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Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY
BE USED AND DISCLOSED AND HOW YOU CAN GAIN ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY. |
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| Citizens Choice Healthplan HMO
Members have the right: |
Our Commitment to your Privacy,
Citizens Choice Healthplan HMO is dedicated to maintaining the privacy
of your individually identifiable health information, also known
as Protected Health Information (PHI). While conducting our
business we will create and maintain certain records regarding
you and the services we provide to you. We are required by law
to maintain the confidentiality of health information that identifies
you. While Citizens Choice Healthplan HMO already follows current
state confidentiality laws, the federal government now requires
that this notice be made to help educate patients about their
rights. Please let us help if you have any questions or concerns
about this notice or your privacy rights.
Sincerely,
Compliance Manager
Citizens Choice Healthplan HMO
(323) 728-7232 ext. 2118
Citizens Choice Healthplan HMO is not only required by law to maintain
the privacy of Protected Health Information (“PHI”)
we must also provide you with this notice of our legal duties
and privacy practices with respect to PHI. PHI is information
that may identify you and that relates to your past, present,
or future physical or mental health or condition and related
to health care services.
This Notice of Privacy Practices (“Notice”) describes
how we may use and disclose PHI to carry out treatment, payment
or health care operations and for other specified purposes that
are permitted or required by law. The Notice also describes
your rights with respect to your PHI. We are required to provide
this notice to you by the Health Insurance Portability and Accountability
Act (“HIPAA”).
Citizens Choice Healthplan HMO is required to follow the terms of
this Notice. We will not use or disclose your PHI without your
written authorization, except as described or otherwise permitted
by this Notice. We reserve the right to change our practices
and this Notice and to make the new Notice effective for all
PHI we maintain. Upon request, we will provide any revised Notice
to you.
Examples of How We Use and Disclose Protected Health
Information About You:
The following categories describe different ways that we use
and disclose your PHI. We have provided you with examples in
certain categories; however, not every use or disclosure in
a category will be listed.
Treatment - We may use your health information
to provide and coordinate the treatment, medications, and services
you receive. For example, we may order physical therapy services
to improve your strength and walking abilities. We will need
to talk with the physical therapist so that we can coordinate
services and develop a plan of care. We also may need to refer
you to another healthcare provider to receive certain services.
We will share information with that health care provider in
order to coordinate your care and services.
Payment - We may use your health information
for various payment-related functions. For example, we may need
to give health information to others involved in your care.
Health Care Operations - We may use your health
information for certain operational, administrative, and quality
assurance activities. For example, we may use information in
your health record to monitor the performance of the staff providing
treatment to you. This information will be used in an effort
to continually improve the quality and effectiveness of the
health care and service we provide. We may disclose health information
to business associates if they need to receive this information
to provide a service to us and will agree to abide by specific
HIPAA rules relating to the PHI.
We may also use your health information to provide you with
information about benefits available to you, and in limited
situations, about health-related products or services that may
be of interest to you.
We are permitted to use or disclose your PHI for the following
purposes. (However, Citizens Choice Healthplan HMO may never have
reason to make some of these disclosures).
To Communicate with Individuals Involved in Your Care
or Payment for Your Care - We may disclose to a family
member, other relative, close personal friend or any other person
you identify, PHI directly relevant to that person’s involvement
in your care or payment related to your care.
Food and Drug Administration (FDA) - We may
disclose to the FDA, or persons under the jurisdiction of the
FDA, PHI relative to adverse events with respect to drugs, foods,
supplements, products, and products defects, or post-marketing
surveillance information to enable product recalls, repairs,
or replacements.
Workers’ Compensation - We may disclose
your PHI to the extent authorized by and to the extent necessary
to comply with laws relating to workers’ compensation
or other similar programs established by law.
Public Health - As required by law, we may
disclose your PHI to public health or legal authorities charged
with preventing or controlling disease, injury, or disability.
Law Enforcement - We may disclose your PHI for law
enforcement purposes as required by law or in response to a
subpoena or court order.
As Required by Law - We will disclose your
PHI when required to do so by federal, state, or local law.
Health Oversight Activities - We may disclose
your PHI to an oversight agency for activities authorized by
law. These oversight activities include audits, investigations,
inspections, and credentialing, as necessary for licensure and
for the government to monitor the health care system, government
programs, and compliance with civil rights laws.
Judicial and Administrative Proceedings - If
you are involved in a lawsuit or dispute, we may disclose your
PHI in response to a court or administrative order. We may also
disclose health information about you in response to a subpoena,
discovery request, or other lawful process instituted by someone
else involved in the dispute, but only if efforts have been
made, either by the requesting party or us, to tell you about
the request or to obtain an order protecting the information
requested.
Research - We may disclose your PHI to researchers
when their research has been approved by an institutional review
board or privacy board that has reviewed the research proposal
and established protocols to ensure the privacy of your information.
Coroners, Medical Examiners, and Funeral Directors -
We may release your PHI to a coroner or medical examiner. This
may be necessary, for example, to identify a deceased person
or determine the cause of death. We may also disclose PHI to
funeral directors consistent with applicable law to enable them
to carry out their duties.
Organ or Tissue Procurement Organizations -
Consistent with applicable law, we may disclose your PHI to
organ procurement organizations or other entities engaged in
the procurement, banking, or transplantation of organs for the
purpose of tissue donation and transplant.
Notification - We may use or disclose your
PHI to notify or assist in notifying a family member, personal
representative, or another person responsible for your care,
regarding your location and general condition.
Fundraising - We may contact you as part of
a fundraising effort.
Correctional Institution - If you are or become an
inmate of a correctional institution, we may disclose to the
institution or its agents, PHI necessary for your health and
the health and safety of other individuals.
To Avert a Serious Threat to Health or Safety - We may use and
disclose your PHI when necessary to prevent a serious threat
to your health and safety or the health and safety of the public
or another person.
Military and Veterans - If you are a member
of the armed forces, we may release PHI about you as required
by military command authorities. We may also release PHI about
foreign military personnel to the appropriate foreign military
authority.
National Security, Intelligence Activities, and Protective
Services for the President and Others - We may release
PHI about you to federal officials for intelligence, counter
intelligence, protection to the President, and other national
security activities authorized by law.
Victims of Abuse or Neglect - We may disclose PHI about
you to a government authority if we reasonably believe you are
a victim of abuse or neglect. We will only disclose this type
of information to the extent required by law, if you agree to
the disclosure, or if the disclosure is allowed by law and we
believe it is necessary to prevent serious harm to you or someone
else.
Other Uses and Disclosures of PHI - We will
obtain your written authorization before using or disclosing
your PHI for purposes other than those provided for above (or
as otherwise permitted or required by law). You may revoke an
authorization in writing at any time. Upon receipt of the written
revocation, we will stop using or disclosing your PHI, except
to the extent that we have already taken action in reliance
on the authorization.
Your Health Information Rights:
Obtain a paper copy of the Notice upon request - You
may request a copy of our current Notice at any time. Even if
you have agreed to receive the Notice electronically, you are
still entitled to a paper copy. You may obtain a paper copy
from Citizens Choice Healthplan HMO’s Privacy Office.
Request a restriction on certain uses and disclosures of PHI - You have the right to request additional restrictions
on our use or disclosure of your PHI by sending a written request
to Citizens Choice Healthplan HMO’s Privacy Office. We are
not required to agree to those restrictions. We cannot agree
to restrictions on uses or disclosures that are legally required,
or which are necessary to administer our business.
Inspect and obtain a copy of PHI - In most
cases, you have the right to access and copy the PHI that we
maintain about you. To inspect or copy your PHI, you must send
a written request to Citizens Choice Healthplan HMO’s Privacy
Office. We may charge you a fee for the costs of copying, mailing,
and supplies that are necessary to fulfill your request. We
may deny your request to inspect and copy in certain limited
circumstances.
Request an amendment of PHI - If you feel the
PHI we maintain about you is incomplete or incorrect; you may
request that we amend it. To request an amendment, you must
send a written request to Citizens Choice Healthplan HMO’s
Privacy Office. You must include a reason that supports your
request. In certain cases, we may deny your request for amendment.
Receive an accounting of disclosures of PHI -
You have the right to receive an accounting of the disclosures
we have made of your PHI after April 14, 2004, for most purposes
other than treatment, payment, or health care operations. The
right to receive an accounting is subject to certain exceptions,
restrictions, and limitations. To request an accounting, you
must submit a request in writing to Citizens Choice Healthplan HMO’s
Privacy Office. Your request must specify the time period. The
time period may not be longer than six years and may not include
dates before April 14, 2004.
Request communication of PHI by alternative means or
at alternative locations - For instance, you may request
that we contact you at a different residence or post office
box. To request confidential communication of your PHI, you
must submit a request in writing to Citizens Choice Healthplan HMO’s
Privacy Office. Your request must tell us how or where you would
like to be contacted. We will try to accommodate all reasonable
requests.
Where to obtain forms for submitting written requests
- You may obtain forms for submitting written requests
from our Privacy Office at:
Citizens Choice Healthplan HMO
Attention: Privacy Office
17315 Studebaker Rd., Suite #200
Cerritos, CA 90703
Or by telephone at: (323) 728-7232 ext. 2118
Incidental Disclosures - Citizens Choice Healthplan HMO
will make reasonable efforts to avoid incidental disclosures
of protected health information.
Minors - If you are a minor who has lawfully
provided consent for treatment and you wish for Citizens Choice
Healthplan to treat you as an adult for purposes of access to
and disclosure of records related to such treatment, please
notify Citizens Choice Healthplan HMO’s Privacy Office.
For more information, or to report a problem
- If you have questions or would like additional information
about Citizens Choice Healthplan HMO’s privacy practices,
you may call or write to our Privacy Office.
If you believe your privacy rights have been violated, you can
file a complaint with Citizens Choice Healthplan HMO’s Privacy
Office or with the Secretary of Health and Human Services. There
will be no retaliation for filing a complaint.
Effective Date - This notice is effective as
of December 5, 2005 |
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