Medical Information Notice of Privacy Practices
Effective Date: November 19, 2021
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.
WHO WILL FOLLOW THIS NOTICE
This Notice of Privacy Practices (the “Notice”) describes Covid Clinic, Inc.’s (“Covid Clinic”) practices and those of Covid Clinic employees, staff, volunteers, and other personnel who are involved in the provision of services to you. Covid Clinic and these individuals will follow the terms of this Notice and may use or disclose medical information about you to carry out the services, payment or health care operations, or for other purposes as permitted or required by law. This Notice describes how you can access and control medical information about you, including information that may identify you and that relates to your past, present, or future physical, medical, or mental condition and medical care and related health care services.
COVID CLINIC’S PLEDGE REGARDING MEDICAL INFORMATION
Covid Clinic understands that medical information about you and your health is personal. Covid Clinic is committed to protecting medical information about you. In order to provide you with quality services and to comply with certain legal requirements, Covid Clinic creates a record of the services you receive at Covid Clinic. This Notice applies to all of the records of your services generated by Covid Clinic. This Notice will tell you about the ways in which Covid Clinic may use and disclose medical information about you. Covid Clinic will: (1) make sure that medical information that identifies you is kept private; (2) give you this Notice of its privacy practices concerning medical information about you; (3) follow the terms of the Notice that are currently in effect, and (4) notify you in case there is an unauthorized use or disclosure of your unsecured medical information.
HOW COVID CLINIC MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
The following categories describe different ways that Covid Clinic may use or disclose medical information. For each category of uses and disclosures, Covid Clinic will explain what is meant and may give some examples. Not every use or disclosure in a category will be listed.
For the Provision of Services. Covid Clinic may use medical information about you to provide you with medical services and to coordinate or manage your medical services and any related services. We may disclose information about you to Covid Clinic staff or other providers involved in the provision of medical services to you. We may also disclose your medical information to family members or other individuals involved in your continuing medical care after you leave Covid Clinic. For example, Covid Clinic may share your medical information between or among Covid Clinic personnel to assist your health care providers in providing services to you.
For Payment. Covid Clinic may use and disclose medical information about you so that Covid Clinic can get paid for the services you receive from Covid Clinic. For example, Covid Clinic may need to give information to your health plan or to the Medi-Cal or Medicare program about services you receive from Covid Clinic so that they will pay Covid Clinic or reimburse you for your services. Covid Clinic may also tell your health plan about a proposed service to determine whether your plan will cover the service.
For Health Care Operations. Covid Clinic may use and disclose medical information about you to carry out activities that are necessary for Covid Clinic operations. These uses or disclosures are made for quality of services, compliance activities, administrative purposes, contractual obligations, grievances or lawsuits. For example, Covid Clinic may use medical information to review services provided by Covid Clinic or to evaluate the performance of its staff and contractors in providing services to you.
To Individuals or Family Members Involved in Your Health Care. Unless you object, Covid Clinic may disclose medical information about you to a member of your family, a relative, close friend or any other person that you identify who is involved in your receipt of services from Covid Clinic.
For Appointment Reminders. Covid Clinic reserves the right to contact you, in a manner permitted by law, with appointment reminders or information about service alternatives and other health related benefits that may be appropriate for you.
Emergencies. Covid Clinic may disclose medical information about you to a public or private entity assisting in disaster relief so that your family can be notified about your condition, status, or location. You may object to this disclosure with a written request. However, if you are not available or are unable to agree or object, or in some emergency circumstances, Covid Clinic will use its professional judgment to decide whether this disclosure is in your best interest.
As Required By Law. Covid Clinic will disclose your health information when required to do so by federal, state or local law.
Workers’ Compensation. Covid Clinic may release medical information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
For Public Health Activities. Covid Clinic may disclose medical information about you for public health activities. These purposes generally include the following: (1) to prevent or control disease, injury, or disability; (2) to report deaths; (3) to report abuse or neglect of children, elders, and dependent adults; (4) to report reactions to medications or problems with products; (5) to notify people of recalls of products they may be using; and (6) to notify a person who may have been exposed to a disease or who may be at risk for contracting or spreading a disease or condition.
For Health Oversight Activities. Covid Clinic may disclose medical information about you to a health oversight agency for activities authorized by law.
For Lawsuits and Disputes. Covid Clinic may disclose medical information about you in response to a court or administrative order, subpoena, discovery request, or other lawful process.
Disclosure to Law Enforcement. If asked to do so by law enforcement and as authorized or required by law, Covid Clinic may release medical information: (1) to identify or locate a suspect, fugitive, material witness, or missing person; (2) about a suspected victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement; (3) about a death suspected to be the result of criminal conduct; (4) about criminal conduct at Covid Clinic; and (5) in case of a medical emergency, to report a crime, the location of the crime or victims, or the identity, description or location of the person who committed the crime.
Decedents. Covid Clinic may release medical information about you to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. Covid Clinic may also release medical information about you to funeral directors. Covid Clinic may also release information to any individual known to Covid Clinic as a family member, close personal friend of the family, or any other person identified, who was involved in your care or the payment for your care prior to your death, unless you indicate otherwise. Your medical information may be used or disclosed to others without your authorization after fifty (50) years from the date of your death.
For Specialized Government Functions. Covid Clinic may disclose medical information about you to authorized federal officials for intelligence, counter intelligence, and other national security activities.
Information About Inmates/Individuals in Custody. If you are an inmate or under the custody of a law enforcement official, Covid Clinic may release medical information about you to the correctional institution or law enforcement official responsible for you as authorized or required by law.
Disclosure For Threats to Health and Safety. In certain circumstances, Covid Clinic may be required to disclose medical information to avert a serious threat to your health and safety or the health and safety of another person as required by law enforcement. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law.
SPECIAL PROVISIONS RELATED TO PATIENT PRIVACY
Marketing. Covid Clinic will not release your medical information for marketing purposes without an authorization from you.
Sale of Medical Information. Covid Clinic will not sell your medical information without an authorization from you.
Inspect and Copy. With certain exceptions, you are permitted to inspect and receive copies of your medical information.
Amendment. If you feel that medical information about you is incorrect or incomplete, you may ask Covid Clinic to amend the information.
Accounting of Disclosures. You may request a list of certain disclosures that we may have made of your medical information.
Request Restrictions. You may request a restriction or limitation on medical information that Covid Clinic uses or discloses about you for the provision of services, payment or health care operations, and to request a limit on the medical information that Covid Clinic may disclose to family members or friends involved in your receipt of services.
Request Confidential Communications. You may request that Covid Clinic communicate with you about your appointments or other matters related to your receipt of services in a specific way or at a specific location.
Receive a Copy. You may obtain a copy of this Notice.
CHANGES TO THIS NOTICE
Covid Clinic reserves the right to change the terms of this Notice at any time. Covid Clinic reserves the right to make the revised or changed notice effective for medical information Covid Clinic already has about you as well as any information Covid Clinic receives in the future. Covid Clinic will post a copy of the current Notice. The Notice will contain an effective date.
QUESTIONS AND COMPLAINTS
If you have any questions or complaints related to your privacy rights, you may contact Covid Clinic at 18800 Delaware Street Suite 800 Huntington Beach, CA 92648 or firstname.lastname@example.org
OTHER USES OF MEDICAL INFORMATION
Other uses and disclosures of medical information not covered by this Notice or the laws that apply to use will be made only with your written permission. If you provide Covid Clinic permission to use or disclose medical information about you, you may revoke that permission in writing at any time. If you revoke your permission Covid Clinic will stop any further use or disclosure of your medical information for the purposes covered by your written authorization, except if Covid Clinic has already acted in reliance on your permission. You understand that Covid Clinic is unable to take back any disclosure Covid Clinic has already made with your permission and that Covid Clinic is required to retain its records of the services that Covid Clinic provided to you.