HIPAA Policy

THIS NOTICE OUTLINES THE USAGE AND DISCLOSURE OF YOUR MEDICAL INFORMATION AND EXPLAINS HOW YOU CAN ACCESS IT. PLEASE READ IT CAREFULLY.

If you have any questions about this notice, please contact our privacy officer, whose contact information is provided at the end of this notice.

Whenever you visit a healthcare provider, a record of your visit is created. This record typically includes details like your symptoms, test results, diagnoses, treatment, future care plans, and billing information. This notice covers all records related to your care generated by your healthcare provider.

Our Responsibilities:

Incluskin is legally obligated to maintain the privacy of your health information and to inform you about our legal duties and privacy practices concerning your health information. You can obtain a copy of the current notice from any receptionist in our waiting area. This notice also outlines your rights regarding your medical information.

How We Use and Disclose Your Medical Information

The subsequent sections delineate the ways in which we handle and divulge medical information:

1. For Treatment: We may utilize your medical information to deliver, coordinate, and oversee your treatment services. Such information may be disclosed to other healthcare professionals such as doctors, nurses, technicians (e.g., clinical laboratories or imaging companies), medical students, or other relevant personnel involved in your care. Communication of this information can be oral or written, through methods like mail or facsimile. Additionally, subsequent copies of pertinent reports may be provided to aid in your treatment.

2. For Payment: Your medical information concerning treatment and services may be employed and disclosed for billing and payment collection purposes from you, your insurance company, or a third-party payer. For instance, it may be necessary to furnish information to your insurance company for approval or payment of recommended healthcare services.

3. For Health Care Operations: We may use or disclose your health information, as required, to support our operational activities. These activities encompass quality assessment, employee evaluations, licensing, legal counsel, accounting assistance, information systems support, and the facilitation or arrangement of other operational endeavors. Moreover, we may call you by name in the waiting area when your care provider is prepared to see you. Furthermore, we may use or disclose your protected health information as needed to remind you of appointments via telephone or reminder cards.

4. Business Associates: Our organization engages in services through contracts with business associates, such as billing collections, document management, software support, and quality assurance. In the event of such contracted services, your health information may be disclosed to these business associates to fulfill their responsibilities and bill you or your third-party payer for rendered services. To safeguard your health information, we mandate that business associates appropriately protect your information through a formal written agreement.

Additionally, we may utilize and disclose your health information with your consent, authorization, or an opportunity for you to object. You have the option to agree or dissent regarding the use or disclosure of all or part of your health information in these scenarios. If you are unable to provide consent or objection (e.g., during an emergency), your clinician may, based on professional judgment, decide whether disclosure is in your best interest, ensuring only relevant information pertaining to your healthcare is disclosed. subsequent sections delineate the ways in which we handle and divulge medical information:

Regarding the release of medical information:

1. Care: Unless you express objection, we reserve the right to disclose your medical information to a friend or family member involved in your medical care or assisting with payment for your care. Additionally, in situations of disaster relief efforts, we may disclose your medical information to entities to notify your family about your condition, status, and whereabouts.

2. Future Communications: We may communicate with you through various channels such as newsletters, mailings, or other means concerning treatment options, health-related benefits or services, appointment reminders, or community initiatives in which our facility participates. Should you wish to opt out of receiving such materials, please contact us via email.

Furthermore, there are circumstances where we may use or disclose your eHealth information without your explicit consent or an opportunity to object.

These include:

• As Required by Law: Disclosure of health information may be made to entities like the Food and Drug Administration, public health or legal authorities responsible for disease prevention or control, correctional institutions, workers’ compensation agents, organ and tissue donation organizations, military command authorities, health oversight agencies, funeral directors, coroners, medical directors, national security and intelligence agencies, protective services for dignitaries, or authorities handling reports of abuse and neglect.

• Law Enforcement/Legal Proceedings: Many states have reporting requirements pertaining to activities aimed at improving health or reducing healthcare costs, maintaining registries for conditions like cancer or birth defects, and other legal proceedings.

Your Rights Regarding Health Information:

1. Inspection and Copying: You have the right to inspect and obtain copies of your medical information that is pertinent to your care decisions. We require written requests for such access, typically encompassing medical and billing records. However, access may be denied in very limited circumstances. If access is denied, you have the option to request a review of the denial, which will be conducted by a different person than the one who denied your initial request. Requests for access and copies must be submitted in writing to Incluskin accompanied by a $5.00 copying fee for medical record copies.

2. Amendment: If you believe that the medical information we possess about you is inaccurate or incomplete, you can request an amendment by submitting a written request. You have the right to request an amendment for as long as we retain the information. If your request for an amendment is denied, you will be informed of the reason for the denial.

3. Accounting of Disclosures: You may request an accounting of disclosures of your medical information, with some exceptions like disclosures for treatment, payment, health care operations, or instances where you provided specific authorization. The first accounting within a 12-month period is provided free of charge upon your written request. Subsequent requests for an accounting within the same period will incur a $5.00 fee.

Regarding your rights:

1. Request Restrictions: You have the right to request limitations on how we use or disclose your medical information for treatment, payment, or healthcare operations. Additionally, you can request restrictions on the disclosure of your medical information to individuals involved in your care or payment, such as family members or friends. For instance, you may request that we refrain from disclosing information about a specific procedure. These requests should be submitted in writing. While we are not obligated to agree to all requests, if we do agree, we will adhere to the agreed-upon restrictions unless the information is necessary for emergency treatment.

2. Request Confidential Communications: You may request specific ways or locations for us to communicate with you regarding medical matters. We will accommodate reasonable requests, such as using an alternative address for billing purposes. Please submit these requests in writing.

3. Paper Copy of Notice: You have the right to receive a paper copy of this notice upon request, regardless of whether you have agreed to receive it electronically. To exercise any of these rights, please obtain the necessary forms from our practice and submit your request in writing to the privacy officer indicated below.

Regarding complaints:

If you believe your privacy rights have been violated, you can file a complaint with us by contacting us via email or by reaching out to the Secretary of the Federal Department of Health and Human Services at 1-800-368-1019. Complaints must be submitted in writing within 180 days of becoming aware of the issue. You will not face any penalties for filing a complaint.

Additional notes:

Any other uses or disclosures of your medical information not covered in this notice or permitted by law will require your written permission. You have the right to revoke this permission at any time in writing. However, please note that we cannot retract disclosures already made with your permission, and we are obligated to retain records of the care providers.