HIPAA Statement Posted on January 6, 2022 by Swank Family Hearing 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 a copy of your health and claims records: You can ask to see or get a copy of your health and claims records and other health information we have about you. We will provide a copy or a summary of your health and claims records, usually within 30 days of your request. We may charge a reasonable, cost-based fee. Ask us to correct health and claims records: You can ask us to correct your health and claims records if you think they are incorrect or incomplete. 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, by home or office phone) or to send mail to a different address. We will consider all reasonable requests and must say “yes” if you tell us you would be in danger if we do not. Get a list of those with whom we’ve shared information: You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, whom we shared it with and why. We will include all the disclosures except for those about treatment, payment and health care operations, and certain other disclosures. 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 ensure the person has this authority and can act for you before we take any action. How do we typically use or share your health information? We use it to help manage the health care treatment you receive. We can share your information with professionals who are treating you. Pay for your health services: We can use and disclose your health information as we pay for your health services. Administer your plan: We may disclose your health information to your health plan sponsor for plan administration. 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 suspected abuse, neglect or domestic violence Preventing or reducing a serious threat to anyone’s health or safety We can use or share your information for health research. 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. Addressing workers’ compensation, law enforcement and other government requests 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 services Responding to lawsuits and legal actions In response to a court or administrative order, or in response to a subpoena File a complaint if you feel your rights are violated: You can complain if you feel we have violated your rights by contacting us. You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Ave. SW, 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. For more information, see www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html. Changes to the Terms of This Notice We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request and on our website, and we will mail a copy to you. I have read and understand my HIPAA rights as outlined above. I acknowledge that I have the right to request a copy of this information and that a copy will be provided immediately.