This Notice Describes How Medical Information About You May be Used and Disclosed and How You Can Access This Information. Please Review It Carefully.
Our company is permitted by federal privacy laws to make uses and disclosures of your health information for purposes of treatment, payment and health care operations. Protected health information is the information we create and obtain in providing services to you.
If you have any questions about this Notice, please contact the HIPPA Privacy Officer at (505) 255- 5501.
Your protected health information may be used or disclosed only for these purposes unless LifeROOTS, Inc. has obtained your authorization or the use or disclosure is otherwise permitted by the HIPPA privacy regulations or state law. Disclosures of your protected health information for the purposes described in the Privacy Notice may be made in writing, orally, or electronically.
LifeROOTS understands medical information about you and your health is personal. We are committed to protecting personal health information about you. This notice describes our obligations and your rights regarding the use and disclosure of personal health information.
We are required to:
• Maintain the privacy of your health information as required by law;
• Provide you with a notice about our duties and privacy practices;
• Abide by the terms of this Notice;
• Notify you if we cannot accommodate a requested restriction or request;
• Accommodate your reasonable requests regarding methods to communicate the information with you;
• Accommodate your request for an accounting of disclosures.
Uses and Disclosures of Your Protected Health Information
The following categories describe different ways that we use and disclose protected health information (PHI). For each category of uses and disclosures, we will explain what we mean and, where appropriate, provide examples for illustrative purposes. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted or required to use and disclose PHI will fall within one of the categories.
Except as outlined below, we will not use or disclose your PHI unless you have signed a form authorizing the use or disclosure. You have the right to revoke that authorization in writing except to the extent that we have taken action in reliance upon the authorization.
Uses and Disclosures for Treatment.
We may use and disclose your PHI to facilitate services by providers.
Uses and Disclosures for Payment.
We may make requests, uses and disclosures of your PHI as necessary for payment purposes. For example, we may use information regarding services we provided to you to process and request payment.
Uses and Disclosures for Health Care Operations.
We may use and disclose your PHI as necessary for our operations. For example, we may use your PHI in quality assessment and improvement activities.
In addition, LifeROOTS may disclose PHI without your consent or authorization when it is necessary to further certain public policy objectives, including:
Required by Law.
We will disclose PHI about you when we are required to do so by federal, state or local law. For example, we may disclose PHI when required by a court order in a litigation proceeding.
To Avert a Serious Threat to Health and Safety.
We may use or disclose PHI about you when necessary to prevent a serious threat to your health or to the health and safety of the public or another person. Any disclosure, however, would only be to someone able to prevent the threat. For example, LifeROOTS may disclose PHI about you in a proceeding regarding the licensure of a service provider, such as behavior therapist.
To Report Suspected Abuse, Neglect or Domestic Violence.
We may disclose your PHI to the proper authorities if we suspect abuse, neglect or domestic violence or if we believe you to be the victim of abuse, neglect or domestic violence.
Public Health Activities.
We may disclose PHI about you for public health activities, including:
• To prevent or control disease, injury or disability;
• To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
• To report births or deaths;
• To report reactions to medications or problems with products;
• To notify people of recalls of products they may be using; and
• For public health investigations.
Health Oversight Agencies.
We may disclose your PHI authorized by law to a government oversight agency (e.g. Department of Health, Adult Protective Services and Child Protective Services) conducting audits, investigations or civil and criminal proceedings. These activities are necessary for the government to monitor government programs and compliance with civil rights laws.
Judicial and Administrative Proceedings.
We may disclose your PHI in the course of a judicial or administrative proceeding (e.g., to respond to a subpoena or discovery request).
We may disclose your PHI to the proper authorities for law enforcement purposes, including criminal conduct and legal proceedings.
Coroners, Medical Examiners and Funeral Directors.
We may release PHI to a coroner or medical examiner consistent with law.
Organ and Tissue Donation.
We may disclose your PHI for organ, eye or tissue donation.
We may disclose your PHI for research purposes, but only as permitted by law.
National Security and Intelligence Activities.
We may release PHI about you to authorized federal officials for intelligence, counterintelligence and other national security activities authorized by law.
We may disclose your PHI to workers’ compensation agencies for work-related illnesses or injuries.
If you are an inmate of a correctional institution or under the custody of a law enforcement office, we may release PHI about you to the correctional institution or law enforcement official. This release would be necessary for the institution to provide you with health care, to protect your health and safety or the health and safety of others, or for the safety and security of the correctional institution.
We will, if required by law, release your PHI to the Secretary of the Department of Health and Human Services for enforcement of HIPPA.
Your Health Information Rights
The health record we maintain and billing records are the physical property of LifeROOTS, Inc. The information in it, however, belongs to you. You have the right to:
Inspect and copy your protected health information. You have the right of access to inspect and copy your personal health information that we maintain in designated records sets. To inspect and copy personal health information, you must submit your request in writing to LifeROOTS. 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.
Request a restriction on uses and disclosures. You have the right to request a restriction or limitation on the personal health information we use or disclose about you for treatment, payment or health care operations. To request restrictions, you must make your request in writing to LifeROOTS. In your request, you must tell us:
• What information you want to limit;
• Whether you want to limit our use, disclosure or both; and
• To whom you want the limits to apply, for example disclosures to your spouse.
We are not required to agree to your request but will attempt to accommodate reasonable requests when appropriate. We retain the right to terminate an agreed-to restriction if we believe such termination is appropriate. In the event of a termination by us, we will notify you of such termination. You also have the right to terminate, in writing or orally, any agreed-to restriction.
Receive confidential communication from us by an alternative means or location. You have the right to request that we communicate with you about your protected health information in a certain way or at a certain location. For example, you can ask that we only contact you by telephone or at work.
To request confidential communications, you must make your request in writing to LifeROOTS. 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.
Request amendments to your protected health information. If you feel that protected health 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 LifeROOTS.
To request an amendment, your request must be made in writing and submitted to LifeROOTS and provide a reason that supports your request. We are not required to make all requested amendments but will give each request careful consideration.
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:
• Is not part of personal health information kept by LifeROOTS;
• Was not created by us;
• Is not part of the information which you would be permitted to inspect and copy; or
• Is accurate and complete.
Obtain 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. You may obtain a copy of this Notice at our website, www.lifeROOTSnm.org. To obtain a copy of this Notice, contact the LifeROOTS Privacy Officer at 505-255-5501.
Obtain an accounting of disclosures. You have the right to request an “accounting of disclosures” where such disclosure was made for any purpose other than treatment, payment or health care operations. To request this list of accounting of disclosures, you must submit your request in writing to LifeROOTS. Your request must state a time period which may not be longer that six years and may not include dates before April 2003. Your request should indicate in what form you want the list (for example, paper or electronic). 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.
Complaints. If you believe your privacy rights have violated, you can file a complaint with us in writing at 1111Menaul Blvd. NE, Albuquerque, NM 87107. You may also file a complaint in writing with the Secretary of the U.S. Department of Health and Human Services in Washington, D.C. There will be no retaliation for filing a complaint.
We may contact you with information about health related services that may be of interest to you or appointment reminders. Unless you object we may also notify or assist in notifying a family member, personal representative or other person responsible for your care, about your location, about your general condition or death.
Changes to This Notice
We reserve the right to amend, change or eliminate provisions in our privacy practices and access practices and to enact new provisions regarding the protected health information we maintain. If our information practices change, we will amend our Notice. You are entitled to receive a revised copy of the Notice by calling and requesting a copy or visiting our office and picking up a copy.
The effective date is noted below in the bottom right-hand corner. Effective MAR 2005 Rev. JUN 2008 Rev. JUN 2011 – See more at: http://www.liferootsnm.org/privacypractices.aspx#sthash.RBpsATG4.dpuf