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.
Provided in compliance with 45 C.F.R. § 164.520
Sapphire Therapeutic Services, Inc. uses health information about you for treatment, to obtain payment for treatment, to evaluate the quality of care you receive, and for other administrative and operational purposes. Your health information is contained in a medical record that is the physical property and responsibility of Sapphire Therapeutic Services, Inc..
How We May Use And Disclose Your Protected Health Information (PHI):
1. Routine Uses and Disclosures of Protected Health Information
We are permitted under federal law to use and disclose PHI, without your written authorization, for certain routine uses and disclosures, such as those made for treatment, payment, and the operation of our business. The following are examples of the types of routine uses and disclosures of PHI that we are permitted to make:
2. For Treatment:We will use and disclose your PHI to provide, coordinate and manage your treatment. For example, we will use your medical history to assess your health and perform requested services.
3. For Payment:Your PHI will be used and disclosed, as needed, to obtain payment for the health care services we provide you. For example, we may need to disclose to your health plan information about your current medical condition so that it will pay us for the services that we have furnished you.
4. For Health Care Operations:We may also use and disclose your PHI for to support our business activities. For example, we may disclose your PHI to accreditation organizations, auditors, or other consultants to review our practice, evaluate our operations, and tell us how to improve our services.
5. Uses and Disclosures That May Be Made Without Your Authorization or Opportunity to Object We may use or disclose your PHI in the following situations without your authorization or providing you the opportunity to object.
6. Required by the Secretary of Health and Human Services:We may be required to disclose your PHI to the Secretary of the United States Department of Health and Human Services to investigate or determine our compliance with certain legal requirements.
7. Required by Law:We may disclose PHI about you when we are required to do so by federal, state, or local law.
8. Public Health:We may disclose PHI about you in connection with certain public health reporting activities. For instance, we may disclose PHI to a public health authority authorized to collect or receive PHI such as state health departments and federal health agencies.
9. Abuse or Neglect:We may disclose your PHI to a public health authority or other government authority authorized by law to receive reports of child abuse or neglect. We may also disclose your PHI in situations of domestic abuse to a government agency authorized to receive such information.
10. Health Oversight:We may disclose your PHI in connection with certain health oversight activities of licensing and other agencies, such as audit, investigation, inspection, licensure, or disciplinary actions, and civil, criminal, or administrative proceedings.
11. Judicial and Administrative Proceedings:We may disclose your PHI in response to a warrant, subpoena, or other order of a court or administrative hearing body, and in connection with certain government investigations and law enforcement activities.
12. Coroner and Funeral Directors:We may release your PHI to a coroner, medical examiner or funeral director to identify a deceased person or determine the cause of death.
13. Workers’ Compensation:We may release your PHI to workers’ compensation insurers or similar programs.
14. Serious Threat to Health or Safety:We may disclose PHI about you also when necessary to prevent a serious threat to your health and safety or the health and safety of others.
15. Specialized Government Functions:If you are a member of the Armed Forces, we may disclose PHI about you as required by military command authorities. We also may release PHI about foreign military personnel to the appropriate foreign military authority.
16. National Security and Intelligence Activities:We may disclose your PHI to authorized federal officials for intelligence, counterintelligence, protection of the President, other authorized persons or foreign heads of state, for purpose of determining your own security clearance and other national security activities authorized by law.
17. Organ Donation:If you are an organ donor, we may disclose your PHI to organ procurement organizations as necessary to facilitate organ donation or transplantation.
18. Inmates:We may use or disclose your PHI if you are an inmate of a correctional facility and we created or received your PHI in the course of providing care to you.
19. Research: Under certain circumstances, we may disclose your PHI to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your PHI.
20. Business Associates: We may disclose your PHI to our business associates so that they can perform the tasks that we hire them to do. Our business associates must guarantee to us that they will respect the confidentiality of your PHI.
21. Uses and Disclosures That May Be Made Either With Your Agreement or the Opportunity to Object
Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, orally or in writing, your PHI that directly relates to that person’s involvement in your health care. If you are unable to agree or object to such disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose your PHI to notify or assist in notifying a family member, personal representative or any person responsible for your care of your location or general condition.
22. Uses and Disclosures of Protected Health Information Based upon Your Written Authorization
23. Marketing: We must obtain your written authorization to use and disclose your PHI for most marketing purposes.
24. Sale of PHI: We must obtain your written authorization for any disclosure of your PHI which constitutes a sale of PHI.
25. Other Uses: We are also required to obtain written authorization from you for uses and disclosures of PHI other than those described above. If you provide us with such permission, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose protected information about you for the reasons covered by your written authorization. We will be unable to take back any disclosures already made based upon your original permission.
Your Rights Regarding your Protected Health Information:
You have certain rights regarding your PHI, which are explained below. You may exercise these rights by submitting a request in writing to our Privacy Officer at the address below.
1. You have the right to request a restriction of your PHI.You have the right to ask for restrictions on the ways in which we use and disclose your PHI for purposes of treatment, payment or health care operations. You may also request that any part of your PHI not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice. Your request must state the specific restriction requested and to whom you want the restriction to apply. We are not required to agree to a restriction that you request, except we must agree not to disclosure your PHI to your health plan if the disclosure (1) is for payment or health care operations purposes and is not otherwise required by law, and (2) the disclosure deals solely with health care items or services that were paid for in full by a person or entity other than your health plan. For example, if you paid out-of-pocket in full for a service, we must agree to your request to restrict disclosure of that information to your health plan.
2. You have the right to request that you receive communications containing your PHI from us by alternative means or at alternative locations.You have the right to request that we communicate with you in a certain way or at a certain location. For example, you may ask that we only contact you at home or by mail. We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact.
3. You have the right to opt out of receiving fundraising communications from us.We may contact you for fundraising purposes, and you have the right to opt out of receiving these communications.
4. You have the right to inspect and copy your PHI.Except under certain circumstances, you have the right to inspect and copy your PHI, and we are required to provide you access to such PHI for inspection and copying within 30 days after receipt of your request (with up to a 30-day extension if needed). If you ask for copies of this information, we may charge you a cost-based fee for copying and mailing. We will base this fee on current Colorado law. If we maintain your records in electronic format, you have the right to access your PHI in electronic format. It is our policy only to accept written requests for access to medical and billing records. In addition, there are situations where we may deny your request for access to your PHI. For example, we may deny your request if we believe the disclosure will endanger your life or that of another person. Depending on the circumstances of the denial, you may have a right to have this decision reviewed.
5. You have the right to amend your PHI.If you believe that PHI in your records is incorrect or incomplete, you have the right to ask us to correct the existing information or to correct the missing information. We will respond to your request within 60 days (with up to a 30-day extension if needed). Under certain circumstances, we may deny your request. We may deny your request if, for example, we determine that your PHI is accurate and complete. If we deny your request, we will send you a written explanation and allow you to submit a written statement of disagreement. It is our policy to require requests for correction or amendment be submitted in writing.
6. You have the right to receive an accounting of certain disclosures that we have made of your PHI.You have a right to ask for a list of instances when we have used or disclosed your PHI for reasons other than your treatment, payment for services furnished to you, our health care operations, or disclosures you give us authorization to make. You must specify a time period for the accounting, which may not be longer than 6 years prior to the date of the request. You may request a shorter timeframe. If you ask for this information from us more than once every twelve months, we may charge you a fee. We will respond to your request within 60 days (with up to a 30-day extension if needed).
7. You also have the right to be notified if you are affected by a breach of unsecured PHI.
8. You have the right to a copy of this Notice in paper form.You may ask us for a copy at any time.
You may complain to us or to the Secretary of the United States Department of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our Privacy Officer at (714) 828-1800 ext. 385.
We will not retaliate against you in any way for filing a complaint.
If you have any questions, requests, or concerns about this notice or your Sapphire Therapeutic Services, Inc.-related health information rights or our use and disclosure of health information, please contact:
The Privacy Officer at (281) 714-5121.
EFFECTIVE DATE: October 7, 2021