NOTICE OF PRIVACY PRACTICES

Your Information. Your Rights. Our Responsibilities.

This notice describes how medical information about you may be used and disclosed and how you can obtain access to this information. Please review it carefully.

YOUR RIGHTS

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you exercise them.

Get an Electronic or Paper Copy of Your Medical Record

You may ask to see or obtain an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.

We will generally provide a copy or summary of your health information within 30 days of your request. We may charge a reasonable, cost-based fee as permitted by law.

You may ask us to correct health information about you that you believe is incorrect or incomplete.

We may deny your request under certain circumstances permitted by law. If we deny your request, we will explain the reason in writing, generally within 60 days.

Ask Us to Correct Your Medical Record

Request Confidential Communications

You may ask us to contact you in a specific way, such as at your cell phone, work phone, or another number, or to send mail to a different address.

We will agree to all reasonable requests.

Ask Us to Limit What We Use or Share

You may ask us not to use or share certain health information for treatment, payment, or our health care operations.

We are not required to agree to every request and may deny a request, for example, if the restriction could affect your care. If we agree to a restriction, we may still disclose the information if you need emergency treatment.

If you pay for a health care service or item completely out of pocket, you may ask us not to share information about that service or item with your health insurer for payment or health care operations. We will agree unless the law requires us to share that information.

Get a List of Certain Disclosures

You may request a list, known as an accounting of disclosures, of certain times we have shared your health information during the six years prior to the date of your request, including who we shared it with and why.

This list will not include certain disclosures, such as those made for treatment, payment, or health care operations, or other disclosures excluded by law.

We will provide one accounting of disclosures per year at no charge. If you request another within 12 months, we may charge a reasonable, cost-based fee.

You may request a paper copy of this notice at any time, even if you previously agreed to receive the notice electronically.

We will provide you with a paper copy promptly.

Get a Copy of This Privacy Notice

If someone has legal authority to act as your personal representative, such as through a valid medical power of attorney or legal guardianship, that person may exercise your rights and make decisions regarding your health information.

We will verify that the person has the appropriate authority before taking action on your behalf.

Choose Someone to Act for You

If you believe we have violated your privacy rights, you may file a complaint with us by contacting:

Clínica Médica de Las Américas
4070 South 4000 West
West Valley City, UT 84120
Phone: 801-955-1644

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights (OCR).

We will not retaliate against you for filing a complaint.

File a Complaint if You Believe Your Rights Have Been Violated

YOUR CHOICE

For certain health information, you may tell us your preferences about what we share.

If you have a specific preference regarding how we share your information in the situations described below, tell us what you want us to do. We will follow your instructions as permitted by law.

In Certain Situations, You May Tell Us Whether You Want Us To:

Share information with your family, close friends, or others involved in your care or payment for your care.
Share information in a disaster relief situation.

If you are unable to tell us your preference, for example, if you are unconscious, we may share your information if we believe doing so is in your best interest and is permitted by law.

We may also share your information when necessary to lessen a serious and imminent threat to health or safety.

In Certain Situations, We Need Your Written Authorization

We generally will not use or share your health information without your written authorization for:

Marketing purposes when HIPAA requires authorization.
The sale of your health information.
Most uses and disclosures of psychotherapy notes, if we maintain such notes.

If you provide us with written authorization to use or share your information, you may later revoke that authorization in writing.

Your revocation will not affect information that we have already used or shared based on your authorization before receiving your revocation.

HOW WE MAY USE AND SHARE YOUR INFORMATION

We typically may use or share your health information in the following ways.

To Treat You

We may use your health information and share it with other health care professionals who are treating you.

Example: A provider treating you for an injury may consult with another provider about your overall health, laboratory results, X-rays, medications, or other information relevant to your care.

We may use and share your health information to operate our clinic, improve the quality of care, and contact you when necessary.

Example: We may use health information to manage your treatment, coordinate services, or evaluate and improve the quality of care we provide.

To Run Our Organization

To Bill for Our Services

We may use and share your health information to bill and receive payment from health plans, insurance companies, or other entities responsible for payment.

Example: We may provide information about your treatment to your health insurance company so it can process and pay for the services you received.

OTHER PERMITTED OR REQUIRED USES AND DISCLOSURES

The law permits or requires us to share your health information in certain other situations. Before doing so, we must meet the conditions established by applicable laws.

These situations may include:

Public Health and Safety

We may share health information for certain public health and safety purposes, such as:

Preventing or controlling disease.
Assisting with product recalls.
Reporting adverse reactions to medications.
Reporting suspected abuse, neglect, or domestic violence as permitted or required by law.
Preventing or reducing a serious threat to the health or safety of a person or the public.

Research

We may use or share health information for health research when applicable legal requirements are satisfied.

Complying With the Law

We may share health information when federal or state law requires it, including with the U.S. Department of Health and Human Services when it wants to verify our compliance with federal privacy laws.

Organ and Tissue Donation

We may share health information with organ procurement organizations when applicable.

Medical Examiners and Funeral Directors

We may share health information with a coroner, medical examiner, or funeral director when necessary and permitted by law.

Workers' Compensation, Law Enforcement, and Other Government Requests

We may use or share health information:

For workers' compensation claims.
For certain law enforcement purposes.
With health oversight agencies for activities authorized by law.
For certain special government functions as permitted by law.

Lawsuits and Legal Actions

We may share health information in response to a court or administrative order, subpoena, or other lawful process when permitted or required by law.

INFORMATION RELATED TO SUBSTANCE USE DISORDERS

To the extent that we maintain information about you that is protected by federal confidentiality rules for substance use disorder patient records, including 42 CFR Part 2, additional protections apply.

We will not use or disclose such records to initiate or substantiate a civil, criminal, administrative, or legislative investigation or proceeding against you based on those records unless you provide written consent or a court order and subpoena meet the requirements of applicable federal law.

When applicable, we will comply with all additional protections required under 42 CFR Part 2.

OUR RESPONSIBILITIES

Clínica Médica de Las Américas is committed to protecting the privacy and security of your health information.

We are required by law to maintain the privacy and security of your protected health information.
We will notify you promptly if a breach occurs that may have compromised the privacy or security of your information, as required by law.
We must follow the duties and privacy practices described in this notice.
We must provide you with a copy of this notice when required or when you request one.
We will not use or share your information in a manner other than described in this notice unless you authorize us in writing or the law permits or requires the use or disclosure.
If you authorize us in writing, you may change your mind and revoke your authorization at any time by submitting a written request, subject to limitations permitted by law.

CHANGES TO THIS NOTICE

We may change the terms of this Notice of Privacy Practices.

Changes may apply to all health information we maintain about you, including information created or received before the change.

When we make material changes, the updated notice will be available at our clinic, provided upon request, and posted on our website.