Privacy Statement

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 READ CAREFULLY.

This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment, or healthcare operations and other purposes that are permitted or required by law. Also described herein are your rights to access and control your protected health information. “Protected Health Information” is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health and related health services.

We are required by applicable federal and state laws to maintain the privacy of your medical information, to provide you with this notice and to abide by the terms of this notice. We may change the terms of this notice at any time. The new notice will be effective for all protected health information that we maintain at that time. You will be requested to verify, by signature, that you have read this notice. You may request a copy of this notice at any time. You may also get a copy of this notice off of our website at www.besiada.com.

1. Our Uses and Disclosures of Your Medical Information

A. Uses and disclosures based upon your written consent: You will be asked to sign a consent form. This consent form will allow us to use your protected health information for treatment, payment or healthcare operations. Your health care information may also be used for payment of your healthcare bills and services to you. The following are some examples of how we may use and disclose your healthcare information.

Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your healthcare and any related services. In addition, we may disclose your protected health information to another healthcare provider who, at the request of your healthcare professional, becomes involved in your care.

Payment: Your protected health information may be used, as needed, to obtain payment for services. This may include activities that the healthcare reimburse may undertake prior to approval of payment of services we recommend for you.

Healthcare Operations: We may use or disclose your protected health information in order to support our business activities as a healthcare provider. These activities may include, but are not limited to, quality assessments and outcomes, evaluation of our staff, training of staff and medical students, licensing, medical review and conducting or arranging other business activities.

We may use or disclose your protected health information to provide you with alternative treatments, other benefits or services, and for treatment reminders. If you do not want to receive these materials, please contact our Privacy Official to discontinue receipt.

B. Other permitted and required uses and disclosures that may be made without your consent, authorization or opportunity to object:

Required by Law: Sometimes we must report some of your health information to legal authorities, such as law enforcement officials, court officials, or government agencies. For example, we may have to report abuse, neglect, domestic violence or certain physical injuries, or to respond to a court order.

Public Health: The use and disclosure will be made to a public health authority that is permitted by law to collect or receive the information for the purposes of disease control, injury or disability.

Communicable Diseases: The use and disclosure will be made to a person who may have been exposed or may otherwise be at risk of contracting or spreading a disease or condition.

Health Oversight: We may disclose to a health oversight agency for activities authorized by law such as audits, investigations and inspections.

Abuse or Neglect: We may disclose if we believe that you have been a victim of abuse, neglect or domestic violence to a governmental agency authorized to oversee the healthcare system, government benefit programs or other government regulatory programs and civil rights laws.

Food and Drug Administration: We may disclose to report adverse events, product defects or problems, biologic product deviations or to make repairs or replacements, as required.

Legal Proceedings: We may disclose in the course of any judicial or administrative proceeding, in response to an order of the court or administrative tribunal (to the extent that such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request or other lawful purpose.

Law Enforcement: We may disclose so long as legal requirements are met. These law enforcement purposes include (1) legal processes and otherwise required by law, (2) limited information requests for identification and location purposes, (3) pertaining to victims of a crime, (4) suspicion that death has occurred as a result of criminal conduct, (5) in the event that a crime occurs on the premises and (6) medical emergency and it is likely that a crime has occurred.

Criminal Activity: We may disclose if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose if it is necessary for law enforcement authorities to identify or apprehend an individual.

Research: We may disclose to researchers when an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information has approved their research.

Military Activity and National Security: We may disclose for (1) activities deemed necessary by appropriate military commands authorities; (2) determination by the Department of Veterans Affairs of your eligibility for benefits, or (3) to foreign military authority if you are a member of that foreign military service. Also, we may disclose to authorized federal officials for national security and intelligence activities.

Workers’ Compensation: We may disclose to comply with workers’ compensation laws and other similar legally established programs.

Inmates: We may disclose if you are an inmate of a correctional facility and your physician created or received your protected health information in the course of providing care to you.

To those involved with your care or payment of your care: If people such as family members, relatives, or close personal friends are helping care for you or helping you pay your medical bills, we may release important health information about you to those people. The information released to these people may include your location within our facility, your general condition, or death. You have the right to object to such disclosure, unless you are unable to function or there is an emergency. In addition, we may release your health information to organizations authorized to handle disaster relief efforts so those who care for you can receive information about your location or health status. We may allow you to agree or disagree orally to such release, unless there is an emergency. It is our duty to give you enough information so you can decide whether or not to object to release of your health information to others involved with your care.

D. Uses and disclosures based upon your written authorization: Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law as described below. You may revoke this authorization, at any time, in writing, except to the extent that we have taken action on the use or disclosure indicated on the authorization.

2. Your Individual Rights

Access: You have the right to inspect and copy your health information, including billing records. A written request to inspect and copy records containing your health information must be made to BHI’s Privacy Official. If you request a copy of your health information, we may charge a reasonable fee for copying and assembling costs associated with your request.

Restriction: You have a right to ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment, or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.

Your physician and healthcare professional is not required to agree to a restriction that you may request. If physician and healthcare professional believe it is in your best interest to permit use and disclosure, your protected health information will not be restricted. If your physician and healthcare professional does agree with your request, we may not use or disclose your protected health information unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request with your physician and healthcare professional. You may request a restriction in writing by contacting our Privacy Official.

Confidential Communications: You have the right to request that we communicate with you in a certain way. For example, you may ask that we only conduct communications pertaining to your health information with you privately with no other family members present. If you wish to receive confidential communications, contact your BHI healthcare provider who will refer the request to the Privacy Official. We must accommodate reasonable requests.

Amendment: If you believe your health information is incorrect, you may ask us to amend the information. You may make such requests in writing and to give a reason as to why your health information should be changed. However, if we did not create the health information that you believe is incorrect, or if we disagree with you and believe your health information is correct, we may deny your request.

Disclosure Accounting: In some limited instances, you have the right to ask for a list of the disclosures of your health information we have made during the previous six years, but the request cannot include dates before April 14, 2003. This list must include the date of each disclosure, who received the disclosed health information, a brief description of the health information disclosed, and why the disclosure was made. We must comply with your request for a list within 60 days, unless you agree to a 30-day extension, and we may not charge you for the list, unless you request such a list more than once per year. In addition, we will not include in the list disclosures made to you, or for purposes of treatment, payment, healthcare operations, our directory, national security, law enforcement/corrections, and certain health oversight activities.

Electronic Notice: If you receive this notice on our website or by electronic mail (e-mail), you are entitled to receive this notice in written form. Please contact us using the information at the end of this notice to obtain this notice in written form.

3. Questions and Complaints

If you want more information about our privacy practices or have questions or concerns, please contact us using the information listed at the end of this notice.

You may complain to us or to the Secretary 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 Official of your complaint. We will not retaliate against you for filing a complaint.

Contact Office: Privacy Official, Besiada Health Innovators, toll free telephone 1-866-626-5758 or 920-491-9079.
This notice was published and is effective on April 14, 2003.