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.
In this Notice, we use terms like “we,” “us” or “our” or “GMS” to refer to Genome Medical Services, P.C. and its providers. We may share your protected health information to provide you with health care services, to treat you, to pay for your care, and to conduct our business operations (e.g., quality assurance, compliance, and utilization review).
What is “Protected Health Information” or “PHI”?
“Protected health information,” or “PHI” for short, is information that identifies who you are and relates to your past, present, or future physical or mental health or condition, the provision of health care to you, or past, present, or future payment for the provision of health care to you. PHI does not include information about you that is in a summary form that does not identify who you are.
Purpose of this Notice
In the course of doing business, we gather and maintain PHI about our clients. We respect the privacy of your PHI and understand the importance of keeping this information confidential and secure. We are required by law to maintain the privacy of your PHI by implementing reasonable and appropriate safeguards. We are also required to explain to you by this Notice our legal duties and privacy practices with respect to PHI. We are also required by law to notify affected individuals following a breach of unsecured PHI.
How We Protect Your PHI
We restrict access to your PHI to those workforce members who need access in order to provide services to our clients. We have established and maintain appropriate physical, electronic and procedural safeguards to protect your PHI against unauthorized use or disclosure. We train all workforce members on protecting your PHI. We also have a Privacy Officer, who has overall responsibility for developing, training and overseeing the implementation and enforcement of policies and procedures to safeguard your PHI against inappropriate access, use and disclosure.
Types of Use and Disclosure of PHI We Make without Your Authorization
1. Treatment, Payment and Health Care Operations
Federal and state law allow us to use and disclose your PHI in order to provide health care services to you. For example, we may use your PHI to authorize referrals to specialists and to review the quality of care provided, or to perform billing and collection activities in connection with care provided to you.
We may also use or disclose your PHI, for example, to recommend to you treatment alternatives, to inform you about health-related benefits and services that we offer, or to contact you to remind you of your appointments. We conduct these activities to provide health care to you, and not as marketing.
Federal and state law also allow us to use and disclose your PHI as necessary in connection with our health care operations. For example, we may use your PHI for resolution of any grievance or appeal that you file if you are unhappy with the care you have received. We may use your PHI to perform certain business functions and disclose your PHI to our business associates, who must also agree to safeguard your PHI as required by law.
2. Other Types of Use and Disclosures (No Authorization Required)
We are also allowed by law to use and disclose your PHI without your authorization for the following purposes when the conditions set forth by applicable law for each respective type of disclosure are met:
1. When required by law – In some circumstances, we are required by federal or state laws to disclose certain PHI to others, such as public agencies for various reasons;
2. For public health activities – Such as reports about communicable diseases, defective medical devices or work-related health issues;
3. Reports about child and other types of abuse or neglect, or domestic violence;
4. For health oversight activities – Such as reports to governmental agencies that are responsible for licensing or disciplinary action against physicians or other health care providers;
5. For lawsuits and other proceedings – In connection with court proceedings or proceedings before administrative agencies;
6. For law enforcement purposes – In response to a warrant, or to report a crime;
7. Reports to coroners, medical examiners, or funeral directors – To assist them in performance of their legal duties;
8 For tissue or organ donations – To organ procurement or transplant organizations to assist them;
9. For research – To medical researchers with an approval of an institutional review board (IRB) or privacy board that oversees studies on human subjects. Researchers are also required to safeguard your PHI;
10. To avert a serious threat to the health or safety of you or other members of the public;
11. For specialized government functions and activities; and
12. In connection with services provided under workers’ compensation laws.
Uses and Disclosures Requiring You to Have the Opportunity to Agree or Object
Before we make certain uses and disclosures of your PHI without your written authorization, we must provide you with an opportunity to agree or object. We may disclose your PHI to your family members or other persons if they are involved in your care or payment for that care. We may disclose your PHI to notify and assist disaster relief organizations in their relief efforts. We will provide you with the opportunity to agree or object prior to these disclosures if you are present or otherwise available prior to these uses or disclosures. If you cannot agree or object because you are incapacitated or otherwise unavailable, we will use our professional judgment to determine whether, based on the circumstances, the disclosure appears to be in your best interests; if it is, we will disclose only PHI that is directly relevant to such person’s involvement in your care.
Special Rules for Highly Confidential PHI
There are some types of PHI, such as HIV test results or mental health information, which are protected by stricter laws. However, even such PHI may be used or disclosed without your written authorization if required or permitted by law.
Uses and Disclosures Requiring Your Authorization
We must obtain your written authorization prior to the following uses and disclosures of your PHI:
1. Marketing Activities – We must obtain your written authorization in order to use your PHI to send you marketing materials. However, no authorization is required for the following communications: (1) information relating to your treatment, including case management, care coordination or recommendation of treatment alternatives; (2) refill reminders or other communications about drugs that are currently prescribed for you; (3) information about health-related products or services; (4) marketing information provided to you during a face-to-face communication; and (5) promotional gifts of nominal value.
2. Psychotherapy Notes – With very limited exceptions, we must obtain your authorization in order to disclose any notes recorded by a mental health professional about you in a counseling session.
All other uses and disclosures of your PHI that are not described in this Notice require your written authorization.
If you need an authorization form, we will send you one for you or your personal representative to complete. When you receive the form, please fill it out and send it to the following address:
Genome Medical Services, P.C.
95 Third Street
San Francisco, CA 94103
You may revoke or modify your authorization at any time by writing to us at the same address. Please note that your revocation or modification may not be effective in some circumstances, such as with respect to PHI we have already used or disclosed relying on your authorization.
Your Rights Regarding Your PHI
You have the right to request amendments to your PHI (with certain limited exceptions, such as information compiled in anticipation of a legal proceeding) for so long as the information is maintained in our medical and billing records. If you wish to have your PHI corrected or updated, please write to us and tell us what you want changed and why. We will respond to you in writing within 60 days of receipt, either accepting or denying your request. If we deny your request, we will explain why and you may send us a written statement disagreeing with the denial that is no longer than 250 words in length for each item you believe is incorrect. Please clearly indicate that you want the written statement to be included in your PHI. If we accept your request, we will amend your PHI and make reasonable efforts to inform any others of the amendment (including any persons you identify as needing the amendment) that may have relied, or could foreseeably rely, on the PHI to your detriment. Your amended PHI will be available for your review upon request.
Right to Receive an Accounting of Disclosures of Your PHI
You have the right to request an accounting of certain disclosures that we make of your PHI. An accounting lists disclosures we have made prior to the date of your request. You can request an accounting by writing to us. We will respond to your request within a reasonable period of time, but no later than 60 days after we receive your written request. Please note that certain disclosures need not be included in the accounting we provide to you, such as disclosures made to you, disclosures made for treatment, payment or health care operations, and disclosures made more than 6 years prior to the date of your request.
Right to Receive a Copy of This Notice
You have the right to request and receive a paper copy of this Notice, even if you have agreed to receive the Notice electronically. You may contact us for a copy, and one will be provided to you at no charge.
Right to Restrictions
You have the right to request restrictions on how we use and disclose your PHI for our treatment, payment, and health care operations and certain other purposes. All requests must be made in writing. Upon receipt, we will review your request and notify you whether we have accepted or denied your request. If we agree to your request, we will comply with the restriction unless a disclosure is required in order to provide you with emergency treatment or unless the restriction is terminated. Please note that we are not required to accept your request for restrictions, except that we are required, based on your written request, to restrict disclosure of your PHI to a health plan if (1) the purpose of the disclosure is to carry out payment or health care operations, (2) the disclosure is not otherwise required by law, and (3) the PHI pertains solely to a health care item or service for which you or someone other than the health plan have paid in full without any contribution from your health plan.
Your PHI is critical for providing you with quality health care. We believe we have taken appropriate safeguards and internal restrictions to protect your PHI, and that additional restrictions may be harmful to your care.
Right to Confidential Communications
You have the right to request that we provide your PHI to you in a confidential manner. For example, you may request that we send your PHI by an alternate means (e.g., sending by a sealed envelope, rather than a post card) or to an alternate address (e.g., calling you at a different telephone number, or sending a letter to you at your office address rather than your home address). We will accommodate any reasonable requests, unless they are administratively too burdensome, or prohibited by law.
Right to Complain
We must follow the privacy practices set forth in this Notice while in effect. If you have any questions about this Notice, wish to exercise your rights, or file a complaint, please direct your inquiries to:
Genome Medical Services, P.C.
95 Third Street
San Francisco, CA 94103
You also have the right to directly complain to the Secretary of the United States Department of Health and Human Service. We will not retaliate against you for filing a complaint against us.
Rights Reserved by Genome Medical
We will use and disclose your PHI as needed to the fullest extent authorized by law. We reserve the rights as expressed in this Notice. We reserve the right to revise our privacy practices consistent with law and make them applicable to all of your PHI that we maintain, regardless of when it was received or created. If we make material or important changes to our privacy practices, we will promptly revise our Notice and make available to you a copy of the revised Notice upon your request. Unless the changes are required by law, we will not implement material changes to our privacy practices before we revise our Notice. You may request a copy of the Notice currently in effect at any time.
When applicable state law is permitted to impose a more stringent requirement than the federal law, that applicable state law will control our use and disclosure of your PHI.
The effective date of this Notice is August 1, 2017.