THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
The terms of this Notice of Privacy Practices (the “Notice”) apply to Cupid Health, P.C., Cupid Health Texas P.A., Cupid Health P.A., and similar affiliated professional entities (“Medical Practices”).
In general, the Medical Practices will share medical information of patients as necessary to carry out treatment, payment, and health care operations as permitted by law. Furthermore, the Medical Practices are required by law to maintain the privacy of our patients' medical information and to provide patients with notice of our legal duties and privacy practices with respect to medical information. This Notice also describes the rights you have concerning your own medical information. The Medical Practices are required to abide by the terms of this Notice for as long as it remains in effect. The Medical Practices reserve the right to change the terms of this Notice as necessary and to make a new notice of privacy practices effective for all medical information. The Medical Practices are required to notify you in the event of a breach of your unsecured medical information.
Uses and Disclosures of Your Medical Information:
Authorization and Consent: The Medical Practices will not use or disclose your medical information for any purpose other than treatment, payment, health care operations or as otherwise required or permitted by law, unless you authorize such use or disclosure. You have the right to revoke such authorization in writing, with such revocation being effective once the Medical Practice receives the notification. Such revocation shall not be effective to the extent that Medical Practices have taken any action in reliance on the authorization. If you would ever like to revoke your authorization, please submit the request to the email address below.
Uses and Disclosures for Treatment: The Medical Practices will make uses and disclosures of your medical information as necessary for your treatment. Health care providers and other professionals involved in your care will use information in your medical record and information that you provide about your symptoms and reactions to your course of treatment that may include procedures, medications, tests, and medical history, among other elements. We may also disclose your medical information to others who need that information to treat you, such as doctors, physician assistants, nurses, medical and nursing students, technicians, medical equipment providers, and other facilities involved in your care. For example, we will allow your physician to have access to your medical record to assist in your treatment and for follow-up care.
We may use and disclose your medical information to contact you to provide treatment-related services, such as refill reminders, adherence communications, treatment alternatives (e.g., available generic products), and other health-related benefits and services that may be of interest to you.
Uses and Disclosures for Payment: The Medical Practices will make uses and disclosures of your medical information as necessary for payment purposes. The Medical Practices may use your information to prepare a bill to send to you or to the person responsible for payment. As the Medical Practices do not currently contract with insurance companies, Medical Practices will not forward your medical information to insurance companies to arrange for payment for the services provided to you.
Uses and Disclosures for Health Care Operations: The Medical Practices will make uses and disclosures of your medical information to run our organization, improve your care, and as necessary, and as permitted by law, for our health care operations, which may include clinical improvement, professional peer review, business management, accreditation and licensing, for example.
Individuals Involved in Your Care: The Medical Practices may from time to time disclose your medical information to designated family, friends and others who are involved in your care or in payment of your care in order to facilitate that person’s involvement in caring for you or paying for your care. If you are unavailable, incapacitated, or facing an emergency medical situation and the Medical Practices determine that a limited disclosure may be in your best interest, the Medical Practices may share limited medical information with such individuals without your approval. The Medical Practices may also disclose limited medical information to a public or private entity that is authorized to assist in disaster relief efforts in order for that entity to locate a family member or other persons that may be involved in some aspect of caring for you.
Business Associates: Certain aspects and components of the service of the Medical Practices are performed through contracts with outside persons or organizations, such as auditing, accreditation, outcomes data collection, legal services, etc. At times it may be necessary for the Medical Practices to provide access to your medical information to one or more of these persons or organizations who assist with health care operations (“Business Associates”). In all cases, the Medical Practices require these Business Associates, through written agreements, to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in the agreement.
Services: The Medical Practices may contact you to provide updates or information about your treatment or other health related benefits and services that may be of interest to you. You have the right to request and the Medical Practices will accommodate reasonable requests by you to receive communications regarding your medical information from the Medical Practices by alternative means. With such request, you must provide an appropriate alternative address or method of contact. You also have the right to request that Medical Practices not send you future marketing materials and Medical Practices will make reasonable efforts to honor such request. You must make such requests in writing, including your name and address, and send such writing to the email address below.
Research: In limited circumstances, the Medical Practices may use and disclose your medical information for research purposes. In all cases where the Medical Practices are not required to obtain your authorization, your privacy will be protected by confidentiality requirements applied by representations of the researchers that limit their use and disclosure of your information.
Other Uses and Disclosures: The Medical Practices are permitted and/or required by law to make certain other uses and disclosures of your medical information without your consent or authorization for the following:
- Any purpose required by law (Federal, state, or local laws sometimes require us to disclose patients’ medical information. For instance, we are required to disclose patient medical information to the U.S. Department of Health and Human Services so that it can investigate complaints or determine our compliance with HIPAA. We also are required to give information to Workers’ Compensation Programs for work-related injuries;
- Public health activities such as required reporting of immunizations, disease, injury, birth and death, in connection with public health investigations;
- If the Medical Practices suspect child abuse or neglect; if Medical Practices believe you to be the victim of abuse, neglect or domestic violence;
- For public safety purposes in limited circumstances. We may disclose medical information to law enforcement officers in response to a search warrant or a grand jury subpoena.
- To law enforcement officers and others to prevent a serious threat of health or safety.
- If you are a member of the armed forces, we may release your medical information as required by military command authorities or to the Department of Veterans Affairs. We may also disclose medical information to federal Officers for intelligence and national security purposes or for presidential protective services;
- We may disclose information concerning deceased patients to coroners, medical examiners, and funeral directors to assist them in carrying out their duties;
- To the Food and Drug Administration to report adverse events, product defects, or to participate in product recalls;
- To a government oversight agency conducting audits, investigations, civil or criminal proceedings;
- If ordered to do so by a court or if a subpoena or search warrant is served. You will receive advance notice about this disclosure in most situations so that you will have a chance to object to sharing your medical information.
Disclosures Requiring Authorization:
Psychotherapy Notes: The Medical Practices must obtain your specific written authorization prior to disclosing any psychotherapy notes unless otherwise permitted by law. The Medical Practices do not anticipate needing to obtain such notes.
Marketing: The Medical Practices must obtain your authorization for any use or disclosure of your medical information for marketing, except if the communication is in the form of (1) a face-to-face communication with you, or (2) a promotional gift of nominal value.
Sale of Protected Information: The Medical Practices must obtain your authorization prior to receiving direct or indirect remuneration in exchange for your medical information; however, such authorization is not required where the purpose of the exchange is for:
- Public health activities;
- Research purposes, provided that Medical Practices receive only a reasonable, cost-based fee to cover the cost to prepare and transmit the information for research purposes;
- Treatment and payment purposes;
- Health care operations involving the sale, transfer, merger or consolidation of all or part of the Medical Practices’ businesses and for related due diligence;
- Payment the Medical Practices provide to a business associate for activities involving the exchange of medical information that the business associate undertakes on our behalf (or the subcontractor undertakes on behalf of a business associate) and the only remuneration provided is for the performance of such activities;
- Providing you with a copy of your medical information or an accounting of disclosures;
- Disclosures required by law;
- Disclosures of your medical information for any other purpose permitted by and in accordance with the Privacy Rule of HIPAA, as long as the only remuneration Medical Practices receive is a reasonable, cost-based fee to cover the cost to prepare and transmit your medical information for such purpose or is a fee otherwise expressly permitted by other law; or
- Any other exceptions allowed by the Department of Health and Human Services.
State and Federal Laws Addressing Sensitive Information with Additional Protection: The Medical Practices may also be required to follow state privacy laws and other federal laws when they are stricter (or more protective of your medical information) than HIPAA. For example some state and federal laws are more protective and further restrict the use and disclosure of sensitive information. For those types of sensitive information, the Medical Practices may be required to get your permission before disclosing that sensitive information.
Restrictions on Disclosure of PHI to Health Plan: As mentioned above, the Medical Practices do not currently contract with insurance companies, Medical Practices will not forward your medical information to insurance companies to arrange for payment for the services provided to you. If, however, you request to restrict disclosure of PHI to a health plan if the disclosure is for payment or health care operations and is not otherwise required by law, and pertains to a health care item or service for which the individual has paid out of pocket in full, the Medical Practices will abide by such request.
Rights That You Have Regarding Your Medical Information:
Access to Your Medical Information: You have the right to copy and/or inspect much of the medical information that Medical Practices retain on your behalf. For medical information that Medical Practices maintain in any electronic designated record set, you may request a copy of such medical information in a reasonable electronic format, if readily producible. Please note that exceptions may apply as provided by law. The law requires us to keep the original record. This includes your medical record, your billing record, and other records we use to make decisions about your care. To request your medical information, submit a request to the email address below. A fee may be charged for the expense of fulfilling your request. We will tell you in advance what this copying will cost. You can look at your record at no cost. We may deny your request in certain limited circumstances but we will respond to your request with an explanation within thirty (30) days. If you are denied access to your medical information, you may request that the denial be reviewed.
Amendments to Your Medical Information: You have the right to request amendments or corrections to the medical information that the Medical Practices maintain about you. The Medical Practices are not obligated to make all requested amendments, but will give each request careful consideration. All amendment requests must be in writing, signed by you or your legal representative, and must state the reasons for the amendment/correction request. If an amendment or correction request is made, the Medical Practices may notify others who work with them if they believe that such notification is necessary. To ask us to amend your medical information, submit a written request to the email address below. While we may deny your request under certain circumstances, we will respond to your request with an explanation within sixty (60) days.
Right to Request Confidential Communications: You have the right to ask us to communicate with you in a way that you feel is more confidential. For example, you can ask us not to call your home, but to communicate only by mail. To do this, please discuss this with your caregiver, or submit a written request to the email address below. You can also ask to speak with your health care providers in private outside the presence of other patients – just ask them.
Right to Choose a Representative: If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your medical information. We will make sure this person has the authority and can act for you before we take any action.
Accounting for Disclosures of Your Medical Information: You have the right to receive an accounting of certain disclosures made by us of your medical information. Requests must state the time period which may not go back further than six (6) years and must be made in writing and signed by you or your legal representative. The first accounting in any 12-month period is free; you will be charged a fee for each subsequent accounting you request within the same 12-month period. You will be notified of the fee at the time of your request. We will tell you in advance what this list will cost and you may choose to modify or withdraw your request at that time. If you would like to receive such a list, submit a written request to the email address below.
Restrictions on Use and Disclosure of Your Medical Information: You have the right to request restrictions on uses and disclosures of your medical information for treatment, payment, or health care operations. The Medical Practices are not required to agree to your request, but will attempt to accommodate reasonable requests when appropriate. If you want to request a restriction, submit a request to the email address below and describe your request in detail.
Right to Notice of Breach: The Medical Practices take very seriously the confidentiality of medical information, and are required by law to protect the privacy and security of your medical information through appropriate safeguards. The Medical Practices will notify you in the event a breach occurs involving your unsecured medical information and inform you of what steps you may need to take to protect yourself. Such notification will be provided as soon as possible, but in any event, no later than sixty (60) days following our discovery of the breach.
Paper Copy of this Notice: You have a right, even if you have agreed to receive notices electronically, to obtain a paper copy of this Notice. To do so, please submit a request to the email address below.
Changes to this Notice
From time to time, we may change our practices concerning how we use or disclose medical information, or how we will implement patient rights concerning their information. We reserve the right to change this notice and to make the provisions in our new Notice effective for all medical information we maintain. If we change these practices, we will post a revised Notice of Privacy Practices. You can get a paper copy of our current Notice of Privacy Practices at any time by requesting one at the email address below.
Concerns or Complaints?
Please tell us about any problems or concerns you have with your privacy rights or how the Medical Practices uses or discloses your medical information. If you have a concern, please use the contact information below.
If for some reason the Medical Practices cannot resolve your concern, you may also file a complaint with the federal government by sending a letter to the U.S. Department of Health and Human Services, Office for Civil rights. www.hhs.gov/ocr/privacy/hipaa/complaints/
We will not penalize you or retaliate against you in any way for filing a complaint with the Medical Practices or with the federal government.
The Medical practices are required by law to give you this Notice and to follow the terms of the Notice that is currently in effect. If you have any questions about this notice, or have further questions about how the Medical Practices may use and disclose your medical information, please use the contact information below: