NOTICE OF PRIVACY PRACTICES
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.
Centricity Research is committed to protecting your health information. We are required by the Federal Privacy Rule to protect your medical information (called “protected health information” or “PHI”), provide you with this Notice of Privacy Practices (the “Notice”) describing our legal duties and privacy practices, and abide by the terms of the Notice currently in effect. We reserve the right to change the terms of this Notice and privacy policies, and to make the new terms applicable to all PHI we maintain. If we make a change to this Notice, we will provide the revised Notice on our website at: CentricityResearch.com.
In certain circumstances, pursuant to this Notice, patient authorization or applicable laws and regulations, we can use PHI or disclose your PHI to others as described below.
Uses and Disclosures for Treatment, Payment and Health Care Operations. As your treating provider, we may use, disclose, or share your PHI for the purposes of treatment, payment and health care operations, without obtaining written authorization from you. To the extent required under the Federal Privacy Rule, we will use the minimum amount of your PHI necessary to perform these tasks.
For Treatment. We may use and disclose your PHI in the course of managing or coordinating your treatment. For example, your PHI may be used and disclosed to coordinate and manage the activities of different health care providers who provide you with health care services.
For Payment. We may use and disclose your PHI as part of activities related to our payment for health care services. For example, we may disclose your PHI to your health plan in order to be reimbursed for services provided to you. We may also disclose your PHI to our business associates such as billing companies or claims processing companies.
For Health Care Operations. We may use and disclose your PHI as part of our general business operations. For example, we may disclose your PHI to audit claims processing and payment activities, for fraud and abuse detection activities, for compliance and risk management, for our management and administrative activities, for quality assessment and improvement activities, to review the qualifications and performance of health care professionals, for training, or for legal services.
Other Uses and Disclosures for Which Authorization is Not Required. In addition, we may use and disclose your PHI without your written authorization as described below:
As Required by Law, Judicial or Law Enforcement Purposes. We may use or disclose your PHI when required by law. We may disclose your PHI in judicial or administrative proceedings and in response to a subpoena or other legal process, if we are assured the requesting party made a good faith attempt to provide written notice of such disclosure to you. We may also disclose your PHI for law enforcement purposes.
For Public Health Activities. If appropriate, we may disclose your PHI to a public health authority in charge of collecting information regarding public health activities or risks which generally include preventing or controlling disease, reports of child abuse or neglect, reports of other victims of abuse, neglect, or domestic violence, reactions to medications or product defects or problems, or notification to an individual who may have been exposed to a communicable disease or may be at risk of contracting or spreading a disease or condition.
For Health Oversight Activities. We may disclose your PHI to the government for oversight activities, such as audits, investigations, and other activities for monitoring the health care system, government programs, and compliance with civil rights laws.
Research. We will only use your information for research after taking certain steps as required by law to protect your privacy. Federal regulations permit the use or disclosure of your PHI for research with your authorization. If an Institutional Review Board or Privacy Board approves our programs and measures to protect your privacy, we may use your PHI for reviews preparatory to research, or for research on a decedent’s information.
Coroners; Organ Donation. We may, in certain circumstances, disclose your PHI to coroners, medical examiners, and funeral directors for the purpose of identifying a decedent, determining a cause of death, or otherwise as necessary to enable these parties to carry out their duties consistent with applicable law. We may also in certain circumstances disclose your PHI in connection with organ donation.
Appointment Reminders. We may use or disclose your PHI to provide you with appointment reminders (including voicemail messages, postcards, electronic messages or letters). We may contact you about possible treatment options or alternatives or other health related benefits that may be of service to you.
Uses and Disclosures for Involvement in Your Care. Unless you object, we may disclose your PHI to a family member, other relative, friend, or other person you identify as involved in your health care or payment for your health care. We may use or disclose information to family members or others involved in the care or payment for health care of deceased individuals. Upon request, PHI may be released fifty (50) years after an individual’s death.
To Avoid a Serious Threat to Health or Safety or in Disaster Relief Efforts. We may use and disclose your PHI to law enforcement personnel or other appropriate persons, to prevent or lessen a serious threat to the health or safety of a person or the public. We may also disclose your PHI to an organization assisting in disaster relief efforts so your family can be notified about your location, condition and status. If you do not want us to disclose information for disaster relief efforts, we will not do so unless we must respond in an emergency.
Specialized Government Functions. We may use and disclose PHI of military personnel and veterans under certain circumstances. We may also disclose your PHI to authorized federal officials for intelligence, counterintelligence, and other national security activities, and for the provision of protective services to the President or other authorized persons or foreign heads of state or to conduct special investigations.
Workers’ Compensation. We may disclose your PHI to comply with workers’ compensation or other similar laws that provide benefits for work-related injuries or illnesses.
Correctional Institution. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release your PHI to the correctional institution or law enforcement official.
Fundraising Efforts. Your PHI may be used to contact you or may be disclosed for our fundraising efforts. We may use your demographic information to contact you, such as your name, address, other contact information such as your phone number, age, gender, and date of birth, the dates you required treatment or services, service department information, treating physician, outcome information and health insurance status. You have a right to opt out of receiving such fundraising communications and in the event you are contacted for fundraising, you will be given the opportunity to opt out.
Uses and Disclosures of PHI For Which Authorization is Required. Other types of uses and disclosures of your PHI not described in the Notice will be made only with your written authorization, which you have the limited right to revoke in writing. We may not use and disclose your PHI for marketing purposes except in limited circumstances as authorized by law without your written authorization. We will not disclose your psychotherapy notes except in limited circumstances either with your written authorization or as applicable law permits. We will not sell your PHI unless we have your written authorization or applicable law permits.
Personal Representative. You may request that we disclose your PHI to your personal representative. A personal representative is an individual you designate to act on your behalf and make decisions about your medical care. If you want us to disclose your PHI to your personal representative, we may request that you provide us with a written statement giving Centricity Research permission to release your PHI to your personal representative and document that this individual qualifies as your personal representative under state law.
State or Federal Law. State or Federal law may further limit the permissible ways we use or disclose your PHI. If an applicable State law or Federal law imposes stricter restrictions on us, we will comply with that law.
Your Rights Regarding Your PHI. You have the following rights regarding your PHI we maintain. We are not required to agree to a requested restriction except we must agree to a requested restriction of disclosure regarding your PHI to a health plan for payment purposes if the following conditions are met: (1) you have paid in full in advance for the associated treatment or services, (2) disclosure is not otherwise required by law and (3) you have made this request for restriction in writing when the services are performed. To exercise your rights, you must submit your request in writing to the Privacy Officer, Christine Senn, at Centricity Research 800 Talbotton Rd., Columbus, GA 31904. The Privacy Officer will confirm all requirements are satisfied before accepting your request. Please note that if you are enrolled in a clinical trial, our research staff will counsel you regarding your request and any impact on your continued participation in a trial.
Right to Request Restrictions. You may request that we restrict certain uses and disclosures of your PHI relating to treatment, payment, health care operations, to those involved in your care, or regarding notification purposes. When requesting a restriction, please specify the following: (1) the PHI you want to restrict; and (2) how you want to restrict your PHI.
Right to Request Confidential Communications. You may request that we communicate with you in a certain manner. For instance, you may request that we send you follow-up information at your home address instead of using your work address. We will accommodate your reasonable written requests.
Right to Inspect and Copy Your Records. Generally, you have the right to inspect and obtain a copy of your PHI maintained in the designated record set (the “Record”) by us. We will provide you a copy usually within thirty (30) days of your request. We will provide you access in the format requested, if we can readily do so. For instance, you can request a paper copy of your Record. If you ask for an electronic copy of your Record, we will provide an electronic copy in the format you request if possible. If we cannot provide the Record in the particular format, we will contact you to find another reasonable method. If you want a copy of your Record, we may charge you a reasonable fee to cover copying, postage, or other reasonable expenses with preparing your paper or electronic Record or summary for you. Please note that if you are enrolled in a trial, some records may not be available while the study continues.
Right to Request Amendment. If you believe that your PHI maintained in your Record by us contains an error, you have the right to request that we correct or supplement your Record. Your request must explain why you want to amend your record. If we deny your request, we will explain the reason for denial within sixty (60) days.
Right to Accounting of Disclosures. You generally have the right to request and receive a list of disclosures of your PHI we have made during the six (6) years prior to your request (but not before April 14, 2004). We will provide you a copy usually within sixty (60) days of your request. The list will not include disclosures (i) for which you have provided a written authorization; (ii) for treatment, payment, and health care operations; (iii) made to you; (iv) made to persons involved in your health care; (v) for national security or intelligence purposes; (vi) to correctional institutions or law enforcement officials; or (vii) of a limited data set. The first accounting request in a twelve (12) month period is free. For additional accounting requests within the twelve (12) month period, we may charge a reasonable cost-based fee.
Right to a Paper Copy of this Notice. You have the right to receive a paper copy of this Notice upon request, even if you have agreed to receive this Notice electronically. You also can review and print a copy of this Notice at our Web site via CentricityResearch.com.
Breach Notification. We are committed to protecting your PHI. Please understand that if there is a breach of your PHI, we will contact you as required by law. We are required to notify affected individuals in the event there is a breach of unsecured protected health information.
Complaints. If you believe your privacy rights with respect to your PHI have been violated, you have the right to contact the Privacy Officer and submit a written complaint. We will not penalize you or retaliate against you for filing a complaint regarding our privacy practices. You also have the right to file a complaint with the Secretary of the Department of Health and Human Services.
If you have any questions about this Notice. Please contact the Privacy Officer, Christine Senn, by phone at 706-321-0495, or by mail at Centricity Research, 800 Talbotton Rd., Columbus, GA 31904.
EFFECTIVE: August 10, 2015