TVC 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.

TVC’s Commitment to Your Privacy

TVC is dedicated to maintaining the privacy of your protected health information (“PHI”). PHI is information about you that may be used to identify you (such as your name, social security number or address), and that relates to (a) your past, present or future physical or mental health or condition, (b) the provision of healthcare to you, or (c) your past, present, or future payment for the provision of healthcare. In conducting its business, TVC will receive and create records containing your PHI. TVC is required by law to maintain the privacy and security of your PHI and to provide you with notice of its legal duties and privacy practices with respect to your PHI.

TVC must abide by the terms of this Notice while it is in effect, with this current Notice effective as of August 20, 2019, and remaining in effect until TVC replaces or updates it. TVC reserves the right to change the terms of this Notice at any time, as long as the changes are in compliance with applicable law. If TVC changes the terms of this Notice, the new terms will apply to all PHI that it maintains, including PHI that was created or received before such changes were made. If TVC changes this Notice, it will post the new Notice on its website.

Uses and Disclosures of PHI

TVC may use and disclose your PHI in the following ways:

For Treatment, Payment and Healthcare Operations: TVC is permitted to use and disclose your PHI for purposes of (a) treatment, (b) payment and (c) healthcare operations. For example:

Treatment: TVC may disclose your PHI to another physician or healthcare provider for purposes of a visit or in connection with the provision of follow-up treatment.

Payment: TVC may use and disclose your PHI to your health insurer or health plan in connection with the processing and payment of claims and other charges in the event that TVC accepts your insurance plan and you authorize TVC to bill your insurance plan for services rendered by TVC.

Healthcare Operations: TVC may use and disclose your PHI in connection with its healthcare operations, such as providing customer services and conducting quality review assessments. TVC may engage third parties to provide various services for TVC (“Business Associates”). If any such third party must have access to your PHI in order to perform its services, TVC will require that third party to enter an agreement that binds the third party to the use and disclosure restrictions outlined in this Notice.

Authorization: TVC is permitted to use and disclose your PHI upon your written authorization, to the extent such use or disclosure is consistent with your authorization. You may revoke any such authorization at any time.

Special Circumstances

The following categories describe unique circumstances in which TVC may use or disclose your PHI:

  • As Required by Law: TVC may use and disclose your PHI to the extent required by law.
  • Public Health Activities: TVC may disclose your PHI to public health authorities or other governmental authorities for purposes including preventing and controlling disease, reporting child abuse or neglect, reporting domestic violence and reporting to the Food and Drug Administration regarding the quality, safety and effectiveness of a regulated product or activity. TVC may, in certain circumstances disclose PHI to persons who have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition.
  • Workers’ Compensation: TVC may disclose your PHI as authorized by, and to the extent necessary to comply with, workers’ compensation programs and other similar programs relating to work-related illnesses or injuries.
  • Health Oversight Activities: TVC may disclose your PHI to a health oversight agency for authorized activities such as audits, investigations, inspections, licensing and disciplinary actions relating to the healthcare system or government benefit programs.
  • Judicial and Administrative Proceedings: TVC may disclose your PHI, in certain circumstances, as permitted by applicable law, in response to an order from a court or administrative agency, or in response to a subpoena or discovery request.
  • Law Enforcement: TVC may, under certain circumstances, disclose your PHI to a law enforcement official, such as for purposes of identifying or locating a suspect, fugitive, material witness or missing person.
  • Decedents: TVC may, under certain circumstances, disclose PHI to coroners, medical examiners and funeral directors for purposes such as identification, determining the cause of death and fulfilling duties relating to decedents.
  • Organ and Tissue Donation: If you are an organ donor, we may use or release PHI to organizations that handle organ procurement or other entities engaged in procurement, banking or transportation of organs, eyes or tissues to facilitate organ, eye or tissue donation and transplantation.
  • Research: Under certain circumstances, TVC may use and disclose PHI for research. For example, a research project may involve comparing the health of patients who received one treatment to those who received another, for the same condition.  Before we use or disclose PHI for research, the project will go through a special approval process.  Even without special approval, we may permit researchers to look at records to help them identify patients who may be included in their research project or for other similar purposes, as long as they do not remove or take a copy of any PHI.
  • Threat to Health or Safety: TVC may, under certain circumstances, use or disclose PHI if necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
  • Specialized Government Functions: TVC may, in certain situations, use and disclose PHI of persons who are, or were, in the Armed Forces for purposes such as ensuring proper execution of a military mission or determining entitlement to benefits. TVC may also disclose PHI to federal officials for intelligence and national security purposes.
  • Inmates or Individuals in Custody: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release PHI to the correctional institution or law enforcement official.  This release would be if necessary: (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) the safety and security of the correctional institution.

Your Rights Regarding Your PHI

You have the following rights regarding the PHI maintained by TVC:

Confidential Communication: You have the right to receive confidential communications of your PHI. You may request that TVC communicate with you through alternate means or at an alternate location, and TVC will make reasonable efforts to accommodate any reasonable requests. You must submit your request in writing to TVC.

Restrictions: You have the right to request restrictions on certain uses and disclosures of PHI for treatment, payment or healthcare operations. You also have the right to request that TVC restrict its disclosures of PHI to only certain individuals involved in your care or the payment of your care. You must submit your request in writing to TVC. TVC is not required to comply with your request. However, if TVC agrees to comply with your request, it will be bound by such agreement, except when otherwise required by law or in the event of an emergency.

Inspection and Copies: You have the right to inspect and copy your PHI. You must submit your request in writing to TVC. TVC may impose a fee for the costs of copying, mailing, labor and supplies associated with your request. TVC may deny your request to inspect and/or copy your PHI in certain limited circumstances. If that occurs, TVC will inform you of the reason for the denial, and you may request a review of the denial.

Amendment: You have a right to request that TVC amend your PHI if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is maintained by TVC. You must submit your request in writing to TVC and provide a reason to support the requested amendment. TVC may, under certain circumstances, deny your request by sending you a written notice of denial. If TVC denies your request, you will be permitted to submit a statement of disagreement for inclusion in your records.

Accounting of Disclosures: You have a right to receive an accounting of all disclosures TVC has made of your PHI. However, that right does not include disclosures made for treatment, payment or healthcare operations, disclosures made to you about your treatment, disclosures made pursuant to an authorization, and certain other disclosures. You must submit your request in writing to TVC and you must specify the time period involved (which must be for a period of time less than six years from the date of the disclosure). Your first accounting will be free of charge. However, TVC may charge you for the costs involved in fulfilling any additional request made within a period of 12 months, in compliance with law. TVC will inform you of such costs in advance, so that you may withdraw or modify your request to save costs.

Breach Notification: You have the right to be notified in the event that TVC (or a TVC Business Associate) discovers a breach of unsecured PHI.

Paper Copy: You have the right to obtain a paper copy of this Notice from TVC at any time upon request. To obtain a paper copy of this notice, please contact TVC by calling 1-800-XXX-XXXX.

Complaint: You may file a complaint to TVC and to the Secretary of the Department of Health and Human Services if you believe that your privacy rights have been violated. To file a complaint with TVC, you must submit a statement in writing to TVC at: Thyroid Virtual Clinic PC, Attn: Privacy Officer, 345 U.S. 9 South – Suite 8, Manalapan, NJ, 07726. TVC will not retaliate against you for filing a complaint.

Further Information: If you would like more information about your privacy rights, please contact TVC in writing. To the extent you are required to send a written request to TVC to exercise any right described in this Notice, you must submit your request to TVC at: Thyroid Virtual Clinic PC, Attn: Privacy Officer, 345 U.S. 9 South – Suite 8, Manalapan, NJ, 07726.

YOUR WRITTEN AUTHORIZATION IS REQUIRED FOR OTHER USES AND DISCLOSURES

The following uses and disclosures of your PHI will be made only with your written authorization:

  1. Uses and disclosures of PHI for marketing purposes; and
  2. Disclosures that constitute a sale of your PHI.

Other uses and disclosures of PHI not covered by this Notice or the laws that apply to us will be made only with your written authorization.  If you do give us an authorization, you may revoke it at any time by submitting a written revocation to our Privacy Officer and we will no longer disclose PHI under the authorization.  Disclosure(s) that we made in reliance on your authorization before you revoked it will not be affected by the revocation.

Notice of Non-Discrimination

Thyroid Virtual Clinic PC complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. TVC does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

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