Notice of Privacy Practices

NOTICE OF PRIVACY PRACTICES FOR MALE FERTILITY AND PEYRONIE’S CLINIC

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

I. OUR PLEDGE REGARDING HEALTH INFORMATION:

We understand that health information about you and your health care is personal. We are committed to protecting health information about you. We create a record of the care and services you receive from us, and we require this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all the records of your care generated by this health care practice. This notice will tell you about the ways in which we may use and disclose health information about you. We also describe your rights to the health information that we keep about you and describe certain obligations we have regarding the use and disclosure of your health information. We are required by law to:

  • Make sure that protected health information (“PHI”) that identifies you is kept private.
  • Give you this notice of my legal duties and privacy practices with respect to health information.
  • Follow the terms of the notice that is currently in effect.

II. HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU:

The following categories describe different ways that we use and disclose health information. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all the ways we are permitted to use and disclose information will fall within one of the categories.

For Treatment, Payment, or Health Care Operations: Federal privacy rules (regulations) allow health care providers who have direct treatment relationship with the patient/client to use or disclose the patient/client’s personal health information without the patient’s written authorization, to carry out the health care provider’s own treatment, payment or health care operations. We may also disclose your protected health information for the treatment activities of any health care provider. This too can be done without your written authorization. For example, if a clinician were to consult with another licensed health care provider about your condition, we would be permitted to use and disclose your person health information, which is otherwise confidential, in order to assist the clinician in diagnosis and treatment of your health condition.

Disclosures for treatment purposes are not limited to the minimum necessary standard. Other health care providers may require access to the full record in order to provide quality care. The word “treatment” includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers and referrals of a patient for health care from one health care provider to another.

Lawsuits and Disputes: If you are involved in a lawsuit, we may disclose health information in response to a court or administrative order.

We may use and share your information as we:

  • Treat you. We can use your health information and share it with other professionals who are treating you.
  • Run our organization. We can use and share your health information to run our practice, improve your care, and contact you when necessary.
  • Bill for your services. We can use and share your health information to bill and get payment from health plans or other entities.
  • Help with public health and safety issues. We can share health information about you for certain situations such as:

o Preventing disease

o Helping with product recalls

o Reporting adverse reactions to medications

o Reporting suspected abuse, neglect, or domestic violence

o 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 organizations.
  • Work with a medical examiner or funeral director. We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
  • Address workers' compensation, law enforcement, and other government requests. We can use or share health information about you:

o For workers' compensation claims

o For law enforcement purposes or with a law enforcement official

o With health oversight agencies for activities authorized by law

o For special government functions such as military, national security, and presidential protective services.

  • Respond to lawsuits and legal actions. We can share health information about you in response to a court or administrative order, or in response to a subpoena.

III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:

  • Marketing Purposes. We will not use or disclose your PHI for marketing purposes unless authorized by you to do so. This may include items such as newsletters, where authorization is granted by indicating that you are interested in receiving the newsletter.  This may be revoked at a later time by unsubscribing or otherwise indicating that you would no longer wish to receive the newsletter
  • Sale of PHI. We will not sell your PHI.

IV. USE OF EMAIL

  • Sending of Email. This authorization permits us to email you as a form of communication and which may include PHI.
  • Newsletter. We may use your email and name in any newsletter types of materials only if you opt-in to receiving the newsletter.  You may later choose to opt out of the newsletter at a later time.

V. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION.

Subject to certain limitations in the law, we can use and disclose your PHI without your Authorization for the following reasons:

  • When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law.
  • For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s health or safety.
  • For health oversight activities, including audits and investigations.
  • For judicial and administrative proceedings, including responding to a court or administrative order, although our preference is to obtain an Authorization from you before doing so.
  • For law enforcement purposes, including reporting crimes occurring on my premises.
  • To coroners or medical examiners when such individuals are performing duties authorized by law.
  • For research purposes, including studying and comparing outcomes of patients who received various treatments.
  • For workers’ compensation purposes. Although our preference is to obtain an Authorization from you, we may provide your PHI to comply with workers’ compensation laws.
  • Appointment reminders and health related benefits or services. We may use and disclose your PHI to contact you to remind you that you have an upcoming appointment.

VI. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT.

Disclosures to family, friends, or others. We may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.

VII. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:

  • The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask us not to use or disclose certain PHI for treatment, payment, or health care operations purposes. We are not required to agree to your request, and we may say “no” if we believe it would affect your health care.
  • The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full.
  • The Right to Choose How We Send PHI to You. You have the right to ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and we will agree to all reasonable requests.
  • The Right to See and Get Copies of Your PHI. You have the right to get an electronic or paper copy of your medical record and other information that we have about you. We will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 30 days of receiving your written request.
  • The Right to Get a List of the Disclosures We Have Made. You have the right to request a list of instances in which we have disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided us with an Authorization. We will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list we will give you will include disclosures made in the last six years unless you request a shorter time. We will provide the list to you at no charge.
  • The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that we correct the existing information or add the missing information. We may say “no” to your request, but we will tell you why in writing within 60 days of receiving your request.
  • The Right to Get a Paper or Electronic Copy of this Notice. You have the right to get a paper copy of this Notice.
  • The Right to request confidential communication in a specific way (for example, home or office phone) or to send mail to a different address.
  • The Right to ask for a list of the times we have shared your health information for six years prior to the date of the request, who we have shared it with, and why.
  • The Right to give 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.
  • The Right to file a complaint if you feel we have violated your rights in any way.

VIII. YOU HAVE THE FOLLOWING CHOICES WITH RESPECT TO YOUR PHI:

  • The Right and Choice to tell us to:
      1. Share information with your family, close friends, or others involved in your care
      2. Share information in a disaster relief situation
      3. Include your information in a hospital directory
  • We will NEVER share your information without written permission
      1. For marketing purposes
      2. For sale of your information
      3. For sharing of psychotherapy notes

IX. CONTACT INFORMATION:

If you would like further information about our privacy practices, please contact our compliance officer at email@mfp.clinic.

EFFECTIVE DATE OF THIS NOTICE

This notice was most recently updated on 4/3/2024.

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