* IMPORTANT INFORMATION *
I. HIPAA NOTICE OF INFORMATION REGARDING PRIVACY:
This notice is provided in pursuant to the regulations regarding patient privacy act enacted as the Health Insurance Portability and Accountability Act of 1996, often referred to, and from now on referred to in this document, as HIPAA. This act required certain practices regarding your medical information and how it may be used and access to your information. This Notice refers to your medical information obtained and maintained through Myasic Medical, referred to as we in this document.
II. COMMITTED TO PRIVACY ~
* We are committed to maintaining the privacy of your personal and health information.
* We will not share your information other than as described here unless you tell us in writing we are permitted. If you notify us that we can, you can change your mind at any time, just notify in writing of your preferences.
* We must provide information on:
– how we collect information
– obligations on how we use and disclose your health information
– your privacy rights
* We are required by law to:
– maintain the privacy of your health information
– provide you with this notice of our legal obligations and privacy practices
– follow the terms of the privacy practices implemented
– notify you if there is a breach of your personal or health information
* This notice does NOT authorize personal and medical information but provides you information on the disclosure process and protection of your Protected Health Information, for remainder of document referred to as PHI.
* This notice is updated and kept available for access at any time via this website. You may also request a copy of this HIPAA Notice at any time.
For additional information regarding HIPAA see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
III. NOTICE SUMMARY:
- We may use and share information:
– To provide treatment and care
– Bill for services
– Business operations
– Report to public health and safety entities
– Conduct research activities
– Respond to organ/tissue procurement
– Work with medical examiner/funeral director
– Workers compensation, legal commitments or Government requests
– Lawsuits and legal actions and to comply with law
** SEE SECTION IV & VI BELOW
- You have choices about information shared:
– With friends/family
– In event of disaster
– Market services
– Conducting research
** SEE SECTION V BELOW
- You have the right to:
– Request correction of records
– Obtain a copy of your medical record
– Request route of communication
– Ask to restrict shared information
– Get a list of those who have received your information
– Get a copy of this privacy notice
– Choose someone to act on your behalf
– File a complaint if you are concerned about your privacy
** SEE SECTION VII BELOW
IV. LIMITED RIGHT TO USE PERSONAL INFORMATION:
There may be certain circumstances where information may need to be disclosed. Some pertain to contacting you or a health care agent for information and other times may be due to specified circumstances.
* We may share information to provide medical treatment and services with other health professionals and providers who are caring for you. As our focus at Mysaic Medical is as a specialty provider of Functional Medicine, you will have a primary health care provider who may require information to continue your care.
* Other providers may include, but are not limited to, other physicians, nurses, pharmacists or compounding pharmacies, lab technicians, health coaches, nutritionists etc.
* An example may be your primary care physician who asks about information obtained during Functional Medical testing.
Bill for Services:
* Although Mysaic Medical is a fee-for-service provider and billing your medical insurer directly will not be an option, you may request a print out of your services or verification of use of your Health Savings Account.
* We will use personal data you provide to process your payment for the purchase of goods or services. We only use third party payment processors that take the utmost care in securing data.
* Mysaic Medical may also disclose your information to a collection agency to obtain overdue payments, to a regulatory agency or other entity to provide verification of medically necessary and appropriately billed services.
* Your PHI may be disclosed to run our practice, improve care and contact you directly when needed.
* Your PHI may be disclosed or used under other potential situations:
a) conducting quality or safety activities, evaluating improved health or reducing health care costs, care coordination and contacting your health care providers with information about potential treatment option
b) during training programs or when completing any licensing or credentialing activities
c) when arranging for medical review, legal services or auditing
d) for management and administration evaluation, such as customer service, resolving grievances, planning
e) de-identified information may be provided for certain business operation purposes
f) visits may be recorded to document your care via scribe services
V. USE AND DISCLOSURE OF PHI:
Collection of Information:
* We, at Mysaic Medical, along with staff and employees collect data through a variety of sources; including but not limited to letters, phone calls, emails, voicemails and from the submission of forms that are required to obtain your medical history or other requests for assistance or upon contact or receiving care through this health care corporation.
* We may disclose your PHI to contact you for appointment reminders, check-in and contact for results. For instance, we may have a sign-in at a front desk and call you by name at the time of your appointment. We may also need to remind you of an appointment or follow up on results and a message may be left regarding this information, with the minimum amount left to communicate necessary information.
* We may contact you if we feel you will benefit or may have a legitimate interest of hearing from us. For example, if you sign up for a webinar, we may send you marketing emails based on the content of the webinar. You will always have the option to opt out of any of our emails.
* Mysaic Medical may use and disclose PHI to inform you of treatment options or alternatives as well as certain health-related benefits or services that may be of interest. We will disclose your PHI to describe these services or inform other providers participating in your care.
Disclosures to Friends/Family:
* Your PHI may be disclosed to individuals involved in your care or treatment who are responsible for your payment for care or treatment. Should you become incapacitated, we may disclose your PHI to the person named in your Durable Power of Attorney for Health Care or chosen personal representative with your permission.
* Your PHI may be disclosed in the event of a disaster to a disaster relief organization to coordinate your care and/or notify family members or friends of your location and condition.
* PHI may be disclosed to researchers. In the event of research your authorization would be required in most cases to participate in Institutional Review Board (IRB) approved studies. In certain circumstances, non-identifiable information may be used without requiring authorization.
* Any pictures, stories, letters, biographies, correspondence, or thank you notes sent to us via any method, be it cards, paper or electronic messages, become the exclusive property of Mysaic Medical.
* We reserve the right to use non-identifying information about our clients (those who receive services or goods from or through us) for promotional purposes.
* Clients will not be compensated for use of this information and no identifying information (photos, addresses, phone numbers, contact information, last names or uniquely identifiable information) will be used without client’s express advance permission.
* You may specifically request that NO information be used whatsoever for promotional purposes, but you must identify any requested restrictions in writing.
* We respect your right to privacy and assure you no identifying information or photos that you send to us will ever be publicly used without your direct or indirect consent.
Legally Required Disclosures:
* If required by law to do so, Mysaic Medical will comply with federal, state or local law and disclose information where necessary.
VI. SPECIAL CIRCUMSTANCES – USE AND DISCLOSURE OF PHI:
Under certain circumstances, Mysaic Medical may disclose or be required by law to disclose your PHI.
Public Health and Safety:
* The Food and Drug Administration (FDA) may be evaluating the quality and safety of a medication, product, procedure or activity and request information regarding use in our facility.
* Evaluate potential recalls or problems with services, equipment or medications or evaluation of health products.
* Preventing or mitigating disease.
* Work with medical examiner, report births or deaths.
* Report abuse concerns as required by law.
* Prevent or reduce threat to anyone’s health or safety as deemed appropriate, this may entail providing information in the case you are unconscious and/or if it is felt in the best interest of public concern your information may be provided.
Lawsuits and Disputes:
* Mysaic Medical may disclose your PHI in response to a court or administrative order, subpoena, request for discovery, or other legal processes. Absent a court order this will be disclosed only if you have authorized the disclosure.
* Your information may also be disclosed if required for our legal defense in the event of a lawsuit.
* If requested by law enforcement official, Mysaic Medical may be required to disclose your PHI
a) crime victim in a certain situation and unable to obtain person’s agreement
b) death resulting from a crime on our premises or any criminal conduct on our premises
c) response to warrant, summons, court order, subpoena or other legal proces
d) identify a suspect, witness, fugitive or missing perso
e) emergency to report a crime
* We can share information regarding your PHI with organ or tissue procurement organizations.
* Your PHI may be shared with a coroner, medical examiner or funeral director following death.
* Mysaic Medical will disclose necessary PHI for worker’s compensation in compliance with worker’s compensation laws and may be reported to your employer and/or employer’s representative in the case of occupational injury or illness.
* In situations involving the Military, National Security and Presidential Protective Services release of information may be required by law.
* Generally defined as an individual under 18 years old, information may be disclosed to a parent or guardian unless otherwise prohibited by law.
VII. YOUR PHI PRIVACY RIGHTS:
* If you wish for us to communicate with you in a specific way or send mail to a specified address please notify and update changes to your contact information. Mysaic Medical will do our best to comply with all requests.
View and Obtain Copies of Your Records:
* This is your record and you may review and/or request a copy of your PHI that is used to make decisions about you.
* If possible you may obtain this via an electronic copy or we may provide a paper copy of your record.
* This will be provided to you or your designated representative within thirty (30) days of request.
* There may be a cost-based fee to cover costs of copying, mailing, labor and supplies associated with such a request.
Medical Record Correction:
* If you feel there is a needed correction or amendment of your PHI and that information is not correct or incomplete, we value your input. You may request a correction to your records or amendment in writing.
* Mysaic Medical will notify you in writing within sixty (60) days pertaining to your request, if it cannot be fulfilled and the reasoning.
* You have the right to request Mysaic Medical not use or share PHI for treatment, payment or health care operations. We are not required to agree to your request and may say “no” if we feel it will affect optimal care.
* If you pay for your health care out-of-pocket, you may ask us not to share information for the purpose of our operations with any health insurer. However, the care provided through Mysaic Medical at this time is not covered by any health insurance and, therefore, we will not share any information unless a law specifically requires us to release the information.
Documentation of Disclosures:
* At any time you can request an accounting of disclosures made of your PHI by Mysaic Medical. This list will not include information made for the purposes of treatment, payment, health care operations, disclosures required by law and certain other disclosures (if you asked for them to be made on your behalf).
* You must make this request in writing and note the time frame that you wish to receive the accounting report and this time must be within the past six (6) years from the date you make the request.
* Mysaic Medical will provide one accounting review each year free of charge but if another is requested in a twelve (12) month period a cost will be incurred.
Breach of Unsecured Medical/Bill Information:
* If any breach of your PHI occurs you will receive prompt notice in writing of the breach.
* Although this HIPAA notice is accessible via the Mysaic Medical website, you have a right to receive a paper copy of this notice at any time even if you have agreed to receive it electronically.
Right to File a Complaint:
* While Mysaic Medical will do everything possible to prevent violation of your privacy rights, if you believe your rights have been violated you have the right to a grievance.
* Please notify the Privacy Officer for Mysaic Medical in order to rectify the issue in the timeliest manner.
* You may also file a complaint directly with the Secretary of The Department of Health and Human Services (HHS), Office for Civil Rights, 200 Independence Avenue, SW., Washington, DC, 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
* All complaints must be submitted in writing.
VIII. TECHNOLOGY IN HEALTHCARE:
As advances in technology are incorporated into healthcare practices, certain situations apply to the use of these services regarding HIPAA policies and are continually evolving.
* Mysaic Medical may use and disclose PHI through a variety of secure patient portals for you to view, download and utilize. This may include medical and billing information and as a form of communication in a secure manner through the portal.
* Should you email us from a private email address, we cannot guarantee a secure transmission of your information. We recommend using the patient portal for all correspondence regarding care or billing concerns.
* If you make the request for information to be sent to a private email, it will be sent in an encrypted manner unless otherwise requested.
* Mysaic Medical is not responsible for privacy breach if a request is made via an insecure manner or downloaded through another unsecure medium. We are not responsible for PHI re-disclosed or otherwise misused by an authorized recipient. If you share account information with another individual or you choose to store, print, email or post your own PHI, this information cannot be securely maintained.
* At times, clients may opt to follow up via telemedicine, including video or phone calls and, while the physician is not recording the visit, these visits will be conducted through a provider offering a business associate agreement to “uphold the HIPAA privacy rules”.
* We may use the standard “cookies” feature of major web browsers. We do not set any personally identifiable information in cookies, nor do we employ any data-capture mechanisms on our Website other than cookies. You may choose to disable cookies through your own web browser’s settings. However, disabling this function may diminish your experience on our Website and some features may not work as intended.
Client Contact Information:
* Your home address, email address, home/work/cell numbers or other contact information provided is assumed to be accurate and correct and you consent to our use of this information to communicate to you in regards to any treatment, payment of services and any health care function. You are responsible to notify us of any change in contact information. Mysaic Medical reserves the right to utilize a third party for updating this information of our records if needed.
* Despite best efforts to protect privacy, PHI may be overheard or seen by other people not involved in your care. Incidental disclosures are not a violation of HIPAA.
* PHI may also be disclosed to an individual providing services to Mysaic Medical. While confidentiality agreements are requested before utilizing business associates/services, inadvertent information may be disclosed.
* Certain information, such as substance use and mental health care, are provided special protection through federal regulations and although information regarding previous/current care may be collected while receiving Functional Medical care with Mysaic Medical, this will not be a primary service and only would be disclosed under Federal law and regulations or with express permission by clients.
IX. CHANGES TO NOTICE:
At any time Mysaic Medical reserves the right to change this HIPAA Notice. These changes would apply to information already obtained regarding your information. New notices will be posted through this website and available via the website with each amendment.
X. CONTACT/CONCERN INFORMATION:
If you have any questions about this HIPAA Notice or wish to file a privacy complaint, please contact:
Andrea M. Dalve-Endres, MD.
7967 Hawthorne Avenue
Livermore, CA 94550
Mysaic Medical Notice of Privacy Practices
Effective Date: July 7, 2019
NOTICE TO CONSUMERS
Medical doctors are licensed and regulated by the Medical Board of California
(1-800-633-2322 | www.mbc.ca.gov)