| STATEMENT
OF PRIVACY
You are hereby
instructed to review this Statement of Privacy carefully as you
will be required to acknowledge your review of and agreement to
its statements.
This notice states the privacy practices of Consults4Less.com
("C4Less") and its owners. This statement supplies to all of these
primary care physicians and specialists, nurses, residents, researchers
and Physician Assistants of C4Less.
C4Less is required
by federal HIPPA regulations to maintain the privacy of your health
information ("protected Health Information" or "PHI") and to provide
you with this notice.
We will take precautions
to protect information necessary to your care. We will use your
health information for treatment, to run our healthcare network
and to obtain payment.
We may use and disclose
(give out) your PHI in connection with your treatment and/or other
services provided to you - for example, to diagnose and treat you.
In addition, we may contact you to provide appointment reminders
or information about treatment alternatives or other health-related
benefits and services. We may record your information at the nurse's
stations, provide it in bedside charts and collect it in sign-in
sheets in order to coordinate your care.
We may disclose your
PHI to obtain payment for services that we provide to you.
We may use and disclose
your PHI for healthcare operations. These include internal administration
and planning and various activities that improve the quality and
cost effectiveness of healthcare services. We may use your PHI to
evaluate our physicians, nurses and other healthcare workers - or
to support training of these professionals. We may also use PHI
to address patient concerns, to provide patient education and to
assess patient satisfaction. We may provide licensing and accrediting
organizations with your PHI to maintain approvals we need to continue
our services.
We may also disclose
PHI to other healthcare providers when such PHI is required for
them to treat you (e.g., specialists, pharmacists), receive payment
for services they provide to you, or conduct certain healthcare
operations. For example, emergency ambulance companies use PHI to
request payment for services in bringing you to the hospital.
We may disclose your
PHI to a family member, other relative, friend or any other person
if we: 1) obtain your agreement; 2) provide you with the opportunity
to object to the disclosure, and you do not object; 3) we reasonably
assume that you do not object. If we provide information on any
individual(s) listed above we will release only information that
we believe is directly relevant to that person's involvement with
your healthcare or payment related to your healthcare. We may also
disclose your PHI in the event of an emergency or to notify (or
assist in notifying) such persons of your location, general condition
or death.
We may use PHI to
communicate with you about products or services relating to your
treatment, case management or care coordination, or alternative
treatments, therapies, providers or care settings without your written
authorization. We offer you help in finding a physician and look
at how this referral service is used. We may send you newsletters
or informational mailers regarding our services, programs and community
events. If you have taken part in one of our health screenings or
other community events, we may follow up with you by telephone or
mail about services that may benefit you.
We may disclose your
PHI for the following public health activities: 1) reporting births
or deaths; 2) preventing or controlling disease; 3) reporting child
abuse and neglect to public health or other government authorities
authorized by law to receive such reports; 4) reporting information
about products and services under the jurisdiction of the United
States Food and Drug Administration, such as reactions to medications
and problems with products; 5) alerting a person who may have been
exposed to an infectious disease or may be at risk of contracting
or spreading disease or condition; 6) notifying people of recalls
of products they may be using; and 7) reporting information to your
employer as required by law addressing work-related illnesses and
injuries or workplace medical surveillance.
If we reasonably
believe you are a victim of abuse, neglect or domestic violence,
we may disclose your PHI to a governmental authority, including
a social service protective agency, authorized by law to receive
reports of such abuse, neglect or domestic violence.
We may disclose your
PHI to a health oversight agency that is responsible for ensuring
compliance with rules of government health programs such as Medicare
or Medicaid.
We may disclose your
PHI in response to a court order, subpoena, or other lawful process.
We may disclose PHI
of deceased individuals to a coroner or medical examiner authorized
by law to receive such information.
We may disclose your
PHI to organizations that obtain organs or tissue for banking and/or
transplantations.
We may use or disclose
your PHI to prevent or lessen a serious and imminent threat to personal
or public safety.
We may disclose your
PHI as authorized by state law relating to worker's compensation
or other similar government programs.
If you are or become
a correctional institution inmate or you are in custody of a law
enforcement official, we may release your PHI to the institution
or official if required to provide you with healthcare or to protect
the health and safety of others.
We may use and disclose
your PHI when required to do so by any other laws not already referenced
above.
If a business associate
assists C4Less operations. C4Less will disclose PHI as needed, but
only if the business associate has signed a privacy addendum agreeing
to maintain the privacy of PHI.
For any purpose other
than the ones described above, we may use or disclose your PHI only
when you give C4Less your specific written authorization. For instance,
you will need to sign an authorization form before we can send your
PHI to a life insurance company.
You may request to
see and obtain copies of your medical and billing records and to
have copies sent to others. To do so, please submit a written request
to C4Less. We will charge you for copies. Under limited circumstances
defined by law, we may deny you access to a portion of your records.
You may request additional
restrictions on C4Less' use and disclosure of your PHI 1) for treatment,
payment and healthcare operations; 2) to individuals (such as family
members, or other relatives, close friends or any other person identified
by you) involved with your care or with payment related to your
care; and 3) to notify or assist in the notification of such individuals
regarding your location in the hospital and your general condition.
Although we will consider all requests for restrictions carefully,
we are not required to agree to a request.
You may request to
receive your PHI by alternate means of communication or at alternate
locations. For example, you may instruct us not to contact you by
telephone at home, or you may give us a mailing address other than
your home for test results.
You may revoke your
authorization by delivering a written form requesting us to stop
using your authorization. The request will be effective once agreed
to by as set forth above. A revocation form is available upon request
from C4Less.
You have the right
to request that we amend the PHI maintained in your medical or billing
records. To do so, you must submit a written request to the C4Less.
We may deny your request if C4Less reasonably believes that the
information is accurate and complete, if the PHI was not created
by C4Less, or other special circumstances apply.
If you wish further
information about your privacy rights, are concerned that your privacy
rights were violated, or disagree with a decision that we made about
access to your PHI, you may contact C4Less by clicking on "Contact".
Additionally, you
may file a written complaint with the Director, Office for Civil
Rights of the U.S. Department of Health and Human Services. Upon
request, C4Less will provide you with contact information.
We may change the
terms of this notice at any time. If we change this notice, we will
post the revised list online at www.Consults4Less.com. You may obtain
any revised notice by contacting us.
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