Background of Privacy
At Connected Health, we are committed to protecting the privacy of your medical information, health, treatment, or payment information that identifies you, as federal and state laws require. Below you will find Connected Health’s “Notice of Privacy Practices” which explains our approach to your privacy, your legal rights concerning your privacy, and how all of the people and services employed and offered by Connected Health must follow the notice. Please note that this is not a complete listing of how we use and share your health information. If you have a question about any of the information in this summary, you should review the full notice of privacy practices or ask Connected Health staff members for more information. Connected Health has the right to change this summary and the notice without first notifying you.
Why you are receiving this notice from Connected Health, as well as other providers?
Your healthcare provider must provide you a notice that tells you how they may use and share your health information and how you can exercise your health privacy rights. In most cases, you should get this notice on your first visit to a provider or in the mail, and you can ask for a copy at any time. The provider cannot use or disclose information in a way that is not consistent with their notice.
Why you are asked to “sign” a form?
The law requires your doctor, hospital, or other health care provider you see to ask you to state in writing that you received the notice. Please note, the law does not require you to sign the “acknowledgment of receipt of the notice”. Signing does not mean that you have agreed to any special uses or disclosures of your health record. Refusing to sign the acknowledgment does not prevent the entity from using or disclosing health information as the rule permits it to do – in service of your health. If you refuse to sign the acknowledgment, the provider must keep a record that they failed to obtain your acknowledgment.
Connected Health Medical Services, LLC is required by the HIPAA Privacy Rules to obtain your consent in order to share your medical information for certain reasons. This consent will be in effect for as long as Connected Health Medical Services, LLC provides service to you. We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website.
You may withdraw this consent at any time by writing to the address below.
Connected Health Medical Services, LLC 12620 Perry HighwayWexford, PA 15090Email: firstname.lastname@example.org
When it comes to your health information, you have certain rights.
This section explains your rights and some of our responsibilities to help you:
Get an electronic or paper copy of your medical record**.**
You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this. We will provide a copy or a summary of your health information, usually within 30 days of the request. We may charge a reasonable, cost-based fee.
Ask us to correct your medical record.
You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this. We may say “no” to your request, but we’ll tell you why in writing within 60 days.
Request confidential communications.
You can ask us to contact you in a specific way (for example, home or cell phone or email) or to send mail to a different address. We will say “yes” to reasonable requests.
Ask us to limit what we use or share.
You can ask us not to use or share certain health information for treatment, payment or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care. If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
Get a list of those with whom we’ve shared information.
You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any that you have asked us to make). We’ll provide one accounting year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
Get a copy of this privacy notice.
You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
Choose someone to act for you.
If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.
File a complaint if you feel your rights are violated.
For certain health information, you can tell us your choices about what we share.
If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.
In these cases, you have both the right and choice to tell us to:
- Share information with your family, close friends, or others involved in your care
- Share information in a disaster relief situation
- Include your information in an EMR system
- If you are not able to tell us your preference, for instance if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In these cases, we never share your information unless you give us written permission:
- Marketing purposes
- Sale of your information
- Most sharing of psychotherapy notes
In the case of fundraising:
- We may contact you for fundraising efforts, but you can tell us not to contact you again.
We typically use or share your health information in the following ways:
- To treat you:
- We can use your health information and share it with other professionals who are treating you. For example: A doctor treating you for an injury asks another doctor about your overall health condition.
- Run our organization:
- We can use and share your health information to run our practice, improve your care, and contact you when necessary. For example: We use health information about you to manage your treatment and services.
- Bill for your services:
- We can use and share your health information to bill and get payment from health plans or other entities. For example: We give information about you to your health insurance plan so it will pay for certain services.
We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research.
We have to meet many conditions in the law before we can share your information for these purposes.
We can share health information about you for certain situations such as**
- Preventing disease
- Helping with product recalls
- Reporting adverse reactions to medications
- Reporting suspected abuse, neglect, or domestic violence
- Preventing or reducing a serious threat to anyone’s health or safety
- Do research – we can use or share your information for health research
- Comply with the law – we will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
- Respond to organ and tissue donation requests – we can share health information about you with organ procurement organization.
- Work with medical examiner or funeral director – we can share your information with a coroner, medical examiner, or funeral director if you become deceased.
- Address workers’ compensation, law enforcement, and other government requests
We can use or share health information about you:
- For workers’ compensation claims
- For law enforcement purposes or with a law enforcement official
- With health oversight agencies for activities authorized by law
- For special government functions such as military national security, and presidential protective services
- Respond to lawsuits and legal actions
- In response to a court or administrative order, or in response to a subpoena
File a complaint if you feel your rights are violated.
You can complain with the US Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington DC 20201, calling 1-877-696-6775
We will not retaliate against you for filing a complaint.
We are required by law to maintain the privacy and security of your protected health information. We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. We must follow the duties and privacy practices described in this notice and give you a copy of it. We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.