Notice of Privacy Information Practices
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.
A. PURPOSE OF THIS NOTICE.
Lapis Group, LLC is committed to preserving the privacy and confidentiality
of your health information that is created and/or maintained at our office.
State and federal laws and regulations require us to implement policies
and procedures to safeguard the privacy of your health information. This
notice will provide you with information regarding our privacy practices
and applies to all of your health information created and/or maintained
at our office, including any information that we receive from other health
care providers, agencies, or facilities. The Notice describes the ways
in which we may use or disclose your health information and also describes
your rights and our obligations concerning such uses or disclosures.
We will abide by the terms of this Notice, including any future revisions
that we may make to the Notice as required or authorized by law. We reserve
the right to change this Notice and to make the revised or changed Notice
effective for health information we already have about you, as well as
any information we receive in the future. We will post a Copy of the current
Notice, which will identify its effective date, in our office.
The privacy practices described in this Notice will be followed by:
1. Any health care professional, provider, or agency authorized to enter
information into your medical record created and/or maintained at our office.
2. All employees, students, residents, and other service providers who
have access to your health information at our office; and
3. Any member of a volunteer group that is allowed to help you while receiving
services at our office.
• The individuals identified above will share your health information
with each other strictly for purposes of treatment, payment, and health
care operations, as further described in the Notice.
B. USES AND DISCLOSURES OF HEALTH INFORMATION FOR TREATMENT, PAYMENT, AND
HEALTH CARE OPERATIONS.
1. Treatment, Payment and Health Care Operations. The following section
describes different ways that we may use and disclose your health information
for purposes of treatment, payment, and health care operations. We explain
each of these purposes below and include examples of the types of uses
or disclosures that may be made for each purpose.
We have not listed every type of use or disclosure, but the ways in which
we use or disclose your information will fall under one of these purposes.
a. Treatment. We may use your health information to provide you with health
care services. We may disclose your health information to doctors, nurses,
nursing assistants, medication aides, technicians, medical and nursing
students, rehabilitation therapy specialists, or other personnel who are
involved in your health care.
For example, we will need to talk with the physical therapist so that we
can coordinate services and develop a plan of care. We will share information
with that health care provider in order to coordinate your care and services.
b. Payment. We may use or disclose your health information so that we may
bill and receive payment from you, an insurance company, or another third
party for the health care services you receive from us. We may also disclose
health information about you to your health plan in order to obtain prior
approval for the services we provide to you, or to determine that your
health plan will pay for the treatment.
For example, we may need to give health information to your support plan
coordinator in order to obtain prior approval for a change in your services
that we provide to you.
Health Care Operations. We may use or disclose your health information
in order to perform the necessary administrative, educational, quality
assurance, and business functions of our office.
For example, we may also use your health information to evaluate the performance
of our staff in caring for you, as well as to evaluate whether certain
services offered by our office are effective. We also may disclose your
health information to other providers, physicians, nurses, technicians,
or health profession students for teaching and learning purposes.
C. USES AND DISCLOSURES OF HEALTH INFORMATION IN SPECIAL SITUATIONS.
We may use or disclose your health information in certain special situation
as described below. For these situations, you have the right to limit these
uses and disclosures as provided for in Section E of this Notice.
1. Appointment Reminders. We may use or disclose your health information
for purposes of contacting you to remind you of a service appointment.
2. Treatment Alternatives & Health Related Products and Services.
We may use or disclose your health information for purposes of contacting
you to inform you of service alternatives or health-related products
that may be of interest to you. For example, if you are diagnosed with
a diabetic condition, we may contact you to inform you of a diabetic
instruction office being offered at a local office or hospital.
3. Family Members and Friends. We may disclose your health information
to individuals, such as family members and friends, who are involved in
your care or who help pay for you care. We may make such disclosures when
(a) we have your verbal agreement to do so; (b) we make such disclosures
and you do not object; or (c) we can infer from the circumstances that
you would not object to such disclosures.
For example, if someone comes with you, we will assume that you agree to
our disclosure of your information while that someone is present in the
room with you.
We also may disclose your health information to family members or friends
in instances when you are unable to agree or object to such disclosures,
provided that we feel it is in your best interests to make such disclosures,
and the disclosures relate to that family member or friend's involvement
in your care. For example, if you present to our office with an emergency
service situation, we may also share information with the family member
or friend that comes with you to our office. We also may share your health
information with a family member or friend who calls us to make a request
for you.
D. OTHER PERMITTED OR REQUIRED USES AND DISCLOSURES OF HEALTH INFORMATION.
There are certain instances in which we may be required or permitted by
law to use or disclose your health information without your permission.
These instances are as follows:
1. As Required By Law. We may disclose your health information when required
by federal, state, or local law to do so. For example, we are required
by the Department of Health and Human Services (DHHS) to disclose your
health information in order to allow DHHS to evaluate whether we are in
compliance with the federal privacy regulations.
2. Public Health Activities. We may disclose your health information to
public health authorities that are authorized by law to receive and collect
health information for the purpose of preventing or controlling disease,
injury or disability, to report births, deaths, suspected abuse or neglect,
reactions to medications or to facilitate product recalls.
3. Health Oversight Activities. We may disclose your health information
to a health oversight agency that is authorized by law to conduct health
oversight activities, including audits, investigations, inspections, or
licensure and certification surveys. These activities are necessary for
the government to monitor the persons or organizations that provide health
care to individuals and to ensure the compliance with applicable state
and federal laws and regulations.
4. Judicial or Administrative Proceedings. We may disclose your health
information to courts or administrative agencies charged with the authority
to hear and resolve lawsuits or disputes. We also may disclose your health
information pursuant to a court order, a subpoena, a discovery request,
or other lawful process issued by a judge or other person involved in the
dispute, but only if efforts have been made to ( 1 ) notify you of the
request for disclosure or ( 2 ) obtain an order protecting your health
information.
5. Worker's Compensation. We may disclose your health information to worker's
compensation programs when your health condition arises out of a work-related
illness or injury.
6. Law Enforcement Official. We may disclose your health information in
response to a request received from a law enforcement official to report
criminal activity or to respond to a subpoena, court order, warrant, summons
or similar process.
7. Coroners, Medical Examiners, or Funeral Directors. We may disclose your
health information to a coroner or medical examiner for the purpose of
identifying a deceased individual or to determine a cause of death. We
also may disclose your health information to a funeral director for the
purpose of carrying out his/her necessary activities.
8. Organ Procurement Organizations or Tissue Banks. If you are an organ
donor, we may disclose your health information to organizations that handle
organ procurement, transplantation, or tissue banking for the purpose of
facilitating organ or tissue donation or transplantation.
9. To Avert a Serious Threat to Health or Safety. We may disclose your
health information when necessary to prevent a serious threat to the health
or safety of you or other individuals.
10. Military and Veterans. If you are a member of the armed forces, we
may use or disclose your health information as required by military command
authorities.
11. National Security and Intelligence Activities. We may use or disclose
your health information to authorized federal officials for purposes of
intelligence, counterintelligence, and other national security activities,
as authorized by law.
12. Inmates. If you are an inmate of a correctional institution or under
custody of a law enforcement official, we may use or disclose your health
information to the correctional institution or to the law enforcement official
as may be necessary (i) for the institution to provide you with health
care, (ii) to protect the health or safety of you or another person, or
(iii) for the safety and security of the correctional institution.
E. USES AND DISCLOSURES PURSUANT TO YOUR WRITTEN AUTHORIZATION.
Except for the purposes identified in Sections B through D, we will not
use or disclose your health information for any other purposes unless we
have your specific written authorization. You have the right to revoke
a written authorization at any time as long as you do so in writing. If
you revoke your authorization, we will no longer use or disclose your health
information for the purposes identified in the authorization, except to
the extent that we have already taken some action in reliance upon your
authorization.
F. YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION.
You have the following rights regarding your health information. You may
exercise each of these rights, in writing, by providing us with a completed
form that you can obtain from the Lapis Group, LLC Office. In some instances,
we may charge you for the cost(s) associated with providing you with the
requested information. Additional information on regarding how to exercise
your rights, and the associated costs, can be obtained from the Privacy/Security
Officer.
1. Right to Inspect and Copy. You have the right to inspect and Copy health
information that may be used to make decisions about your care. 48 hours
written notice is required prior to records being inspected or copied.
This is to ensure that we have adequate staff available to handle your
request. We may deny your request to inspect and Copy your health information
in certain limited circumstances. If you are denied access to your health
information, you may request that the denial be reviewed.
2. Right to Amend. You have the right to request an amendment of your health
information that is maintained by or for our office, and is used to make
health care decisions about you. We may deny your request if it is not
properly submitted or does not include a reason to support your request.
We may also deny your request if the information sought to be amended:
(a) was not created by us, unless the person or entity that created the
information is no longer available to make the amendment; (b) is not part
of the information that is kept by or for our office; (c) is not part of
the information which you are permitted to inspect and Copy; or (d) is
accurate and complete.
3. Right to an Accounting of Disclosures. You have the right to request
an accounting of the disclosures of your health information made by us.
This accounting will not include disclosures of health information that
we made for purposes of treatment, payment. or health care operations or
pursuant to a written authorization that you have signed.
4. Right to Request Restrictions. You have the right to request a restriction
or limitation on the health information we use or disclose about you for
treatment, payment or health care operations. You also have the right to
request a limit on the health information we disclose about you to someone,
such a family member or friend, who is involved in your care or in the
payment of your care. For example, you could ask that we not use or disclose
information regarding particular treatment that you received. We are not
required to agree to your request. If we do agree, that agreement must
be in writing and signed by you and us.
5. Right to Request Confidential Communications. You have the right to
request that we communicate with you about your health care in a certain
way or at a certain location. For example, you can ask that we only contact
you at work or by moil. You may also ask that we do not leave a message
on your answering machine or with another individual at your home.
6. Right to a Paper Copy of this Notice. You have the right to receive
a paper Copy of this Notice. You may ask us to give you a Copy of this
Notice at any time, even if you have agreed to receive this Notice electronically.
G. QUESTIONS OR COMPLAINTS.
If you have any questions regarding this Notice or wish to receive additional
information about our privacy practices, please contact our Privacy/Security
Officer at Lapis Group, LLC. If you believe your privacy rights have been
violated, you may file a complaint with our office or with the Secretary
of the DHHS. To file a complaint with our office, contact our Privacy/Security
Officer at: 7033 W. Muriel Dr, Glendale, Arizona 85308. All complaints
must be submitted in writing. You will not be penalized for filing a complaint.