This Joint Notice of Privacy Practices (“NOPP”) is provided by Preventive Medicine Associates, P.C., a California professional corporation, Knowledge Health Medical Services, P.C., a New York professional corporation, and Knowledge Health Medical Services, P.C., a New Jersey professional corporation, K Pharmacy LLC (together, the “K Entities”). The K Entities are part of an Organized Health Care Arrangement (“OHCA”) under the Health Insurance Portability and Accountability Act (“HIPAA”). HIPAA defines an (“OHCA”) to include, among other arrangements, an organized system of health care in which more than one covered entity participates and in which the participating covered entities hold themselves out to the public as participating in a joint arrangement and participate in certain joint activities as specified in the Privacy Regulations. The K Entities have agreed to collaborate to provide coordinated, high-quality care to their patients. For the purposes of the Privacy Regulations, the K Entities qualify as an OHCA and wish to declare themselves as such for the purposes of quality of care and to enable the sharing of PHI for joint activities of the K Entities.
Your Information. Your Rights. Our Responsibilities.
This NOPP describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
You have the right to:
- Get a copy of your paper or electronic medical record;
- Request that we correct your paper or electronic medical record;
- Request confidential communication;
- Ask us to limit the information we share;
- Get a list of those with whom we’ve shared your information;
- Get a copy of this NOPP;
- Choose someone to act for you; and
- File a complaint if you believe your privacy rights have been violated
For certain health information, you can tell us your choices about what we share:
- Tell family and friends about your condition
- Provide disaster relief
- Market our services and sell your information
Our Uses and Disclosures
We may use and share your information as we:
- Treat you
- Run our organization
- Bill for our services
- Help with public health and safety issues
- Do research
- Comply with the law
- Respond to organ and tissue donation requests
- Work with a medical examiner or funeral director
- Address workers’ compensation, law enforcement, and other government requests
- Respond to lawsuits and legal actions
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
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 for six years prior to the date you ask, who we shared it with, and why.
- 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 per 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 at the bottom of this NOPP.
- 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.
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; and
- Share information in a disaster relief situation.
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; and
- Sale of your information.
Our Uses and Disclosures
How do we typically use or share your health information?
We typically use or share your health information in the following ways:
For treatment activities
We can use your health information and share it with other professionals who are treating you. We may use and disclose your health information among doctors, nurses, technicians, medical students and other personnel who are involved in taking care of you. We may use or share information about you to coordinate the different services you need, such as prescriptions, lab work and x-rays. We may disclose information about you to people outside of KMD who may be involved in your care, such as family members, home health agencies, therapists, nursing homes, clergy, and others. We may give information to your health plan or another provider to arrange a referral or consultation.
For health care operations activities
We may use health information to evaluate the quality of services that you received. We may use health information to improve our performance or to find better ways to provide care. We may use health information evaluate the competence of our health care professionals. We may use your health information to decide what additional services we should offer and whether new treatments are effective. We may use and disclose your information to our business associates (described in more detail below) to assist us with evaluating patient outcomes, developing new clinical guidelines, and other activities related to health care operations, including improving health and reducing health care costs. These health care operations uses and disclosures help us to develop new tools to assist our health care providers and to provide better health care services to you. We may disclose information to students and professionals for review and learning purposes. We may combine our health information with information from other health care facilities to compare how we are doing and see where we can make improvements. We may use health information for business planning, or disclose it to attorneys, accountants, consultants and others in order to make sure we are complying with the law. We may remove health information that identifies you so that others may use the de-identified information to study health care and health care delivery without learning who you are.
We can use and share your health information to bill and get payment from health plans or other entities. We may use and disclose your health information so that we can receive payment for the treatment and services that were provided. We may share this information with your insurance company or a third party used to process billing information. (As described above, if you pay for your health care in full and out-of-pocket, you may request that we not share your information with your insurance company.) We may contact your insurance company to verify what benefits you are eligible for, to obtain prior authorization, and to tell them about your treatment to make sure that they will pay for your care. We may disclose information to third parties who may be responsible for payment, such as family members, or to bill you. We may disclose information to third parties that help us process payments, such as billing companies, claims processing companies, and collection companies.
To work with our business associates
We engage with vendors to perform some services on our behalf. For example, we may have a contract with a billing service, or cloud storage provider. These vendors are called our business associates. When we contract for these services, we may disclose your PHI to our business associates so that they can perform the job we have asked them to do. To protect your information, we require all business associates to appropriately safeguard your information and comply with HIPAA.
How else can we use or share your health information?
We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
Help with public health and safety issues
We can share health information about you for certain situations such as:
- Preventing disease;
- Helping with product recalls;
- Reporting adverse reactions to medications;
- Reporting suspected abuse, neglect, or domestic violence; and
- Preventing or reducing a serious threat to anyone’s health or safety.
We can use or share your information for health research subject to certain legal requirements.
Comply with the law
We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
Respond to organ and tissue donation requests
We can share health information about you with organ procurement organizations.
Work with a medical examiner or funeral director
We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
Address workers’ compensation, law enforcement, and other government requests
We can use or share health information about you:
- For workers’ compensation claims
- For law enforcement purposes or with a law enforcement official
- With health oversight agencies for activities authorized by law
- For special government functions such as military, national security, and presidential protective services
Respond to lawsuits and legal actions
We can share health information about you in response to a court or administrative order, or in response to a subpoena.
Other uses and disclosures of your health information not covered by this NOPP, or applicable, will be made only with your HIPAA-compliant authorization. These include the sale of your health information, or use of your health information for marketing purposes as defined under HIPAA. You may revoke your authorization in writing at any time, and we will discontinue future uses and disclosures of your health information for the reasons covered by your authorization.
- 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 must follow the duties and privacy practices described in this notice and give you a copy of it.
- 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.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
Changes to the Terms of this NOPP
We may change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, and on our web site.
- The original effective date of this NOPP was April 14, 2021. This NOPP was last updated September 22, 2021.
If you have any questions about this Notice, if you wish to contact us about your privacy rights or obtaining a copy of your records, or you wish to file a complaint, you can contact our Privacy Officer:
- Our Privacy Official: Allison Swartz
- Telephone: (888)-564-5250 Fax: 646-350-0525
- Address: 125 W. 25th St, 7th Floor, New York, NY 10001
- Email: [email protected]
In the event that state law provides greater protection than the HIPAA protections listed in this NOPP, we will follow the requirements of state law.
Please note that your PHI may be disclosed electronically under this NOPP.