Health Information Consents

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.

Introduction

This Notice is provided on behalf of a Spring Health–affiliated professional practice and the employees and practitioners who work at the practice with respect to services provided by the practice (collectively, “we,” “us,” or “our”). We understand that your medical information is private and confidential. We are required by law to maintain the privacy of protected health information (“PHI”). PHI includes individually identifiable information that relates to your past, present, or future physical or mental health or condition, the health care you receive, or payment for that care.

We may share PHI among members of the practice as necessary to carry out treatment, payment, and health care operations related to services we provide. This Notice describes your rights and our legal duties and privacy practices with respect to PHI. We are required to follow the terms of this Notice as currently in effect. We reserve the right to change this Notice and to make the revised Notice effective for all PHI we maintain. You may request a paper copy of the most current Notice at any time.

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. You have the right to:

• Receive a copy of your health records
  You may ask to inspect or get a copy of your health records and other health information we have about you. We will provide a copy or a summary of your health and claims records, within 30 days of your request, or notify you if an extension is needed.

• Request that we correct your health records
  You can ask us to correct your health  records if you think they are incorrect or incomplete. We may say “no” to your request, but we’ll tell you why in writing within 60 days.

• Request confidential communications
  You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. 

• Ask us to limit what we use or share
  You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request.
  If you pay for a service in full out of pocket, you may request that we not share information about that service with your health plan, and we will comply unless required by law.

• Get a list of those with whom we’ve shared information
  You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make).

• Choose someone to act for you
  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 health information. We will make sure the person has this authority and can act for you before we take any action.

• Get a copy of this privacy notice
  Upon request we will provide a copy of this notice to you in either electronic or paper format.

Requests to exercise your rights under this Notice should be submitted in writing to the Privacy Officer using the contact information below. Any fees charged will be reasonable and cost-based, as permitted by law, and you will be informed of any applicable fees in advance.

Permitted Uses and Disclosures

We may use or disclose your PHI for treatment, payment, and health care operations, as described below. Not every possible use or disclosure within these categories is listed.

Treatment 

Treatment includes the provision, coordination, or management of your health care and related services among health care providers. For example, we may share PHI with other providers involved in your care to coordinate treatment, make referrals, or consult regarding your health.

Payment

Payment includes activities undertaken to obtain reimbursement for health care services, such as billing, claims management, utilization review, eligibility determinations, and collections. We may disclose PHI to health plans or other payors for these purposes. When required by law, we will obtain your authorization before disclosing protected information.

Health Care Operations

Health care operations include activities necessary to run our practice and support care delivery, such as quality improvement, care coordination, training, accreditation, compliance, auditing, business management, analytics, administrative activities, and the development, testing, evaluation, and improvement of tools, technologies, and models used to support health care operations, care delivery, and compliance. We may also create and use information that has been de-identified in accordance with applicable law for research and other operational purposes.

We limit all uses, disclosures, and requests for protected health information to the minimum necessary to accomplish the intended purpose, except where otherwise permitted or required by law.

Other Permitted Uses and Disclosures

We may also use or disclose your PHI for the following purposes, as permitted by law:

Care Communications

To contact you with appointment reminders, information about treatment alternatives, care coordination activities, or other health-related services.

Individuals Involved in Your Care

To family members, friends, or others you identify, to the extent directly relevant to their involvement in your care or payment for your care. This may include sharing information or items related to your care. If you are present and able to object, we will honor your preferences. If you are not available, we may disclose PHI if we determine it is in your best interest based on professional judgment.

Disaster Relief

To coordinate disclosures with public or private entities assisting in disaster relief efforts.

Research

For research purposes, subject to applicable legal requirements, including review and approval by an institutional review board or privacy board when required. Where appropriate, research may be conducted using de-identified information or limited data sets.

Required or Permitted by Law and Other Uses

We may use or disclose your PHI when required or permitted by applicable law. Such uses and disclosures may include, but are not limited to, public health activities; health oversight activities; judicial and administrative proceedings; law enforcement purposes; workers’ compensation and occupational health activities; organ and tissue donation; military, national security, and intelligence activities; correctional institutions and custodial situations; disclosures to coroners, medical examiners, and funeral directors; and uses or disclosures necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.

All uses and disclosures described in this Notice are subject to applicable law and may occur only to the extent permitted or required by law. Certain uses and disclosures of PHI may occur incidentally as a by-product of an otherwise permitted or required use or disclosure. We take reasonable safeguards to limit such incidental disclosures in accordance with applicable law.

Substance Use Disorder Records (42 CFR Part 2)

Certain records related to substance use disorder diagnosis, treatment, or referral for treatment may be protected by federal law under 42 CFR Part 2 (“Part 2”) These protections apply regardless of whether services are provided in person or through telehealth.

When applicable, these records generally may not be used or disclosed without your written consent, except as permitted or required by law. 

When disclosure of Part 2 protected information is permitted, recipients are generally prohibited from redisclosing this information unless further disclosure is expressly permitted by federal law or authorized by your consent. Once you provide consent for the use or disclosure of Part 2 protected information for treatment, payment, and health care operations, such records may be used or disclosed in accordance with HIPAA, except as otherwise prohibited by law. 

You have the right to revoke your consent for Part 2 disclosures at any time, except to the extent that action has already been taken in reliance on it, and to file a complaint if you believe your Part 2 rights have been violated.

Federal law restricts the use and disclosure of substance use disorder treatment records subject to Part 2. These records, and testimony relaying their contents, may not be used or disclosed to investigate or prosecute you, impose criminal penalties, discriminate against you, or in civil, criminal, administrative, or legislative proceedings against you, unless you provide written consent or a court order is issued after notice and an opportunity to be heard, as permitted by Part 2. Any such court order must be accompanied by a subpoena or other legal requirement compelling disclosure.

In some circumstances, your rights with respect to substance use disorder records are more protective than those provided under HIPAA, and when the laws differ, the more protective federal law applies.

Uses and Disclosures Requiring Authorization

Certain uses and disclosures of PHI will be made only with your written authorization, including uses or disclosures of psychotherapy notes (when applicable), for marketing purposes, or that constitute a sale of PHI under the HIPAA Privacy Rule. You may revoke an authorization at any time in writing, except to the extent action has already been taken in reliance on it.

Our Responsibilities

• We are required by law to maintain the privacy and security of your protected health information. 
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it. 

Changes to the Terms of this Notice

We may change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available on our website and upon request.

Complaints

If you believe your privacy rights have been violated, you may contact the Privacy Officer at privacy@springhealth.com. You may also file a complaint with the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.

Contact Information

If you have questions about this Notice or would like additional information, please contact the Privacy Officer at privacy@springhealth.com.