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.
Effective date June 2, 2021.
This Notice of Privacy Practices (the “Notice”) describes how Brightline Medical Associates, P.A. and all members of its Affiliated Covered Entity (collectively, “Brightline Medical Associates,” “we” or “our”) may use and disclose your protected health information to carry out treatment, payment, or health care operations and for other purposes that are permitted or required by law. An Affiliated Covered Entity is a group of health care providers under common ownership or control that designates itself as a single entity for purposes of compliance with the Health Insurance Portability and Accountability Act (“HIPAA”). The members of the Brightline Medical Associates Affiliated Covered Entity will share protected health information with each other for the treatment, payment, and health care operations of the Brightline Medical Associates Affiliated Covered Entity and as permitted by HIPAA and this Notice of Privacy Practices. For a complete list of the members of the Brightline Medical Associates Affiliated Covered Entity, please contact the Brightline Medical Associates Privacy Office.
Please revise this Notice carefully.
The protection of your health information is very important. We recognize that many of the things we discuss are sensitive, and because of this, it is important that you are aware of how this information is used and may be revealed. This document contains a description about how your protected health information is used and sometimes disclosed. As a provider of services regulated by HIPAA, we are required to give you this Notice and to abide by its terms.
In general, the communications between a patient and provider are confidential and protected by law and we can only release your protected health information with your permission, or under certain circumstances. This Notice summarizes those circumstances. When we make a disclosure, we will always try to limit the information that we reveal to only the amount necessary.
Uses and Disclosures:
We can disclose information for the purposes of treatment, payment, and health care operations.
- Treatment. An example of a disclosure for treatment purposes is one where we discuss your treatment/evaluation with your general physician to coordinate our services.
- Payment. An example of a disclosure for payment is where we discuss your case with your health insurance carrier to determine if you are eligible for coverage.
- Health Care Operations. We may use and disclose your health information to conduct certain of our business activities, which are called health care operations. These uses and disclosures are necessary to run our business and make sure our patients receive quality care. An example of a disclosure for health care operations is where we disclose information for the purposes of conducting quality assessment and quality improvement functions.
Certain aspects and components of our services are performed through contracts with outside persons or organizations, such as administrative services, billing, auditing, accreditation, outcomes data collection, legal services, scheduling, etc. We may disclose your information to these business associates who assist us with our health care operations. In all cases, we require these associates to appropriately safeguard the privacy of your information.
- An example of a disclosure for the purposes of facilitating your care is the disclosure of information to an automated appointment scheduling service for the scheduling and coordination of your appointments, such as if one of our coaches contacts you via text messaging or via phone.
- Another example of a disclosure for the purposes of facilitating your care is the utilization of a third-party messaging service to transmit encrypted messages between you and your clinician.
If you verbally agree to the use or disclosure and in certain other situations, we may make the following uses and disclosures of your health information:
- We may disclose certain health information to your family, friends, and anyone else whom you identify as involved in your health care or who helps pay for your care; the health information we disclose would be limited to the health information that is relevant to that person’s involvement in your care or payment for your care.
- We may also make these disclosures after your death as authorized by applicable law unless doing so is inconsistent with any prior expressed preference.
- We may use or disclose your information to notify or assist in notifying a family member, personal representative, or any other person responsible for your care regarding your location, general condition, or death.
- We may also use or disclose your health information to disaster-relief organizations so that your family or other persons responsible for your care can be notified about your condition, status, and location.
We can also make disclosures without your authorization under the following circumstances:
- Required by Law. We may disclose your information when required by law to do so.
- Public Health Reporting. We may disclose your information to public health agencies as authorized by law. For example, we may report certain communicable diseases to the state’s public health department.
- Legal Proceedings. In some legal proceedings we may be required to disclose information about you without your authorization. We will try to maintain the confidentiality of your protected health information, but if we receive a lawful order from a court or administrative authority, a valid subpoena, search warrant, or coroner’s inquest we may have to disclose information.
- Reporting Victims of Abuse or Neglect. If we believe you or an identified patient pose a serious risk of harm to yourself or someone else, or if the welfare of a child is in jeopardy, we are required to take protective actions. This may mean that we have to contact a potential victim, the police, child and family services, government authorities whose job it is to protect the elderly or dependent adults, or other parties to minimize the risk of harm.
- Health Care Oversight. We may disclose your information to authorities and agencies for oversight activities allowed by law, including audits, investigations, inspections, licensure, and disciplinary actions, or civil, administrative, and criminal proceedings, as necessary for oversight of the health care system, government programs, and civil rights laws.
- Law Enforcement. We may disclose your health information to law enforcement officials for certain specific purposes, such as reporting certain types of injuries.
- Research. Under certain circumstances, we may disclose your health information to researchers who are conducting a specific research project. For certain research activities, an Institutional Review Board (IRB) or Privacy Board may approve uses and disclosures of your health information without your authorization.
- To Avert a Serious Threat to Health or Safety. If there is a serious threat to your health and safety or the health and safety of the public or another person, we may use and disclose your health information in a very limited manner to someone able to help lessen the threat.
- Specialized Government Functions. In certain circumstances, HIPAA authorizes us to use or disclose your health information to authorized federal officials for the conduct of national security activities and other specialized government functions.
When we make disclosures for these purposes, we will disclose only the information necessary. Any additional disclosures other than those listed above will be made only with your written authorization and you can revoke that authorization at any time. Some examples include:
- Psychotherapy Notes: We may maintain psychotherapy notes about you. If we do, we will not use and disclose your psychotherapy notes without your written authorization except as otherwise permitted by law.
- Marketing: We will not use or disclose your information for marketing purposes without your written authorization except as otherwise permitted by law.
- Sale of Your Health Information: We will not sell your information without your written authorization except as otherwise permitted by law.
We are permitted to contact you to remind you about appointments, to discuss treatment alternatives, or other health-related services that may be of interest to you.
Please be aware that state and other federal laws may have additional requirements that we must follow or may be more restrictive than HIPAA on how we use and disclose certain of your health information. If there are specific more restrictive requirements, even for some of the purposes listed above, we may not disclose your health information without your written permission as required by such laws. For example, we may be required by law to obtain your written permission to use and/or disclose information regarding your mental health, developmental disabilities, or substance use disorder, HIV or other communicable disease related information, or your genetic test results in certain situations.
- We are required by law to maintain the privacy of protected health information, to provide you with Notice of our legal duties and privacy practices with respect to your protected health information, and to notify affected individuals following a breach of unsecured protected health information.
- We are required to abide by the terms of the Notice currently in effect.
- We reserve the right to change the terms of this Notice and to make the new Notice provisions effective for all protected health information that we maintain. Each version of the Notice will have an effective date listed on the first page. If we change this Notice, you can access the revised Notice on our website at https://app.hellobrightline.com/policies/notice_of_privacy_practice.
Your Individual Rights:
- You can request that we restrict how we use or disclose your information for treatment, payment, or health care operations, but we are not required to agree to your requested restrictions unless they are regarding disclosure of information to your health insurance company and: (1) the disclosure is for the purpose of carrying out payment or health care operations and is not otherwise required by law; and (2) the information pertains solely to a health care item or service for which you or another person (other than your health insurance company) paid for in full. However, if we do agree to these restrictions we must abide by our agreement unless an emergency occurs. If we do have to disclose information in an emergency we will request the persons to whom we make the disclosure that the information remain as confidential as possible. Any agreement that we make to restrict these disclosures will be written down and signed; if either of us needs to terminate our agreement we will document our agreement in writing and give you a copy. You cannot limit the uses and disclosures that we are legally required or allowed to make.
- If you wish to receive communications from us by alternative means (such as billing at a different address) you have the right to request that we communicate your information to you in a certain manner or at a certain location. This is especially true if our usual means of communicating with you could endanger you or someone else. If you want to make such a request, please do so in writing and we will discuss how it would work and if it would be possible for us to agree to your request. We will grant reasonable requests. We will not ask you the reason for your request.
- You have the right to inspect and copy your protected health information. If you want a copy of your protected health information, we can charge you a fee as authorized by law for providing you with these copies. Further, you may request in writing that we transmit such a copy to any person or entity you designate. Your written signed request must clearly identify such designated person or entity and where you would like us to send the copy. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to your health information, you may request that the denial be reviewed by a licensed health care professional chosen by us. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
- You have the right to request that we amend your protected health information that you believe is incorrect or incomplete. Such requests must be made in writing. You have the right to request an amendment for as long as the information is kept by or for us. Under certain circumstances we may deny your request. If your request is denied, we will provide you with information about our denial and how you can file a written statement of disagreement with us that will become part of your medical record.
- You have a right to receive an accounting of most of the disclosures of your protected health information that have occurred in the last six years. Your request must state a time period which may not go back further than six years. You will not be charged for this accounting, unless you request more than one accounting per year, in which case we may charge you a reasonable cost-based fee for providing the additional accounting(s). We will notify you of the costs involved and give you an opportunity to withdraw or modify your request before any costs have been incurred.
- You have a right to receive a paper copy of this Notice at any time upon request, even if you previously agreed to receive this Notice electronically. A paper copy of this Notice is available at our website at https://app.hellobrightline.com/policies/notice_of_privacy_practice.
- If you have a complaint about how we have disclosed or failed to disclose your protected health information you can make a complaint to us using the contact information below, or to the U.S. Secretary of Health and Human Services at:
Office for Civil Rights Department of HHS
Jacob Javits Federal Building 26 Federal Plaza – Suite 3312 New York, NY 10278
Voice Phone (212) 264-3313
FAX (212) 264-3039
TDD (212) 264-2355
- We will not retaliate against you for filing a complaint.
- If you have any additional questions, you can contact us at our mailing address, via email, or by telephone:
- 175 Forest Ave. Palo Alto, CA 94301
- (888) 224-7332