HIPAA Notice of Privacy Practices
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law designed to protect your privacy whenever your health care providers, such as an International Board Certified Lactation Consultant (IBCLC), have to discuss your health information or send information about you to different health care offices. Breastfeeding Consultants of San Diego, LLC is required to keep a file of record pertaining to your consultation(s). This information will be kept confidential as it is protected health information (PHI).
A. Our Commitment To Your Privacy:
Breastfeeding Consultants of San Diego, LLC is dedicated to maintaining the privacy of your individually identifiable health information (also called protected health information, or PHI). In conducting our business, we will create records regarding you and the treatment and services we provide to you. We are required by law to maintain the confidentiality of health information that identifies you. We also are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your PHI. By federal and state law, we must follow the terms of the Notice of Privacy Practices that we have in effect at the time.
The terms of this notice apply to all records containing your PHI that are created or retained by Breastfeeding Consultants of San Diego, LLC. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all of your records that our practice has created or maintained in the past, and for any of your records that we may create or maintain in the future. Our practice will post a copy of our current Notice in our offices in a visible location at all times, and you may request a copy of our most current Notice at any time.
B. Questions:
If you have questions about this Notice, please contact: Heather Shabestari, Owner/Privacy Officer, at 619.677.2730. She will be happy to answer any questions or concerns you may have in terms of your privacy.
C. We may use and disclose your PHI in the following ways:
1. Treatment. Breastfeeding Consultants of San Diego, LLC may use your PHI to treat you. This means we may speak to you about your PHI and use this information to help develop a care plan. Additionally, we may disclose your PHI to others who may assist in your care, such as your spouse, or parents. Finally, we may also disclose your PHI to other health care providers for purposes related to your treatment.
2. Payment. Our practice may use and disclose your PHI in order to bill and collect payment for the services and items you may receive from us. For example, we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment. We also may use and disclose your PHI to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your PHI to bill you directly for services and items.
3. Health care operations. Our practice may use and disclose your PHI to operate our business. As examples of the ways in which we may use and disclose your information for our operations, our practice may use your PHI to evaluate the quality of care you received from us, or to conduct cost-management and business planning activities for our practice.
4. Appointment reminders. Our practice may use and disclose your PHI to contact you and remind you of an appointment.
5. Treatment options. Our practice may use and disclose your PHI to inform you of potential treatment options or alternatives.
6. Health-related benefits and services. Our practice may use and disclose your PHI to inform you of health-related benefits or services that may be of interest to you.
8. Disclosures required by law. Our practice will use and disclose your PHI when we are required to do so by federal, state or local law.
D. Use and disclosure of your PHI in certain special circumstances:
The following categories describe unique scenarios in which we may use or disclose your identifiable health information:
1. Public health risks. Our practice may disclose your PHI to public health authorities that are authorized by law to collect information for the purpose of:
• Maintaining vital records, such as births and deaths,
• Reporting child abuse or neglect,
• Preventing or controlling disease, injury or disability,
• Notifying a person regarding potential exposure to a communicable disease,
• Notifying a person regarding a potential risk for spreading/contracting a disease/condition,
• Reporting reactions to drugs or problems with products or devices,
• Notifying individuals if a product or device they may be using has been recalled,
• Notifying appropriate government agency(ies) and authority(ies) regarding the potential abuse or neglect of an adult patient (including domestic violence); however, we will only disclose this information if the patient agrees or we are required or authorized by law to disclose this information,
• Notifying your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance. Example: Sending information to Human Resources so that you can get pay reimbursement through their corporate lactation support program.
2. Health oversight activities. Our practice may disclose your PHI to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, audits, surveys, licensure and disciplinary actions; civil, administrative and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.
3. Lawsuits and similar proceedings. Our practice may use and disclose your PHI in response to a court or administrative order (such as a subpoena), if you are involved in a lawsuit or similar proceeding.
4. Law enforcement. We may release PHI if asked to do so by a law enforcement official for reasons such as a crime, a death, a warrant, subpoena, or court order.
E. Your rights regarding your PHI:
You have the following rights regarding the PHI that we maintain about you:
1. Confidential Communications. You have the right to request that our practice communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home, rather than at work.
2. Restrictions. You have the right to request a restriction in our use or disclosure of your PHI for treatment, payment or health care operations. We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies or when the information is necessary to treat you. In order to request a restriction in our use or disclosure of your PHI, you must make your request in writing to Heather Shabestari, Owner/Privacy Officer. Please contact her at: 619-677.2730.
3. Inspection and Copies. You have the right to inspect and obtain a copy of the PHI that our office has obtained in regards to you.
4. Amendment. You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our practice.
5. Accounting of Disclosures. You can ask to whom our office has given your PHI.
6. Right to a Paper Copy of this Notice. You are entitled to receive a paper copy of our notice of privacy practices. You may ask us to give you a copy of this notice at any time.
7. Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services. To file a complaint with our office, contact Heather Shabestari, owner, privacy officer. Her phone number is: 619-677-2730. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
8. Right to Provide an Authorization for Other Uses and Disclosures. Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your PHI may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your PHI for the reasons described in the authorization. Please note: we are required to retain records of your care.
Again, if you have any questions regarding this notice or our health information privacy policies, please contact Heather Shabestari, Owner/Privacy Officer, at: 619-677-2730.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law designed to protect your privacy whenever your health care providers, such as an International Board Certified Lactation Consultant (IBCLC), have to discuss your health information or send information about you to different health care offices. Breastfeeding Consultants of San Diego, LLC is required to keep a file of record pertaining to your consultation(s). This information will be kept confidential as it is protected health information (PHI).
A. Our Commitment To Your Privacy:
Breastfeeding Consultants of San Diego, LLC is dedicated to maintaining the privacy of your individually identifiable health information (also called protected health information, or PHI). In conducting our business, we will create records regarding you and the treatment and services we provide to you. We are required by law to maintain the confidentiality of health information that identifies you. We also are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your PHI. By federal and state law, we must follow the terms of the Notice of Privacy Practices that we have in effect at the time.
The terms of this notice apply to all records containing your PHI that are created or retained by Breastfeeding Consultants of San Diego, LLC. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all of your records that our practice has created or maintained in the past, and for any of your records that we may create or maintain in the future. Our practice will post a copy of our current Notice in our offices in a visible location at all times, and you may request a copy of our most current Notice at any time.
B. Questions:
If you have questions about this Notice, please contact: Heather Shabestari, Owner/Privacy Officer, at 619.677.2730. She will be happy to answer any questions or concerns you may have in terms of your privacy.
C. We may use and disclose your PHI in the following ways:
1. Treatment. Breastfeeding Consultants of San Diego, LLC may use your PHI to treat you. This means we may speak to you about your PHI and use this information to help develop a care plan. Additionally, we may disclose your PHI to others who may assist in your care, such as your spouse, or parents. Finally, we may also disclose your PHI to other health care providers for purposes related to your treatment.
2. Payment. Our practice may use and disclose your PHI in order to bill and collect payment for the services and items you may receive from us. For example, we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment. We also may use and disclose your PHI to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your PHI to bill you directly for services and items.
3. Health care operations. Our practice may use and disclose your PHI to operate our business. As examples of the ways in which we may use and disclose your information for our operations, our practice may use your PHI to evaluate the quality of care you received from us, or to conduct cost-management and business planning activities for our practice.
4. Appointment reminders. Our practice may use and disclose your PHI to contact you and remind you of an appointment.
5. Treatment options. Our practice may use and disclose your PHI to inform you of potential treatment options or alternatives.
6. Health-related benefits and services. Our practice may use and disclose your PHI to inform you of health-related benefits or services that may be of interest to you.
8. Disclosures required by law. Our practice will use and disclose your PHI when we are required to do so by federal, state or local law.
D. Use and disclosure of your PHI in certain special circumstances:
The following categories describe unique scenarios in which we may use or disclose your identifiable health information:
1. Public health risks. Our practice may disclose your PHI to public health authorities that are authorized by law to collect information for the purpose of:
• Maintaining vital records, such as births and deaths,
• Reporting child abuse or neglect,
• Preventing or controlling disease, injury or disability,
• Notifying a person regarding potential exposure to a communicable disease,
• Notifying a person regarding a potential risk for spreading/contracting a disease/condition,
• Reporting reactions to drugs or problems with products or devices,
• Notifying individuals if a product or device they may be using has been recalled,
• Notifying appropriate government agency(ies) and authority(ies) regarding the potential abuse or neglect of an adult patient (including domestic violence); however, we will only disclose this information if the patient agrees or we are required or authorized by law to disclose this information,
• Notifying your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance. Example: Sending information to Human Resources so that you can get pay reimbursement through their corporate lactation support program.
2. Health oversight activities. Our practice may disclose your PHI to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, audits, surveys, licensure and disciplinary actions; civil, administrative and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.
3. Lawsuits and similar proceedings. Our practice may use and disclose your PHI in response to a court or administrative order (such as a subpoena), if you are involved in a lawsuit or similar proceeding.
4. Law enforcement. We may release PHI if asked to do so by a law enforcement official for reasons such as a crime, a death, a warrant, subpoena, or court order.
E. Your rights regarding your PHI:
You have the following rights regarding the PHI that we maintain about you:
1. Confidential Communications. You have the right to request that our practice communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home, rather than at work.
2. Restrictions. You have the right to request a restriction in our use or disclosure of your PHI for treatment, payment or health care operations. We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies or when the information is necessary to treat you. In order to request a restriction in our use or disclosure of your PHI, you must make your request in writing to Heather Shabestari, Owner/Privacy Officer. Please contact her at: 619-677.2730.
3. Inspection and Copies. You have the right to inspect and obtain a copy of the PHI that our office has obtained in regards to you.
4. Amendment. You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our practice.
5. Accounting of Disclosures. You can ask to whom our office has given your PHI.
6. Right to a Paper Copy of this Notice. You are entitled to receive a paper copy of our notice of privacy practices. You may ask us to give you a copy of this notice at any time.
7. Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services. To file a complaint with our office, contact Heather Shabestari, owner, privacy officer. Her phone number is: 619-677-2730. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
8. Right to Provide an Authorization for Other Uses and Disclosures. Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your PHI may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your PHI for the reasons described in the authorization. Please note: we are required to retain records of your care.
Again, if you have any questions regarding this notice or our health information privacy policies, please contact Heather Shabestari, Owner/Privacy Officer, at: 619-677-2730.
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Adapted from American Academy of Family Physicians
HIPAA Downloadable Forms; 2015 |
