NOTICE OF PRIVACY RIGHTS: OUR PRIVACY RESPONSIBILITIES UNDER HIPAA
Many state laws require that all Health Care Providers (Pregnancy Medical Centers) protect health records in our possession. If you receive services through Mosaic Virginia®, federal law, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), also protects your health information. In addition, HIPAA requires that we provide you this Notice of Privacy Rights. It lets you know how we may use and disclose your health information and your rights regarding the health information we have in our possession.
HEALTH INFORMATION THAT WE MAINTAIN ABOUT YOU
We maintain records of:
- Your name and birthdate
- Your address
- Your telephone number
- Your condition that brings you here to Mosaic Virginia®
- Urine Pregnancy Test result; Physician-signed Limited OB Ultrasound Report, if applicable; peer-counseling and medical history notes
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
You have the right to:
- request restrictions on certain uses and disclosures
- receive communications of protected health information by alternative means or at alternative locations
- request to inspect, copy and amend (unless current information is accurate and complete) your protected health information held at Mosaic Virginia®; request to receive an accounting of certain disclosures (of your protected health information)
- receive a paper copy of this notice
HOW WE USE AND DISCLOSE YOUR HEALTH INFORMATION
We only use or disclose your health information as laws require or permit. In some cases the law requires that you authorize the disclosure. In other cases, the law allows us to disclose your health information without your authorization.
Use and Disclosure Not Requiring Your Authorization
Treatment: We may use your health information for our medical activities, such as disclosing it to other healthcare providers as helpful to treat you.
Payment: All of our services are free. No payment is necessary.
Healthcare Operations: We may use and disclose your health information to manage our program operations, such as (but not limited to) reviewing the quality of services you receive or calling you to confirm your appointment or calling you by name in a waiting area.
Business Associates: We may disclose your health information to organizations that help us with our work. We have a written agreement that requires these organizations to use your health information for only the reasons necessary to do the work, and protect it from other uses or disclosures, just like we do.
To Contact You: We may use the information in your health records to contact you if we have information about health-related benefits and services that may be of interest to you. You may indicate on the “Client Information” form the ways we may contact you.
Other Permitted Uses and Disclosures
HIPAA specifically permits us to use or disclose your health information for other purposes without your consent or authorization. In our experience such disclosures are rare, and the limited information we maintain is generally not applicable. However, when authorized by law, and to the extent we may have the information, HIPAA permits us to disclose it to:
- comply with the requirements of federal, state, or local laws, court orders or other lawful process and for administrative or court proceedings
- report a public health authority for the purpose of preventing or controlling disease, injury, or disability
- report to the FDA for the quality, safety or effectiveness of FDA-regulated products or activities
- notify a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition
- report abuse, neglect or domestic violence to a government authority, including, but not limited to, someone who is: suicidal, homicidal, to avert a threat of harm to you or a third person; a sexually active girl under age 16
- provide necessary information to a health oversight agency for activities such as audits, investigations, inspections, licensure of the healthcare system, government benefit programs and regulated entities
- a law enforcement official for specified law enforcement purposes
- coroners or medical examiners for identification or determining cause of death
- funeral directors to carry out their duties with respect to the deceased
- prevent or lessen a serious and imminent threat to the health or safety of a person or the public
- authorized federal officials for specialized government functions such as military and veterans activities; national security and intelligence activities; protective services for the president; medical suitability determinations; correctional institutions; government entities providing public benefits and comply with workers’ compensation laws
Uses and Disclosures with Your Authorization – Other uses and disclosures of your personal information require your written authorization. You may revoke your authorization at any time by doing so in writing.
HOW YOU CAN REACH US
If you want additional information about our privacy practices or if you believe that Mosaic Virginia® has violated your privacy rights, contact us at firstname.lastname@example.org and direct questions to the “Privacy Officer.”
Mosaic Virginia® does not retaliate against people who file a complaint.