Telemedicine HIPAA Notice of Privacy Practices

Effective: August 4, 2020

THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Introduction

This Telemedicine HIPAA Notice of Privacy Practices (the “Notice”) is provided by Blueberry Medical PA, Blueberry Medical PC, or Lyndsey Garbi M.D., PC (each, individually a “Medical Group”), as that entity or its subsidiaries and affiliated entities may be formed and incorporated in your state, and the employees and practitioners that work at such entities (collectively, “We” or “Our”).

It contains important information about your medical information and your privacy rights. You have the right to receive a paper copy of this Notice at any time. If you received this Notice electronically, you may still request a paper copy by contacting the Privacy Officer at (754) 702-7256, or by visiting
https://www.blueberrypediatrics.com/privacy-practices/.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) imposes requirements on health care practices, defined as “Covered Entities,” regarding how individually identifiable health information (“Protected Health Information” or PHI) may be used and disclosed.

We understand your medical information is personal and are committed to protecting it. We will use your PHI only to the minimum necessary extent to accomplish legitimate purposes, as required by law.

This Notice explains your rights and our legal duties and privacy practices regarding PHI. We must comply with this Notice while it is in effect, but we reserve the right to change its terms and apply the revised Notice to all PHI we maintain.

Permitted Uses and Disclosures

We may use or disclose your PHI for treatment, payment, and health care operations. Examples of each are provided below.

Treatment

The provision, coordination, or management of your health care, including consultations between providers or referrals for care.

Example:
A physician treating you for diabetes may need to know if you have a psychiatric condition or take certain medications that could interact with diabetes treatments.

Payment

Activities undertaken to obtain reimbursement for your care, including billing, claims management, eligibility verification, and collections.

Example:
We may share necessary PHI with your insurance carrier to determine coverage or process payment.

Some disclosures for payment may require your written authorization, as required by law.

Health Care Operations

Administrative and support functions related to our practice, including compliance, training, audits, care coordination, and quality assurance.

Example:
We may use PHI to evaluate provider performance or aggregate data for quality improvement.
Identifiers may be removed for research or public health analysis.

Other Uses and Disclosures of PHI

We may also use your PHI in the following ways:

• To provide appointment reminders or schedule visits.

• To recommend possible treatment alternatives or health-related services.

• To share limited PHI with your family, guardian, or representative directly involved in your care or payment.

• To assist disaster relief agencies in locating or identifying individuals, as permitted by law.

• To allow family or friends to pick up prescriptions when deemed appropriate.

• For research purposes, subject to approval processes and your authorization when required.

• To share PHI with Business Associates (e.g., billing, technology, or legal services) under confidentiality agreements.

• To coordinate with insurance or legal entities for risk management or liability purposes.

• When required by law, only to the extent necessary.

• To your employer, when conducting authorized occupational health evaluations.

• For incidental disclosures that occur as a by-product of otherwise permitted use.

Special Situations

Subject to applicable law, we may also disclose PHI in the following circumstances:

Involuntary Patients

Information regarding patients treated involuntarily (by law) may be shared with other providers or legal entities as necessary for care coordination and compliance.

Emergencies

We may disclose information in life-threatening emergencies to prevent serious harm or death.

Organ and Tissue Donation

If you are an organ donor, PHI may be shared to facilitate donation or transplantation.

Public Health Activities

We may disclose PHI to public health authorities to:

• Prevent or control disease, injury, or disability

• Report births, deaths, or child abuse/neglect

• Report adverse reactions or unsafe products to the FDA

• Notify individuals exposed to communicable diseases

• Report adult abuse, neglect, or domestic violence (with consent or as authorized by law)

Health Oversight Activities

We may share PHI with federal or state oversight agencies for audits, investigations, compliance reviews, or civil rights enforcement.

Lawsuits and Disputes

If involved in a legal proceeding, we may disclose PHI as permitted by law or court order.

Law Enforcement

We may disclose PHI to law enforcement when:

• Required by court order or warrant

• To identify or locate a suspect or missing person

• About the victim of a crime (under certain limits)

• Regarding deaths potentially caused by crime

• To report crimes occurring on our premises

• To assist in emergencies involving criminal acts

Coroners, Medical Examiners, and Funeral Directors

We may disclose PHI as necessary for identifying deceased persons or facilitating burial services.

Confidentiality of Patient Records

Federal law does not protect information about suspected child or elder abuse or neglect from being reported to appropriate authorities.

Other Uses of Your Health Information

Certain uses and disclosures of PHI will only be made with your written authorization, including:

• Uses constituting a sale of PHI

• Any other disclosures not expressly permitted under this Notice

You may revoke such authorization at any time in writing, except to the extent we have already acted on it.

Your Rights

You have several rights regarding your PHI:

Request Restrictions

You may request limits on our uses or disclosures for treatment, payment, or operations.
We are not required to agree, except where disclosure is to a health plan for services paid in full by you.

Confidential Communications

You may request that we communicate with you through alternative means or locations (e.g., email).
Requests must be submitted in writing to the Privacy Officer.

Inspect and Copy Records

You may inspect or request copies of your PHI, except for:

• Psychotherapy notes

• Records prepared for legal proceedings

• Restricted lab results or research data

• Confidential sources as protected by law

Requests must be made in writing; reasonable copying and mailing fees may apply.

Request Amendments

You may request an amendment to your PHI if you believe it is incorrect or incomplete.
We may deny your request if:

• The record was not created by us

• It is accurate or complete

• It is not part of your medical record

Requests must be submitted in writing with supporting rationale.

Accounting of Disclosures

You may request a list of non-routine disclosures made in the past six years, except for:

• Treatment, payment, or operations

• Incidental or authorized disclosures

• Disclosures to correctional institutions or law enforcement

• National security disclosures

The first request per year is free; subsequent requests may incur fees.

Breach Notification

You have the right to receive notice if there is a breach of unsecured PHI requiring notification under HIPAA.

Notice Regarding Use of Technology

We use various forms of technology — including email, video conferencing, cloud storage, internet communications, and electronic health records — to facilitate care.

While we take strong measures to protect your data, unencrypted transmissions may not be fully secure. In rare cases, technical failures could result in a privacy breach.

Changes to This Notice

We reserve the right to change this Notice at any time as permitted by law.
Revised versions will apply to existing and future PHI.
Current copies will always be available at:
https://www.blueberrypediatrics.com/privacy-practices/

Complaints

If you believe your privacy rights have been violated, contact the Privacy Officer at (754) 702-7256.

You may also file a complaint with the U.S. Department of Health and Human Services at:

Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
Phone: 1-877-696-6775
Website: www.hhs.gov/ocr/privacy/hipaa/complaints

We will not retaliate against you for filing a complaint.

Contact Person

For questions or additional information about this Notice, please contact:

Privacy Officer
Phone: (754) 702-7256

This Notice is effective as of August 4, 2020.

Would you like me to add a table of contents with anchor links (for example, “Permitted Uses and Disclosures,” “Your Rights,” “Complaints,” etc.) to match the structure of your other Framer CMS legal pages?