law and obtain approval through an independent review process to ensure that research conducted without your authorization poses minimal risk to your privacy. If you have opted in, Probably Genetic or researchers on our behalf may also contact you to see if you are interested in or eligible to participate in studies.
SPECIAL SITUATIONS THAT DO NOT REQUIRE YOUR AUTHORIZATION
Public Health Activities
We may disclose information about you for public health activities. These activities may include, without limitation, the following:
- To prevent or control disease, injury or disability;
- To report regarding the abuse or neglect of children, elders and dependent adults;
- To notify a person who may have been exposed to certain contagious diseases or may be at risk for spreading such disease;
- To notify emergency response employees regarding exposure to HIV/AIDS, to the extent necessary to comply with state and federal laws.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU
You have the following rights regarding information we maintain about you:
Right to Inspect and Copy
You have the right to inspect and obtain a copy of information that may be used to make decisions about your care. Usually, this includes medical and billing records, but may not include some mental health information.
To inspect and obtain a copy of information that may be used to make decisions about you, you must submit your request in writing.
If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.
We may deny your request to inspect and obtain a copy in certain very limited circumstances. If you are denied access to mental health/behavioral information, you may request that the denial be reviewed. Another licensed health care professional chosen by us will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
Right to Amend
If you feel that information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by us.
We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
- Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
- Is not part of the information kept by or for us;
- Is not part of the information which you would be permitted to inspect and copy; or
- Is accurate and complete.
Even if we deny your request for amendment, you have the right to submit a written addendum, not to exceed 250 words, with respect to any item or statement in your record you believe is incomplete or incorrect. If you clearly indicate in writing that you want the addendum to be made part of your health record, we will attach it to your records and include it whenever we make a disclosure of the item or statement you believe to be incomplete or incorrect.
Right to an Accounting of Disclosures
You have the right to request an “accounting of disclosures.” This is a list of the disclosures we made of information about you other than our own uses for treatment, payment and health care operations (as those functions are described above), and with other exceptions by law.
Your request must state a time period which may not be longer than six years and may not include dates before November 14, 2019. Your request should indicate in what form you want the list (for example, on paper or electronically).
The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred. In addition, we will notify you as required by law following a breach of your unsecured protected health information.
Right to Request Restrictions
You have the right to request a restriction or limitation on the information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a therapy you had.
We are not required to agree to your request, except to the extent that you request us to restrict disclosure to a health plan or insurer for payment or health care operations purposes if you, or someone else on your behalf (other than the health plan or insurer), has paid for the item or service out of pocket in full. Even if you request this special restriction, we can disclose the information to a health plan or insurer for purposes of treating you. If we agree to another special restriction, we will comply with your request unless the information is needed to provide you emergency treatment.
In your request, you must tell us 1) what information you want to limit; 2) whether you want to limit our use, disclosure or both; and 3) to whom you want the limits to apply, for example, disclosures to your spouse.
Right to Request Confidential Communications
You have the right to request that we communicate with you about health matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.
We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Right to a Paper Copy of this Notice
You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.
You may obtain a copy of this notice at our website: firstname.lastname@example.org.
Requests Under the Notice
To inspect and obtain a copy of your records or to request an amendment to you records, a list or accounting of disclosures, record restrictions, confidential communications, or obtain a paper copy of this notice, you must make your request in writing to:
665 Third Avenue
San Francisco, CA 94107
You can forward such request to us electronic for quicker review at email@example.com.
Other Uses of Medical Health Information
Other uses and disclosures of information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose information about you, you may revoke the permission, in writing, at any time. If you revoke your permission, this will stop any further use or disclosure of your information for the purposes covered by your written authorization, except if we have already acted in reliance on your permission. This could occur in the event if you authorized us to use your information in a research study and we have begun to use it in such a study. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.
Changes to this Notice
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in the facility. The notice will contain the effective date on the first page.
If you believe your privacy rights have been violated, you may file a complaint with us by contacting the California designated Privacy Officer/Complaint Official listed below. You may also file a complaint with the U.S. Department of Health and Human Services, Region IX, Office of Civil Rights by sending a letter to:
90 7th Street
San Francisco, CA 94103
Attention: OCR Regional Manager
and/or by calling (800) 368-1019, faxing (415) 437-8329, TDD (800) 537-7697 or by emailing OCRComplaint@hhs.gov.
All complaints must be submitted in writing. Probably Genetic will not retaliate or otherwise penalize you if you file a complaint.