Sherpaa Health, Terms and Conditions of Use
Revised May 23, 2016
If you have, or are having, a medical emergency, YOU SHOULD contact YOUR PHYSICIAN OR LOCAL EMERGENCY NOTIFICATION SYSTEM (9-1-1), or go to your local emergency room.
Introduction: This Privacy Notice is being provided to you by JP Physician as that entity may be formed and incorporated in your state, and the employees and practitioners that work at such practice (collectively referred to herein as “We” or “Our”). We understand that your medical information is private and confidential. Further, we are required by law to maintain the privacy of “Patient Information”, which includes any individually identifiable information that we obtain from you or others that relates to your physical or mental health, the health care you have received, or payment for your health care. We will share Patient Information with one another, as necessary, to carry out treatment, payment or health care operations relating to the services to be rendered at the Practice facilities.
As required by law, this notice provides you with information about your rights and our legal duties and privacy practices with respect to Patient Information. This notice also discusses the uses and disclosures we will make of your Patient Information. We must comply with the provisions of this notice as currently in effect, although we reserve the right to change the terms of this notice from time to time and to make the revised notice effective for all Patient Information we maintain. You can always request a written copy of our most current privacy notice from firstname.lastname@example.org, or you can access it on our website at sherpaa.com/privacy.
Permitted Uses and Disclosures: We can use or disclose your Patient Information for purposes of treatment, payment and health care operations. For each of these categories of uses and disclosures, we have provided a description and an example below. However, not every particular use or disclosure in every category will be listed.
Treatment means the provision, coordination or management of your health care, including consultations between health care providers relating to your care and referrals for health care. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. In addition, the doctor may need to contact a physical therapist to create the exercise regimen appropriate for your treatment.
Payment means the activities we undertake to obtain reimbursement for the health care provided to you, including billing, collections, claims management, eligibility and other utilization review activities. For example, we may need to provide Patient Information to your Third Party Payor to determine whether the proposed course of treatment will be covered or if necessary to obtain payment.
Heath care operations means the support functions of the Practice, related to treatment and payment, such as quality assurance, case management, responding to patient complaints, physician reviews, compliance programs, audits, business planning, management and administrative activities. For example, we may use your Patient Information to evaluate the performance of our staff. We may also combine Patient Information about many patients to decide what additional services we should or should not offer and whether certain new treatments are effective. We may also disclose Patient Information for review and learning purposes. We may also remove information that identifies you so that others can use the de-identified information to study health care and health care delivery without learning who you are.
Other Uses And Disclosures of Patient Information: We may also use your Patient Information in the following ways:
- To provide appointment reminders
- To tell you about or recommend possible treatment alternatives or other health-related benefits and services.
- To your family or friends or any other individual identified by you if they are involved in your care. We may use or disclose your Patient Information to notify, or assist in the notification of, a family member, a personal representative, or another person responsible for your care, of your location, general condition or death. If you are available, we will give you an opportunity to object to these disclosures, and we will not make these disclosures if you object. If you are not available, we will determine whether a disclosure to your family or friends is in your best interest, taking into account the circumstances and based upon our professional judgment.
- When permitted by law, we may coordinate our uses and disclosures of Patient Information with public or private entities authorized by law or by charter to assist in disaster relief efforts.
- We will allow your family and friends to act on your behalf to pick-up filled prescriptions, medical supplies, X-rays, and similar forms of Patient Information, when we determine, in our professional judgment, that it is in your best interest to make such disclosures.
- We will use or disclose Patient Information about you when required to do so by applicable law.
- In accordance with applicable law, we may disclose your Patient Information to your employer if we are retained to conduct an evaluation relating to medical surveillance of your workplace or to evaluate whether you have a work-related illness or injury. You will be notified of these disclosures by your employer or the Practice as required by applicable law.
Note: incidental uses and disclosures of Patient Information sometimes occur and are not considered to be a violation of your rights. Incidental uses and disclosures are by-products of otherwise permitted uses or disclosures which are limited and cannot be reasonably prevented.
Special Situations: Subject to the requirements of applicable law, we may use or disclose your Patient Information:
- Organ and Tissue Donation. If you are an organ donor, to organ procurement organizations to facilitate organ or tissue donation and transplantation.
- Military and Veterans. If you are a member of the Armed Forces or foreign military personnel, as required by military command authorities.
- Worker’s Compensation. For programs that provide benefits for work-related injuries or illnesses.
- Public Health Activities. For public health activities, including disclosures:
- to prevent or control disease, injury or disability;
- to report births and deaths;
- to report child abuse or neglect;
- to persons subject to the jurisdiction of the Food and Drug Administration (FDA) for activities related to FDA-regulated products or services;
- to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
- to notify the appropriate government authority if we believe that an adult patient has been the victim of abuse. We will only make this disclosure if the patient agrees or when required or authorized by law.
- Health Oversight Activities. To federal or state agencies that oversee our activities (e.g., health care, seeking payment, and civil rights).
- Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, in response to appropriate legal requests in certain limitations.
- Law Enforcement. If asked to do so by a law enforcement official:* In response to a court order, warrant, summons or similar process;
* To identify or locate a suspect, fugitive, material witness, or missing person;
* About the victim of a crime under certain limited circumstances;
* About a death we believe may be the result of criminal conduct;
* About criminal conduct on our premises; or
* In emergency circumstances, to report a crime, the location of the crime or the victims, or the identity, description or location of the person who committed the crime.
- Coroners, Medical Examiners and Funeral Directors. To a coroner or medical examiner or to funeral directors as necessary to carry out their duties.
- National Security and Intelligence Activities. To authorized federal officials for intelligence, counterintelligence, other national security activities authorized by law or to authorized federal officials so they may provide protection to the President or foreign heads of state.
- Serious Threats. As permitted by applicable law and standards of ethical conduct, if we, in good faith, 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 or is necessary for law enforcement authorities to identify or apprehend an individual.
Note: HIVrelated information, genetic information, alcohol and/or substance abuse records, mental health records and other specially patient information may enjoy certain special confidentiality protections under applicable state and federal law. Any disclosures of these types of records will be subject to these special protections.
Other Uses Of Your Health Information: Certain uses and disclosures of Patient Information will be made only with your written authorization, including uses and/or disclosures: (a) of psychotherapy notes (where appropriate); (b) for marketing purposes; and (c) that constitute a sale of Patient Information. Other uses and disclosures of Patient Information not covered by this notice or the laws that apply to us will be made only with your written authorization. You have the right to revoke that authorization at any time, provided that the revocation is in writing, except to the extent that we already have taken action in reliance on your authorization.
Your Rights: In order to make any requests in this Section, you may contact the Privacy Officer.
1. You have the right to request restrictions on our uses and disclosures of Patient Information. However, we are not required to agree to your request unless the disclosure is to a health plan, the Patient Information pertains solely to health care items or services for which you have paid the bill in full, and the disclosure is not otherwise required by law.
2. You have the right to reasonably request to receive confidential communications of your Patient Information by alternative means or at alternative locations.
3. You have the right to inspect and copy the Patient Information contained in our Practice records, except:
(i) for psychotherapy notes, (i.e., notes that have been recorded during counseling sessions and have been separated from the rest of your medical record);
(ii) for information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding;
(iii) For research, your access to the Patient Information may be restricted for as long as the research is in progress, provided that you agreed to the temporary denial of access;
(iv) for Patient Information contained in records kept by a federal agency or contractor when your access is restricted by law; and
(v) for Patient Information obtained from someone other than us under a promise of confidentiality when the access requested would be reasonably likely to reveal the source of the information.
If you request a copy, we may charge you a fee for the costs of copying and mailing your records.
We may also deny a request for access to Patient Information under certain circumstances if there is a potential for harm to yourself or others. If we deny a request for access for this purpose, you may have the right to have our denial reviewed.
4. You have the right to request an amendment to your Patient Information but we may deny your request for amendment in certain limited circumstances. Any agreed upon amendment will be included as an addition to, and not a replacement of, already existing records. You must submit your request in writing, with a description of the reason for your request.
5. You have the right to receive an accounting of disclosures of Patient Information made by us other than to you for the six years prior to your request, except for disclosures:
(i) to carry out treatment, payment and health care operations;
(ii) incidental to a use or disclosure otherwise permitted or required by applicable law
(iii) pursuant to your written authorization;
(iv) to persons involved in your care or for other notification purposes as provided by law;
(v) for national security or intelligence purposes;
(vi) to correctional institutions or law enforcement officials;
(vii) as part of a limited data set as provided by law.
Your request must state a specific time period for the accounting (e.g., the past three months). The first accounting will be free. For additional accountings, we may charge you for the costs of providing the list. We will notify you of the costs involved.
6. You have the right to receive a notification, in the event that there is a breach of your unsecured Patient Information, which requires notification under applicable law.
Complaints If you believe that your privacy rights have been violated, you should immediately contact the Practice Privacy Officer at email@example.com. We will not take action against you for filing a complaint. You also may file a complaint with the Secretary of the U. S. Department of Health and Human Services.
Contact Person: If you have any questions or would like further information about this notice, please contact the Practice Privacy Officer at firstname.lastname@example.org.
This notice is effective as of May 23, 2016