CLARE KATNER, LLC dba EAST BRIDGE MASSAGE
NOTICE OF PRIVACY PRACTICES
We are required by law to maintain the privacy of your health information and to provide you with notice of our legal duties and privacy practices with respect to your health information. This notice describes how health information about you may be used and disclosed, and how you can get access to this information. Please review it carefully.
WHAT IS PROTECTED HEALTH INFORMATION (“PHI”)
Any information that is being held or transmitted by a covered entity or its associates, in any form or media, whether electronic, paper or oral, that individually identifies you, including demographic data, that relates to:
• Your past, present, or future physical/mental health or conditions
• The provision of health care to you
• The past, present, or future payment for your health care.
HOW WE MAY USE AND DISCLOSE YOUR PHI
We may use and disclose your PHI in the following circumstances:
• Treatment. We may use or disclose your PHI to give you medical treatment or services and to manage and coordinate your medical care.
• Billing/Payment. We may use and disclose your PHI so that we can bill for the treatment and services you receive from us and can collect payment from you, a health plan, or a third party. This use and disclosure may include certain activities that your health insurance plan may require before it approves or pays for the health care services we recommend for you, such as determining eligibility/coverage of benefits, reviewing services provided for medical necessity, and prior authorizations.
• Health Care Operations. We may use and disclose your PHI to run our practice, improve your care, and contact you when necessary. We may leave a message on an automated answering device or person answering the phone, email, fax and text you for the purposes of scheduling appointments, appointment reminders, appointment openings, possible treatment options or alternatives or health related benefits and services.
WE MAY DISCLOSE, OR MAY BE REQUIRED TO DISCLOSE YOUR PHI FOR PURPOSES RELATED TO:
Public Health and Safety issues
Comply with the law
Respond to organ and tissue donation requests
Work with medical examiner or funeral director
Address workers compensation, law enforcement, and other government requests
Respond to lawsuits and legal actions
You have the right to:
Get an electronic or paper copy of your medical records. Records are provided within 30 days of written request and a reasonable fee may be charge.
Ask us to amend your medical record. We are not required to agree to amend it but if your request is declined, you will be provided with an explanation of our denial reason within 60 days.
Request confidential communications
Limit the information we share
Get a list of those with whom we’ve shared your information
Get a copy of this privacy notice
Choose someone to act for you
We are required by law to maintain the privacy and security of your protected health information.
We will inform you if a breach occurs that may compromise the privacy and security of your information.
We must follow the duties and practices described in this notice
We will not use or disclose your information other than described here unless you tell us we can in writing.
CHANGES TO THE TERMS OF THIS NOTICE
We reserve the right to amend this Notice of Privacy Practices at any time in the future and will make the new provisions effective for all information that it maintains. Until such amendment is made, we are required by law to comply with this Notice.
EFFECTIVE DATE OF THIS NOTICE
April 1, 2018
If you have questions about any part of this notice or if you want more information about your privacy rights, please contact:
East Bridge Massage, Privacy Official
If you are not satisfied with the manner in which this office handles your complaint, you may submit a formal complaint to:
DHHS, Office of Civil Rights
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201