HIPAA Notice of Privacy Practices

Brain and Body Regenerative Medicine

Dr. Evan Riggleman · Dr. Erica Riggleman

Effective Date: 1-20-20

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 understand the importance of privacy and are committed to maintaining the confidentiality of your medical information. We make a record of the medical care we provide and may receive such records from others. We use these records to provide or enable other health care providers to provide quality medical care, to obtain payment for services provided to you as allowed by your health plan, and to enable us to meet our professional and legal obligations to operate this medical practice properly.

We are required by law to maintain the privacy of protected health information, to provide individuals with notice of our legal duties and privacy practices with respect to protected health information, and to notify affected individuals following a breach of unsecured protected health information. This notice describes how we may use and disclose your medical information. It also describes your rights and our legal obligations with respect to your medical information. If you have any questions about this Notice, please contact our Privacy Officer at the contact information listed above.

Table of Contents

A. How This Medical Practice May Use or Disclose Your Health Information

B. When This Medical Practice May Not Use or Disclose Your Health Information

C. Your Health Information Rights

D. Changes to This Notice of Privacy Practices

E. Complaints

A. How This Medical Practice May Use or Disclose Your Health Information

This medical practice collects health information about you and stores it in a chart and on a computer. This is your medical record. The medical record is the property of this medical practice, but the information in the medical record belongs to you. The law permits us to use or disclose your health information for the following purposes:

Treatment. We use medical information about you to provide your medical care. We disclose medical information to our employees and others who are involved in providing the care you need. For example, we may share your medical information with other physicians or health care providers who will provide services that we do not provide, with a pharmacist who needs it to dispense a prescription, or a laboratory that performs a test. We may also disclose medical information to members of your family or others who can help you when you are sick or injured, or after you die.

Payment. We use and disclose medical information about you to obtain payment for the services we provide. For example, we give your health plan the information it requires before it will pay us. We may also disclose information to other health care providers to assist them in obtaining payment for services they have provided to you.

Health Care Operations. We may use and disclose medical information about you to operate this medical practice — for example, to review and improve the quality of care we provide, or the competence and qualifications of our professional staff; to get your health plan to authorize services or referrals; or as necessary for medical reviews, legal services and audits, including fraud and abuse detection and compliance programs, and business planning and management. We may also share your medical information with our "business associates," such as our billing service, that perform administrative services for us. We have a written contract with each business associate requiring them and their subcontractors to protect the confidentiality and security of your protected health information. We may also share your information with other health care providers, health care clearinghouses, or health plans that have a relationship with you when they request it to help with quality assessment and improvement activities, patient-safety activities, population-based efforts to improve health or reduce health care costs, protocol development, case management or care-coordination, review of competence, qualifications and performance of health care professionals, training programs, accreditation, certification or licensing activities, or health care fraud and abuse detection and compliance efforts. We may also share medical information with other providers, clearinghouses, and health plans that participate with us in "organized health care arrangements" (OHCAs) for any of the OHCAs' health care operations. A listing of the OHCAs we participate in is available from the Privacy Officer.

Appointment Reminders. We may use and disclose medical information to contact and remind you about appointments. If you are not home, we may leave this information on your answering machine or in a message left with the person answering the phone.

Sign-In Sheet. We may use and disclose medical information about you by having you sign in when you arrive at our office. We may also call out your name when we are ready to see you.

Notification and Communication With Family. We may disclose your health information to notify or assist in notifying a family member, your personal representative, or another person responsible for your care about your location, your general condition, or, unless you instructed us otherwise, in the event of your death. In a disaster, we may disclose information to a relief organization to coordinate notification efforts. We may also disclose information to someone involved with your care or who helps pay for your care. If you are able and available to agree or object, we will give you the opportunity to do so before making these disclosures, although we may disclose this information in a disaster even over your objection if we believe it necessary to respond to the emergency. If you are unable or unavailable to agree or object, our health professionals will use their best judgment.

Marketing. Provided we do not receive payment for making these communications, we may contact you to give you information about products or services related to your treatment, case management, or care coordination, or to recommend other treatments, therapies, providers, or settings of care that may be of interest to you. We may describe products or services provided by this practice and tell you which health plans this practice participates in. We may also encourage you to maintain a healthy lifestyle, get recommended tests, participate in a disease management program, provide you with small gifts, tell you about government-sponsored health programs, or encourage you to purchase a product or service when we see you, for which we may be paid. We may also receive compensation covering our cost of reminding you to take and refill medication, or otherwise communicate about a drug or biologic currently prescribed for you. We will not otherwise use or disclose your medical information for marketing purposes, or accept payment for other marketing communications, without your prior written authorization. That authorization will disclose whether we receive compensation for the marketing activity you authorize, and we will stop any future marketing activity to the extent you revoke your authorization.

Sale of Health Information. We will not sell your health information without your prior written authorization. That authorization will disclose that we receive compensation for the sale, and we will stop any future sale of your information to the extent you revoke your authorization.

Required by Law. As required by law, we will use and disclose your health information, limited to the relevant requirements of the law. Where the law requires us to report abuse, neglect or domestic violence, or respond to judicial or administrative proceedings or to law enforcement, we will comply with the requirements described below.

Public Health. We may, and are sometimes required by law to, disclose your health information to public health authorities for purposes such as: preventing or controlling disease, injury, or disability; reporting child, elder, or dependent adult abuse or neglect; reporting domestic violence; reporting to the FDA problems with products and reactions to medications; and reporting disease or infection exposure. When we report suspected elder or dependent adult abuse or domestic violence, we will inform you or your personal representative promptly unless, in our best professional judgment, doing so would place you at risk of serious harm or would require informing a personal representative we believe is responsible for the abuse or harm.

Health Oversight Activities. We may, and are sometimes required by law to, disclose your health information to health oversight agencies during audits, investigations, inspections, licensure, and other proceedings, subject to legal limitations.

Judicial and Administrative Proceedings. We may, and are sometimes required by law to, disclose your health information in judicial or administrative proceedings to the extent expressly authorized by a court or administrative order, or in response to a subpoena, discovery request, or other lawful process if reasonable efforts have been made to notify you and you have not objected, or your objections have been resolved by a court or administrative order.

Law Enforcement. We may, and are sometimes required by law to, disclose your health information to law enforcement for purposes such as identifying or locating a suspect, fugitive, material witness, or missing person, or complying with a court order, warrant, or grand jury subpoena.

Coroners. We may, and are often required by law to, disclose your health information to coroners in connection with death investigations.

Organ or Tissue Donation. We may disclose your health information to organizations involved in procuring, banking, or transplanting organs and tissues.

Public Safety. We may, and are sometimes required by law to, disclose your health information to appropriate persons to prevent or lessen a serious and imminent threat to the health or safety of a particular person or the general public.

Proof of Immunization. We will disclose proof of immunization to a school required to have it before admitting a student, where you have agreed to the disclosure on behalf of yourself or your dependent.

Specialized Government Functions. We may disclose your health information for military or national security purposes, or to correctional institutions or law enforcement officers with lawful custody of you.

Workers' Compensation. We may disclose your health information as necessary to comply with workers' compensation laws — for example, making periodic reports to your employer about your condition where your care is covered by workers' compensation. We are also required by law to report cases of occupational injury or illness to the employer or workers' compensation insurer.

Change of Ownership. If this medical practice is sold or merged with another organization, your health information/record will become the property of the new owner, though you retain the right to request that copies be transferred to another physician or medical group.

Breach Notification. In the case of a breach of unsecured protected health information, we will notify you as required by law. If you have provided a current email address, we may use email to communicate breach-related information. In some circumstances, our business associate may provide the notification, and we may also notify by other appropriate methods.

B. When This Medical Practice May Not Use or Disclose Your Health Information

Except as described in this Notice, this medical practice will not use or disclose health information which identifies you without your written authorization. If you authorize us to use or disclose your health information for another purpose, you may revoke that authorization in writing at any time.

C. Your Health Information Rights

Right to Request Special Privacy Protections. You have the right to request restrictions on certain uses and disclosures of your health information, by written request specifying what information you want to limit and what limitations you wish imposed. If you tell us not to disclose information to your commercial health plan concerning items or services you paid for in full out-of-pocket, we will abide by your request unless we must disclose the information for treatment or legal reasons. We reserve the right to accept or reject any other request and will notify you of our decision.

Right to Request Confidential Communications. You have the right to request that you receive your health information in a specific way or at a specific location — for example, to a particular email account or work address. We will comply with all reasonable requests submitted in writing that specify how or where you wish to receive communications.

Right to Inspect and Copy. You have the right to inspect and copy your health information, with limited exceptions. To access your medical information, submit a written request detailing what information you want, whether you want to inspect or copy it, and, if copying, your preferred form and format. We will provide copies in your requested form and format if readily producible, or an acceptable alternative format, or your choice of readable electronic or hardcopy format if we maintain the record electronically and cannot agree otherwise. We will also send a copy to any other person you designate in writing. We will charge a reasonable fee covering labor, supplies, postage, and, if agreed in advance, the cost of preparing an explanation or summary. We may deny your request under limited circumstances; if we deny access to a child's records or an incapacitated adult's records you represent because we believe access would likely cause substantial harm, you have a right to appeal. If we deny access to psychotherapy notes, you have the right to have them transferred to another mental health professional.

Right to Amend or Supplement. You have the right to request that we amend health information you believe is incorrect or incomplete. The request must be in writing and include your reasons. We are not required to change your information and will explain any denial and how you may disagree with it. We may deny your request if we do not have the information, did not create it (unless the originator is no longer available to make the amendment), you would not be permitted to inspect or copy the information at issue, or the information is accurate and complete. You may submit a written statement of disagreement, and we may prepare a written rebuttal; all related information will be maintained and disclosed with any subsequent disclosure of the disputed information.

Right to an Accounting of Disclosures. You have the right to receive an accounting of disclosures of your health information made by this practice, with certain exceptions — including disclosures to you, disclosures pursuant to your written authorization, disclosures for treatment, payment, health care operations, notification/communication with family, and specialized government functions, disclosures for research or public health that exclude direct patient identifiers, disclosures incident to an otherwise permitted use or disclosure, and disclosures to a health oversight agency or law enforcement official where we have received notice that providing the accounting would likely impede their activities.

Right to a Paper or Electronic Copy of This Notice. You have the right to notice of our legal duties and privacy practices, including a paper copy of this Notice, even if you have previously requested it by email. For a more detailed explanation of these rights, or to exercise one or more of them, contact our Privacy Officer at the contact information listed above.

D. Changes to This Notice of Privacy Practices

We reserve the right to amend this Notice at any time. Until an amendment is made, we are required by law to comply with the Notice currently in effect. After an amendment, the revised Notice will apply to all protected health information we maintain, regardless of when it was created or received. We will keep a copy of the current Notice posted in our reception area, available at each appointment, and posted on our website.

E. Complaints

Complaints about this Notice or how this medical practice handles your health information should be directed to our Privacy Officer at the contact information listed above.

If you are not satisfied with how this office handles a complaint, you may submit a formal complaint to [email protected]