Prime Injury Care - Health Insurance Portability and Accountability Act (HIPAA) Notice of Privacy Practices

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.

 

Prime Injury Care, LLC uses and discloses health information about you for treatment, obtain payment for treatment, administrative purposes, and evaluate the quality of care you receive.

 

This notice describes our privacy practices. You can request a copy of this notice at any time. For more information about this notice or our privacy practices and policies, please contact our privacy officer. The contact information is listed below, under “Questions and Contact Person for Requests.”

 

Treatment: We are permitted to use and disclose your medical information to those involved in your treatment. For example, when we provide treatment, we may request that your primary care physician share your medical information with us. Also, we may provide your primary care physician information about your particular condition so that he or she can appropriately treat you for other medical conditions if any.

 

Payment: We are permitted to use and disclose your medical information to bill and collect payment for the services provided to you. For example, we may complete a claim form to obtain payment from your insurer or HMO. The form will contain medical information, such as a description of the medical service provided to you, that your insurer or HMO needs to approve the payment.

 

Health Care Operations: We are permitted to use or disclose your medical information for the purposes of health care operations, which are activities that support Prime Injury Care, LLC, and help provide the delivery of quality care to you. For example, we may engage a professional’s services to aid Prime Injury Care, LLC, in its compliance programs. This person may review billing and medical files to ensure compliance with regulations and applicable state and federal law.

 

Disclosures That Can Be Made Without Your Authorization: There are rare situations in which law is permitted to disclose or use your medical information without written authorization or opportunity to object to protect the public. In most cases, we will ask for your written consent before using or disclosing any identifiable health information about you. If you choose to sign an authorization to disclose information, you can later revoke that authorization in writing. However, any revocation will not apply to disclosures or uses already made or taken in reliance on the original approval.

 

Public Health, Abuse or Neglect, and Health Oversight: We may disclose your medical information for public health activities. Public health activities are mandated by federal, state, or local governments for the collection by a public health authority of information about the disease or vital statistics (such as births and deaths). If authorized or required by law, we may disclose medical information to a person who may have been potentially exposed to a disease or may be at risk for contracting or spreading a disease or condition. We may disclose your medical information to report reactions to medications, problems with products, or notify people of recalls of products they may be using.

We may also disclose medical information to a public agency authorized to receive reports of abuse or neglect. Oklahoma law requires physicians to report child abuse or neglect. Regulations also permit the disclosure of information to report abuse or neglect of elders or the disabled. We may disclose your medical information to a health oversight agency for those activities authorized or required by law. Examples of these activities are audits, investigations, licensure applications, and inspections. All government activities are undertaken to monitor the health care delivery system and comply with other laws, such as civil rights laws.

 

Legal Proceedings and Law Enforcement: We may disclose your medical information in the course of judicial or administrative proceedings in response to the court’s order (or the administrative decision-maker) or another appropriate legal process. Specific requirements must be met before the information is disclosed.

 

If asked by a law enforcement official, we may disclose your medical information under limited circumstances provided that the information:

  • Is released pursuant to legal processes, such as a warrant or subpoena;
  • Pertains to a victim of a crime and you are incapacitated;
  • Relates to a person who has died under circumstances that may be related to criminal conduct;
  • Is about a victim of crime and we are unable to obtain the person’s agreement;
  • Is released because of a crime that has occurred on these premises; or
  • Is released to locate a fugitive, missing person, or suspect.

 

We may also release information if we believe the disclosure is necessary to prevent or lessen an imminent threat to a person’s health or safety.

 

Workers’ Compensation: We may disclose your medical information as required by Oklahoma workers’ compensation law.

 

Inmates: If you are an inmate or under the custody of law enforcement, we may release your medical information to the correctional institution or law enforcement official. This release is permitted to allow the institution to provide you with medical care, to protect your health or the health and safety of others, or for the safety and security of the institution.

 

Military, National Security and Intelligence Activities, Protection of the

President: We may disclose your medical information for specialized government functions such as separation or discharge from military service, requests as necessary by appropriate military command officers (if you are in the military), authorized national security and intelligence activities, as well as authorized activities for the provision of protective services for the President of the United States, other authorized government officials, or foreign heads of state.

 

Research, Organ Donation, Coroners, Medical Examiners, and Funeral Directors: When a research project and its privacy protections have been approved by an Institutional Review Board or privacy board, we may release medical information to researchers for research purposes. We may release medical information to organ procurement organizations to facilitate organ, eye, or tissue donation if you are a donor. We may also release your medical information to a coroner or medical examiner to identify a deceased or a cause of death. Further, we may release your medical information to a funeral director where such disclosure is necessary for the director to carry out their duties.

 

Required by Law: We may release your medical information where the disclosure is required by law.

 

Your Rights Under Federal Privacy Regulations: The United States Department of Health and Human Services created regulations intended to protect patient privacy as required by the Health Insurance Portability and Accountability Act (H1PAA). Those regulations create several privileges that patients may exercise. We will not retaliate against a patient that exercises their HIPAA rights.

 

Requested Restrictions: You may request that we restrict how your protected health information is used or disclosed for treatment, payment, or healthcare operations. We do NOT have to agree to this restriction except as stated below, but if we do agree, we will comply with your request except under emergency circumstances.

 

To request a restriction, submit the following in writing:

(a) The information to be restricted

(b) what kind of restriction you are requesting (i.e., on the use of information, disclosure of information, or both)

(c) to whom the limits apply. Please send the request to the address and person listed below.

 

You may also request that we limit the disclosure to family members, other relatives, or close personal friends that may or may not be involved in your care. We must agree to restrict health information disclosed to a health plan for payment or health care operations purposes if you paid for an item or services out-of-pocket.

 

Receiving Confidential Communications by Alternative Means: You may request that we send communications of protected health information by alternative means or to an alternative location. This request must be made in writing to the person listed below. We are required to accommodate only reasonable requests. Please specify exactly how you want us to communicate with you in your correspondence if you are directing us to send information to a particular place, the contact/address information.

 

Inspection and Copies of Protected Health Information: You may inspect or copy health information within the designated record set, which is the information used to make decisions about your care. Requests for copies must be made in writing, and we ask that requests for inspection of your health information also be made in writing. Please send your request to the person listed below. We can refuse to provide some of the information you ask to inspect or ask to be copied if the information:

  • Includes psychotherapy notes.
  • Includes the identity of a person who provided information if it was obtained under a promise of confidentiality.
  • Is subject to the Clinical Laboratory Improvements Amendments of 1988.
  • Has been compiled in anticipation of litigation.

 

We can refuse to provide access to or copies of some information for other reasons if, in our professional judgment, we determine that the access requested is likely to endanger your life or safety or that of another person or that it is likely to cause substantial harm to another person referenced within the information. You have the right to request a review of this decision.

 

To inspect and copy your medical information, you must submit a written request to the Privacy Officer, whose contact information is listed below. Suppose you request a copy of your information. In that case, we may charge you a reasonable fee consistent with any relevant state law for the costs of copying, mailing, or other expenses incurred by us in complying with your request.

 

Amendment of Medical Information: You may request an amendment of your medical information in the designated recordset. Any such request must be made in writing to the person listed below. We will respond within 60 days of your request. We may refuse to allow an amendment if the information;

  • Wasn’t created by Prime Injury Care, LLC, or the physicians of Prime Injury Care, LLC.
  • Is not part of the Designated Record Set.
  • Is not available for inspection because of an appropriate denial.
  • If the information is accurate and complete.

 

Even if we refuse to allow an amendment, you are permitted to include a patient statement about the information at issue in your medical record. If we refuse to allow an amendment, we will inform you in writing. If we approve the amendment, we will notify you in writing.

 

Accounting of Certain Disclosures: The HIPAA privacy regulations permit you to request, and us to provide, an accounting of disclosures that are other than for treatment, payment, health care operations, or made via an authorization signed by you or your representative. Please submit any request for an accounting to the person listed below. Your first accounting of disclosures (within 12 months) will be free. For additional requests within that period, we are permitted to charge for the cost of providing the list. If there is a charge, we will notify you, and you may choose to withdraw or modify your request before any costs are incurred.

 

Notification of Breach: You have the right to be notified in writing if there is a breach involving your protected health information.

Appointment Reminders, Treatment Alternatives, and Other Health-Related Benefits: We may contact you by telephone, mail, or both to provide appointment reminders, information about treatment alternatives, or other health-related benefits and services that may be of interest to you.

 

Copy of Notice: You have the right to obtain a paper copy of this notice even if you have agreed to receive it electronically.

 

Complaints: If you are concerned that your privacy rights have been violated, you may contact the person listed below. You may also send a written complaint to the United States Department of Health and Human Services. We will not retaliate against you for filing a complaint with the government or us. The contact information for the United States Department of Health and Human Services is:

U.S. Department of Health and Human Services HIPAA Complaint

7500 Security Blvd., C5-24-04 Baltimore, MD 21244

 

Our Promise to You: We are required by law and regulation to protect the privacy of your medical information, to provide you with this notice of our privacy practices with respect to protected health information, and to abide by the terms of the notice of privacy practices in effect.

 

Questions and Contact Person for Requests: If you have any questions or want to make a request pursuant to the rights described above, please contact:

 

Prime Injury Care – Privacy Officer

Attn: Sharell Harris

13100 N. Western Ave Oklahoma City, OK 73114

1-405-451-3444

 

This notice is effective as of January 1, 2021.

 

We reserve the right to update our policies, and this notice at any time. Updated policies will be made available through the Privacy Officer at the location listed above.

 

HIPPA-NOTICE-01-01-2021