HIPAA Notice of Privacy Practices – Albright LIFE

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review carefully.

(Effective Date: January 27, 2021.)

YOUR HEALTH INFORMATION AND OUR USES AND DISCLOSURES
How do we typically use or share your health information?
We typically use or share your health information in the following ways.

Treat you – We can use your health information and share it with other professionals who are treating you.
Example: A doctor treating you for an injury asks another doctor about your overall health condition.

Run our organization – We can use and share your health information to run our practice, improve your care, and contact you when necessary. Example: We use health information about you to manage your treatment and services.

Bill for your services – We can use and share your health information to bill and get payment from health plans or other entities. Example: We give information about you to your health insurance plan so it will pay for your services.

How else can we use or share your health information?
We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/ consumers/index.html.

Help with public health and safety issues – We can share health information about you for certain situations such as:

• Preventing disease
• Helping with product recalls
• Reporting adverse reactions to medications
• Reporting suspected abuse, neglect, or domestic violence
• Preventing or reducing a serious threat to anyone’s health or safety
• Do research – We can use or share your information for health research.
• Comply with the law – We will share information about you if state or federal laws require it, including with the
• Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
• Respond to organ and tissue donation requests
• We can share health information about you with organ procurement organizations.
• Work with a medical examiner or funeral director
• We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
• Address workers’ compensation, law enforcement, and other government requests

We can use or share health information about you:

• For workers’ compensation claims
• For law enforcement purposes or with a law enforcement official
• With health oversight agencies for activities authorized by law
• For special government functions such as military, national security, and presidential protective service
• Respond to lawsuits and legal actions
• We can share health information about you in response to a court or administrative order, or in response to a subpoena.

YOUR HEALTH INFORMATION AND OUR RESPONSIBILITIES

• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing.
• If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

YOUR INFORMATION. YOUR RIGHTS. OUR RESPONSIBILITIES.
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. We are committed to preserving the privacy and confidentiality of your personal health information. We will create, receive, or maintain records that contain personal health information about you. Personal health information is information about you, including information about where you live, that can reasonably be used to identify you and that relates to your past, present, or future physical or mental condition, the provision of health care to you or the payment for that care.

Albright LIFE is required by certain state and federal regulations to safeguard the privacy of your personal health information. We are also required by the federal Health Insurance Portability and Accountability Act (or “HIPAA”) Privacy Rule to give you this Notice. This Notice informs you about the possible uses and disclosures of your personal health information and describes your rights and our obligations regarding your personal health information. This Notice applies to all information and records related to your care that Albright LIFE has received or created.

YOUR RIGHTS – A SUMMARY
You have the right to:

• Get a copy of this privacy notice
• Ask us to limit the information we share
• Get a list of those with whom we’ve shared your information
• Choose someone to act for you
• Correct your paper or electronic medical record
• Request confidential communication
• Get a copy of your paper or electronic medical record
• File a complaint if you believe your privacy rights have been violated

OUR USES AND DISCLOSURES
We may use and share your information as we:

• Treat you
• Run our organization
• Bill for your services
• Comply with the law
• Respond to lawsuits and legal actions
• Help with public health and safety issues
• Respond to organ and tissue donation requests
• Work with a medical examiner or funeral director
• Address workers’ compensation, law enforcement, and other government requests
• Do research

YOUR HEALTH INFORMATION AND YOUR RIGHTS
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get an electronic or paper copy of your medical record

• You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
• We will provide a copy or a summary of your health information, usually within 30 days of your request.

Ask us to correct your medical record

• You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
• We may say “no” to your request, but we’ll tell you why in writing within 60 days.
• Request confidential communications
• You can ask us to contact you in a specific way (for example, home or mobile phone) or to send mail to a different address.
• We will say “yes” to all reasonable requests.

Ask us to limit what we use or share

• You can ask us not to use or share certain health information for treatment, payment, or our operations We aren’t required to agree to your request, and we may say “no” if it would affect your care.

Get a copy of this privacy notice
You can ask for a paper copy of this notice at any time. We will provide you with a paper copy promptly.

Choose someone to act for you

• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
• We will make sure the person has this authority and can act for you before we take any action.

File a complaint if you feel your privacy/HIPAA rights are violated

• You can complain if you feel we have violated your rights by contacting us using the information at the end of this notice.
• You can file a complaint with the U.S. Dept. of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy hipaa/complaints.
• We will not retaliate against you for filing a complaint.

YOUR HEALTH INFORMATION AND YOUR CHOICES
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions. In these cases, you have both the right and choice to tell us to:

• Share information with your family, close friends, or others involved in your care
• Share information in a disaster relief situation

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

For more information see: www.hhs.gov/ocr/privacy/hipaa/ understanding/consumers/noticepp.html.

If you have any complaints or questions about our privacy policies, please contact:

Medicare Compliance Officer –Albright LIFE
90 Maplewood Drive, Lewisburg, PA 17837
(570) 522-3880