Notice of Health Information Privacy Practices
Effective Date: February 22, 2022
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.
About Us
In this Notice, we use terms like “we,” “us” or “our” to refer to As You Are, its employees, staff and other personnel. All of the sites and locations of As You Are follow the terms of this Notice and may share health information with each other for treatment, payment or health care operations purposes as described in this Notice.
Health Information
The terms “information or “health information” as used in this Notice include any information that we maintain that reasonably can be used to identify you, and that relates to your physical or mental health condition, the provision of health care to you, or the payment for such health care.
Purpose of this Notice
This Notice describes how we may use and disclose your health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. This Notice also outlines our legal duties for protecting the privacy of your health information, and explains your rights to have your health information protected. We understand that your health information is personal, and we are committed to protecting your privacy and ensuring that your health information is not used inappropriately.
Our Responsibilities
We are required by law to maintain the privacy of your health information, provide you with this Notice of our legal duties and privacy practices with respect to your health information, and to notify you if we have reason to believe that there has been a breach of your health information due to unauthorized acquisition, access, use or disclosure. We will abide by the terms of this Notice.
How We May Use or Disclose Your Health Information
The following categories describe examples of the way we use and disclose health information:
For Treatment: We may use and disclose your health information to other professionals who are treating you or providing you medical care and services. For example, your health information may be disclosed to a physician treating you for a concussion. We may disclose your health information to physicians, nurses, technicians, hospitals or other healthcare providers to be sure those parties have all the information necessary to diagnose and treat you.
For Payment: We may use and disclose your health information to others to bill and receive payment from you, a health care provider, a health plan, or a third party. For example, a bill may be sent to your physician for our services. The bill may contain information that identifies you and your test(s) results.
For Health Care Operations: We may use and disclose your health information as necessary in order to effectively manage and maintain the quality of our business activities. For example, we may use your health information to help us decide what, if any, additional services we should offer, to help us become more efficient, or for quality assessment activities on our behalf. We may disclose your health information to any contractors, agents or other associates who need such information to assist us in carrying out our business activities. Our written contracts with such entities require that they protect and maintain the privacy of your health information.
Treatment Alternatives and Health-Related Benefits and Services: We may use your health information to inform you of services or programs that we believe would be beneficial to you. We may call, mail or e-mail you information about these services or goods. For example, we may contact you to make you aware of new products, supply you product information, or advise you of new treatments or programs that may be available to you.
Individuals Involved in Your Care or Payment for Your Care: In case you become incapacitated, or in an emergency, or when you agree or fail to object when given the opportunity to do so, we may release your health information to a family member or friend who is involved in your medical care or who helps pay for your care. If you would like us to refrain from releasing your health information to a family member or friend, please notify in writing the Privacy Officer at As You Are.
We are also allowed by law to use and disclose your health information without your authorization for the following purposes:
As Required by Law: We may use and disclose your health information when required to do so by federal, state or local law.
Judicial and Administrative Proceedings: If you are involved in a legal proceeding, we may disclose your health information in response to a court or administrative order. We may also release your health information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request, or to obtain an order protecting the information requested.
Health Oversight Activities: We may use and disclose your health information to health oversight agencies for activities authorized by law. These oversight activities are necessary for the government to monitor the health care system, government benefit programs, compliance with government regulatory programs, and compliance with civil rights laws.
Law Enforcement: We may disclose your health information, within limitations, to law enforcement officials for several different purposes, which include, but are not limited to, the following:
- To comply with a court order, warrant, subpoena, summons, or other similar process;
- To identify or locate a suspect, fugitive, material witness, or missing person;
- To report a death we suspect may have resulted from criminal conduct;
- To report criminal conduct we believe in good faith to have occurred on our premises; and
- To report a crime, the location of a crime, and the identity, description and location of the individual who committed the crime, in an emergency situation.
Public Health Activities: We may use and disclose your health information for public health activities, including the following:
- To prevent or control disease, injury, or disability;
- To report child abuse or neglect;
- To notify a person who may have been exposed to a communicable disease or may be at risk for contracting or spreading a disease or condition.
Serious Threat to Health or Safety: If there is a serious threat to your health and safety or the health and safety of the public or another person, we may use and disclose your health information to someone able to help prevent the threat.
Organ/Tissue Donation: If you are an organ donor, we may use and disclose your health information to organizations that handle organ procurement or organ, eye, or tissue transplantation, or to an organ donation bank.
Coroners, Medical Examiners, and Funeral Directors: We may use and disclose health information to a coroner or medical examiner. This disclosure may be necessary to identify a deceased person or determine the cause of death. We may also disclose health information, as necessary, to funeral directors to assist them in performing their duties.
Workers’ Compensation: We may disclose your health information for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
Victims of Abuse, Neglect, or Domestic Violence: We may disclose health information to the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence. We will only make this disclosure if you agree, or when required or authorized by law.
Military and Veterans Activities: If you have been or are a member of the Armed Forces, we may use and disclose your health information to military command authorities, the Department of Defense, or the Department of Veterans Affairs. Health information about foreign military personnel may be disclosed to foreign military authorities.
National Security and Intelligence Activities: We may disclose your health information to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
Protective Services for the President and Others: We may disclose your health information to authorized federal officials so they may provide protective services for the President and others, including foreign heads of state.
Research: We may use and disclose your health information for certain limited research purposes. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project, assesses a number of specific issues, and determines that appropriate privacy safeguards are in place to allow the use of health information in the research project. We will ask for your permission to disclose your health information for these research activities if the researcher will have access to any information that identifies you, such as your name or address.
Other Uses and Disclosures of Your Health Information: Except for the uses and disclosures described and as set forth above in this Notice, other uses and disclosures of your health information will be made only with your written authorization. If you authorize us to use or disclose your health information, you may revoke that authorization, in writing, at any time by submitting your revocation to the Privacy Officer at As You Are. However, we will be unable to take back any uses or disclosures already made with your permission. If you revoke your authorization, we will no longer use or disclose your health information as specified by the revoked authorization, except to the extent that we have taken action in reliance on your authorization.
Your Rights Regarding Your Health Information
You have the following rights regarding health information we maintain about you:
Right to Request Restrictions: You have the right to request restrictions on how we use and disclose your health information for treatment, payment or health care operations. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. Also by law you have the right to request a restriction of the disclosure of your health information to a health plan if the disclosure pertains to services for which you have paid us out-of-pocket in full. To request restrictions, you must make your request in writing and submit it to the Privacy Officer at As You Are
Right to Request Confidential Communications: You have the right to request that we communicate with you in a certain manner or at a certain location regarding the services you receive from us. For example, you may ask that we only contact you at work or only by mail. To request confidential communications, you must make your request in writing and submit it to the Privacy Officer at As You Are. Your request must specify how or where you wish to be contacted. We will not ask you the reason for your request. We will attempt to accommodate all reasonable requests.
Right to Inspect and Receive Copies: You have the right to inspect and receive a copy of any health information that we maintain about you. If the requested health information is maintained electronically by us, we will provide you with a copy in an electronic format. If you wish to inspect and receive a paper copy of your health information, you must make your request in writing by filling out the appropriate form provided by us and submitting it to the Privacy Officer of As You Are. If you request a paper copy of your health information, we may charge you a fee for the costs of copying, mailing or preparing the requested documents. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to your health information, you may request that the denial be reviewed by a licensed health care professional chosen by us. 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 believe that your health information is incorrect or incomplete, you may request that we amend your information for as long as we maintain the information. To request an amendment, you must make your request in writing and provide the reason(s) for the requested amendment by filling out the appropriate form provided by us and submitting it to the Privacy Officer at As You Are. We may deny your request for an amendment if it is not in writing and/or does not include a reason to support your request. In addition, we may deny your request to amend if the information:
- 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 health information maintained by or for us;
- Is not information that you would be permitted to inspect or copy;
- Is accurate and complete.
If we deny your request to amend, you will be notified of the reason for the denial and given the opportunity to file a written statement of disagreement with us.
Right to an Accounting of Disclosures: You have the right to request an accounting of certain disclosures we make of your health information. Please note that certain disclosures, such as those made for treatment, payment or health care operations, as well as disclosures that you have requested or authorized, need not be included in the accounting we provide to you. Also, we need not include disclosures that have been made for national security or intelligence purposes, and disclosures to correctional institutions or law enforcement officials. To request an accounting of disclosures, you must make your request in writing by filling out the appropriate form provided by us and submitting it to the Privacy Officer at As You Are. Your request must state a time period which may not be longer than six years prior to the date of your request, and which may not include dates prior to February 22, 2022. The first accounting you request within a 12-month period will be free. For additional accountings, we may charge you for the costs of providing the accounting. We will notify you of the costs involved and give you an opportunity to withdraw or modify your request before any costs have been incurred.
Right to a Paper Copy of This Notice: You have the right to receive a paper copy of this Notice at any time, even if you have previously agreed to receive this Notice electronically. To obtain a paper copy of this Notice, please contact the Privacy Officer in writing at As You Are.
Right to File a Complaint: If you would like more information about our privacy practices, or have any questions about this Notice, or would like to file a complaint about our privacy practices, please direct your inquiries in writing to: the Compliance Officer at As You Are. You may also file a complaint with the Secretary of the Department of Health and Human Services. We will supply you with the address to file such a complaint upon request. You will not be retaliated against or penalized for filing a complaint.
Changes to this Notice
We reserve the right to change the terms of this Notice at any time. We reserve the right to make the new Notice provisions effective for all health information we currently maintain, as well as any health information we receive in the future. If we make material or important changes to our privacy practices, we will promptly revise the Notice on our website. Each version of the Notice will have an effective date listed on the first page.
Please direct any of your questions or concerns to:
As You Are
