Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED. PLEASE REVIEW THIS CAREFULLY.
If you have any questions about this notice, please contact:
Tingyin Tina Chee, MD
Updesign Primary Care, LLC
812 State Fair Blvd, Suite 2A
Syracuse, NY 13209
admin@updesignprimarycare.com
Effective Date
This notice went into effect on 7/10/2022
Under the Health Insurance Portability and Accountability Act of 1996 (hereafter, “HIPAA”), you have certain rights regarding the use and disclosure of your protected health information (hereafter, “PHI”).
This notice describes the procedures and practices that this clinic and its professional, support, and administrative staff follow to protect the privacy of your health information.
This notice applies to the information and records we have about your health, health status, and the healthcare services you received at this office. Your health information may include information created and received by this office, it may be in the form of written or electronic records or spoken words, and it may include information about your health history, health status, symptoms, examinations, test results, diagnoses, treatments, procedures, prescriptions, related billing activity and similar types of health-related information.
We are required by law to give you this notice. It will tell you about the ways in which we use and disclose health information about you and describe your rights and our obligations regarding the use and disclosure of that information.
Our Pledge
At Updesign Primary Care, we understand that health information about you and your health care is personal. We are committed to protecting your privacy and the health
information about you.
We are required by law to maintain the privacy and security of your protected health information.
We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION
We may use and disclose health information for the following purposes:
I. For Treatment, Health Insurance Coverage, or Healthcare Operations:
Regulations allow health care professionals with direct treatment relationships with the patient to use or disclose the patient’s personal health information without the patient’s written authorization in order to carry out the treatment, payment, or health care operations.
We can use your health information and share it with other professionals who are treating you. This may also include their office staff or technicians who are involved in taking care of you and your health.
We may need to disclose your health information to use your health plan or insurance company for coverage or prior approval of medications, laboratory testing, or imaging services.
We may use your health information for operations purposes including sending you appointment reminders, billing invoices, and other documentation.
We may use health information about you in order to manage the clinic and ensure that you and other patients receive continuously improved quality care. Please notify us if you do not wish to be contacted for appointment reminders.
II. Other Circumstances as required by Law
We may use or disclose health information about you in accordance with the requirements and limitations of state and other laws.
To Avert Serious Threat to Health or Safety.
We may use and disclose health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
We may disclose health information about you for public health reasons in order to prevent or control disease, report suspected abuse or neglect, reporting adverse reactions to medications, or problems with products (such as product recalls).
Research: We may use or share your information for health research.
Law Enforcement and other government Health oversight activities.
We may disclose health information to a health oversight agency for audits, investigation, inspections, or licensing purposes. These disclosures may be necessary for certain state and federal agencies to monitor the health care system, government programs, and compliance with civil rights laws. For law enforcement purposes or with a law enforcement official we will disclose health information about you when required to do so by federal, state or local law.
Family and Friends.
If we obtain your verbal agreement to do so, we may disclose health information about you to your family members or friends. In situations where you are not capable of giving consent (due to your incapacity or medical emergency), we may, using our professional judgment, determine that a disclosure to your family member or friend is in your best interest. In that situation, we will disclose only health information relevant to the person’s involvement in your care.
Coroners, Medical Examiners and Funeral Directors.
We may release health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death.
Lawsuits and Disputes:
We may disclose health information in response to a court or administrative order. We may also disclose health information about you if required in response to a subpoena, discovery request, or other lawful process.
III. OTHER USES AND DISCLOSURES PURSUANT TO YOUR SIGNED AUTHORIZATION
We will not use or disclose your health information for any purpose other than those identified in the previous sections without your specific, written Authorization.
If you sign an Authorization for us to use or disclose health information about you, you may revoke that Authorization, in writing, at any time. If you revoke your Authorization, we will no longer use or disclose information about you for the reasons covered by your written Authorization, but we cannot take back any uses or disclosures already made with your permission.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
You have the following rights regarding health information we maintain about you:
I. Get an electronic or paper copy of your medical record
You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask us to correct your medical record
You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
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, home or office phone) or to send mail to a different address.
We will say “yes” to all reasonable requests.
Ask us to limit what we use or share
You can ask us not to use or share certain health information for treatment, payment, or our operations.
We are not required to agree to your request, and we may say “no” if it would affect your care.
If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer.
We will say “yes” unless a law requires us to share that information.
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. You must submit your request in writing and it must state the time period for which you want an accounting. You may request up to six years prior to the date you ask.
We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months
Get a copy of this privacy notice
You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly
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 make sure the person has this authority and can act for you before we take any action
File a complaint if you feel your rights are violated
You can complain if you feel we have violated your rights by contacting us using the information on the back page.
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 Avenue, S.W., 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.
YOUR CHOICES REGARDING YOUR HEALTH INFORMATION
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.
In these cases, you have both the right and choice to tell us to:
Share information with your family, close friends, or others involved in your care
Share information in a disaster relief situation
If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In these cases we never share your information unless you give us written permission:
Marketing purposes: We will not use or disclose your PHI for marketing purposes without your prior written consent.
Sale of your information: We do not sell your PHI.
In the case of fundraising:
We may contact you for fundraising efforts, but you can tell us not to contact you again.