Notice of Privacy Practices
Updated Effective Date: November 1, 2021
The purpose of the privacy notice is to facilitate your comprehension of how your Protected Health Information (PHI) may be used or disclosed by AssociatesMD and how you can access that information.
AssociatesMD is committed to maintaining and protecting your right to privacy and confidentiality. As required by federal and state law, the practice must protect the privacy of your PHI and provide you with this Notice of how we may use and disclose the information. This Notice is meant to help you understand how the practice protects the privacy of your PHI and notify you of your rights and the practice’s obligations regarding your PHI.
What Kind of Information Are We Talking About?
PHI is information that identifies you, and relates to your past, present, or future physical or mental health or conditions, the delivery of healthcare to you, or the past, present, or future payment of your healthcare. PHI includes both medical information and individually identifiable information, like your name, address, telephone number, or Social Security number. We protect this information in all formats including electronic, written, and oral information.
We understand the importance of protecting your PHI. We restrict access to your PHI to authorized workforce members, who need that information for your treatment, for payment purposes and/or for health care operations. We will not disclose your PHI without your authorization unless it is necessary to provide for your health care needs or as required or permitted by law. If we need to disclose your PHI, we will follow the policies described in this Notice to protect your privacy. We will abide by the terms of this notice as it currently stands.
Here is How We May Use Your PHI
AssociatesMD may disclose your PHI without your written authorization, if necessary, in order to provide your health care needs. We may disclose your PHI for the following purposes:
Business Associates – We may disclose your PHI to our business associates who perform functions for you on our behalf or provide us with services that support you, if the PHI is necessary for those functions or services. All our business associates are obligated, under contract with us, to protect privacy and ensure the security of your PHI.
Coroners, Medical Examiners, and Funeral Directors – We may disclose PHI to a coroner, medical examiner, or funeral director, as necessary to carry out their duties.
Disaster-Relief Efforts – We may disclose PHI to disaster relief organizations that seek your PHI to coordinate your care or notify family and friends of your location or condition in a disaster. We will provide you with an opportunity to agree or object to such a disclosure when reasonably possible.
Fundraising Activities – We may contact you to provide you with information about events and activities, including fundraising programs. If we do contact you for fundraising activities, the communication you receive will have instructions on how you may ask for us not to contact you again for such purposes, also known as an “opt-out.”
Health Care Operations – We may use and disclose your PHI for our health care operations supporting you. We may also disclose your PHI to another health plan or a clinician who has a relationship with you, so that it can conduct quality assessment, improvement activities, auditing functions, cost management analysis and customer service. An example of this would be survey campaigns.
Health or Safety – We may disclose your PHI to prevent or lessen a serious and imminent threat to your health or safety or the health and safety of the general public or another person.
Health-related Benefits and Services – We may contact you about benefits or services provided by the practice.
Individuals Involved in Your Care or Payment for Your Care – Unless you object, we may disclose PHI to a family member, friend, or other person you identify that directly relates to that person’s involvement in your care. We may also disclose such information to such people if we can infer from the circumstances that you would not object. For example, we will assume that you agree to our disclosure of PHI about you to your spouse when your spouse calls us to discuss benefits under your plan. In situations where you are not capable of giving consent (because you are not present or due to your incapacity or medical emergency), we may, using our professional judgment, determine that a disclosure to your family member or friend is in your best interest.
Additionally, we may disclose information to your representative. If a person has the authority under law to make healthcare decisions for you, we will treat that representative the same way we would treat you with respect to your PHI. Parents and legal guardians are generally representatives of minors unless the minors are permitted by law to act on their own behalf and make their own medical decisions.
News-gathering Activities – We may contact you or one of your family members to discuss whether you want to participate in a news story or practice-related publications or external news media. Your written authorization is required if we want to use or disclose any of your PHI for these kinds of purposes.
Payment – We may use and disclose your PHI to make coverage determinations; to make or obtain payment; and to determine and fulfill our responsibility to provide your benefits. We may also disclose your PHI to another health plan or clinician for its payment activities.
Public Health Activities – We may use and disclose your PHI for public health activities by law, such as to prevent or control disease, injury, or disability.
Research – We may disclose your PHI for research purposes under specific rules determined by the confidentiality provisions of applicable law. In some instances, federal law allows us to use your PHI for research without your authorization, provided we get approval from a special review board. Such research will not affect your treatment, and your PHI will continue to be protected.
Treatment – We may disclose your PHI to your clinician for plan coordination; to help obtain services and treatment you may need; or to coordinate your health care related services.
Treatment Alternatives - We may contact you to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
Workers’ Compensation – We may disclose your PHI for Workers’ Compensation or similar programs that provide benefits for work-related injuries or illness.
Uses and Disclosures with Your Written Authorization
We will not use or disclose your PHI for any purpose other than those described in this Notice without your written authorization, unless authorized by state or federal law. Additionally, with certain limited exceptions, we are not allowed to sell or receive anything of value in exchange for your PHI without your written authorization. If you provide us authorization to use or disclose PHI, you may revoke that authorization, in writing, at any time.
However, uses and disclosures made before your withdrawal are not affected by your action and we cannot take back any disclosures we may have already made with your authorization.
If your withdrawal relates to research, researchers are allowed to continue to use the PHI they have gathered before your withdrawal if they need it in connection with the research study or follow-up to the study.
It is Your Information – So Know Your Rights
You have the following rights regarding PHI we maintain about you:
Right to Amend Your Records – If you feel that PHI, we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment if the information is kept in your electronic health record (EHR).
Your request must be submitted in writing, with an explanation as to why the amendment is needed. If we accept your request, we will amend your records. If we cannot change what is in the record, then we will add your supplemental information to the EHR. We may deny or partially deny your request if you ask us to amend PHI because:
If we deny or partially deny your request amendment, you have the right to submit a written rebuttal and request the rebuttal be made a part of your medical record. We have the right to file a rebuttal responding to yours in your medical record. You also have the right to request all documents associated with the amendment request, including rebuttals, be transmitted to any other party any time the involved portion of the medical record is disclosed.
Right to Inspect and Copy Your PHI – You have the right to inspect and copy PHI about you that is maintained by the practice via medical management record systems. Your request to inspect or copy your PHI must be submitted to us in writing. The practice may charge you a reasonable fee for the costs of copying, mailing, or other supplies associated with your request. We may deny your request to inspect or copy your records in certain limited circumstances. If we deny your request, you have the right to have your request reviewed by a licensed health care professional who was not directly involved in the denial of your request.
Right to Notice of Breach – You have the right to receive written notice as soon as possible but no later than 60 days after any unauthorized use or disclosure that compromises the privacy or security of your PHI.
Right to Receive an Accounting of Disclosures – You have the right to receive a list of the disclosures we have made of your PHI in the six years prior to your request. This list will not include disclosures made for treatment. Your request must be submitted in writing and state the time period for which you want to receive the accounting, which may not be longer than six years. You may receive the list in paper or electronic form. The first accounting you request in a 12-month period will be free of charge. We may charge you for responding to any additional requests in that same time period. We will inform you of any costs before you are charged.
Right to Receive Confidential Communications – You may ask to receive communications of your PHI from us in a certain way or at a certain location. You must make any such request in writing, and you must specify how or where we are to contact you. While we will consider reasonable requests carefully, we are not required to agree to all requests. We will not ask you the reason for your request.
Right to Receive Paper Copy of this Notice – You have the right to a paper copy of this Notice, even if you have agreed to receive this Notice electronically. You may request a paper copy of this notice at any time.
Right to Request Additional Restrictions – You may request restrictions on our use and disclosure of your PHI for treatment, payment, and health care operations. You also have the right to request a limit on the PHI we disclose to someone who is involved in your care or the payment for your care, such as a family member or friend. Your request for restriction must be submitted in writing and state the specific restriction requested. We are not required to agree to your request. If we do agree with your request for restriction, our agreement must be in writing, and we will comply with your request unless the information is needed to provide you with emergency treatment, or we are required or permitted by law to disclose it. We are allowed to end the restriction if we tell you. If we end the restriction, it will affect PHI that was created or received only after we notify you.
Right to Opt Out of State Regional Health Information Organization Health Information Exchange (If applicable) - Your state may operate a Regional Health Information Organization. You may have the right to opt-out of participation in, if applicable, your state’s Regional Health Information Organization’s Health Information Exchange Program. Your request to opt-out of the program must be submitted to us in writing.
Checking Your Identity for Your Protection
For your protection, we may check your identity whenever you have questions about your treatment or payment activities. We will check your identity whenever we get requests to look at, copy or amend your records or to obtain a list of disclosures of your PHI.
How to Exercise Your Rights
To exercise your rights described in this Notice, send your request, in writing to our Privacy Officer addressed as follows:
Attn: Privacy Officer
8000 Norman Center Drive, Suite 1200
Minneapolis, MN 55437
We may ask you to fill out and return to us a form that we will provide you with.
If Something is Wrong, Let Us Know Right Away
If you believe AssociatesMD has violated your privacy rights, you may file a complaint with us by calling 1-855-208-3766 at any time or by sending your complaint to the address shown immediately above. You may also file a written complaint with the Secretary of U.S. Department of Health and Human Services (HHS). Your complaint can be sent by fax or mail to the HHS Office for Civil Rights (OCR). To file a complaint with the Secretary, write to:
U.S. Department of Health and Human Services
200 Independence Ave, S.W.
Room 509F HHH Bldg.
Washington, D.C. 20201
Changes to this Notice – We may change our privacy practices and terms of this Notice at any time as allowed by law. We may, at our discretion, make the new terms effective for all your PHI that we maintain, including any PHI we have created or received before we issue the new Notice. When we make significant changes to our privacy practices, we will change this notice and post it to our website at https://associatesmd.com