Impulse Dynamics HIPAA Notice of Privacy Practices
Policy
Impulse Dynamics is committed to maintaining and protecting the confidentiality of an individual’s PHI. Impulse Dynamics is required by federal and state law, including the Health Insurance Portability and Accountability Act (“HIPAA”), to protect an individual’s PHI and other personal information. Impulse Dynamics is required to provide the individual with this Notice of Privacy Practices about Impulse Dynamics’ policies, safeguards, and Practices. When Impulse Dynamics uses or discloses an individual’s PHI, Impulse Dynamics is bound by the terms of this Notice of Privacy Practices, or the revised notice of Privacy Practices, if applicable.
Impulse Dynamics’ obligations:
Impulse Dynamics is required by law to:
• Maintain the privacy of PHI (with certain exceptions)
• Give the individual this notice of the Impulse Dynamics legal duties and privacy Practices regarding health information about the individual.
• Follow the terms of the Impulse Dynamics notice of Privacy Company that is currently in effect
Procedures
How Impulse Dynamics may use and disclose PHI:
The following describes the ways Impulse Dynamics may use and disclose PHI. Except for the purposes described below, Impulse Dynamics will use and disclose PHI only with the individual’s written permission. The individual may revoke such permission at any time by writing to Impulse Dynamics’ Privacy Officer
• For Treatment. Impulse Dynamics may use and disclose PHI for the individual’s services. For example, Impulse Dynamics may disclose PHI to doctors, nurses, technicians, or other personnel, including people outside Impulse Dynamics, who are involved in the individual’s medical care as related to an Impulse Dynamics product, and need the information to provide the individual with medical care.
• For Payment. Impulse Dynamics nay use and disclose PHI so that Impulse Dynamics or others may bill and receive payment from the individual, an insurance company or third party for the treatment and services the individual received.
• For Health Care Operations. Impulse Dynamics may use and disclose PHI for health care operation purposes. The uses and disclosures are necessary to make sure that patients receiving care with an Impulse Dynamics product receive quality care. For example, Impulse Dynamics may share information with doctors, residents, nurses, technicians, clerks, and other personnel for quality assurance and educational purposes. Impulse Dynamics also may share information with other entities that have a relationship with the individual (for example, the individual’s insurance company and anyone other than the individual who pays for the individual’s services) for the individual’s health care operation activities.
• Third Parties Involved in an Individual’s Care or Payment for an Individual’s Care. When appropriate, Impulse Dynamics may share PHI with a person who is involved in the individual’s medical care or payment for the individual’s care, such as the individual’s family or a close friend. Impulse Dynamics also may notify the individual’s family about the individual’s location or general condition or disclose such information to an entity (such as Red Cross) assisting in a disaster relief effort.
• Research. Under certain circumstances, Impulse Dynamics may use and disclose PHI for research. For example, a research project may involve comparing the health of patients who received one treatment to those who received another, for the same condition. Impulse Dynamics will generally ask for the individual’s written authorization before using the individual’s PHI or sharing it with others to conduct research. Under limited circumstances, Impulse Dynamics may use and disclose PHI for research purposes without the individual’s permission. Before Impulse Dynamics uses or discloses PHI for research without the individual’s permission, the project will go through a special approval process to ensure that research conducted poses minimal risk to the individual’s privacy. The individual’s information will be de-identified. Researchers may contact the individual to see if the individual is interested in or eligible to participate in a study.
SPECIAL SITUATIONS:
• As Required by Law. Impulse Dynamics will disclose PHI when required to do so by international, federal, state or local law.
• To Avert a Serious Threat to Health or Safety. Impulse Dynamics may use and disclose PHI when necessary to prevent a serious threat to the individual’s health and safety or the health and safety of others. Disclosures, however, will be made only to someone who may be able to help prevent or respond to the threat, such as law enforcement or a potential victim. For example, Impulse Dynamics may need to disclose information to law enforcement when a patient reveals participation in a violent crime.
• Business Associates. Impulse Dynamics may disclose PHI to Impulse Dynamics’ business associates that perform functions on Impulse Dynamics’ behalf or provide Impulse Dynamics with services if the information is necessary for such functions or services. For example, Impulse Dynamics may use another company to perform billing services on Impulse Dynamics’ behalf. All of Impulse Dynamics’ business associates are obligated to protect the privacy of the individual’s information and are not allowed to use or disclose any information other than as specified in our contract.
• Lawsuits and Disputes If an individual is involved in a lawsuit or a dispute, Impulse Dynamic may disclose PHI in response to a court or administrative order. Impulse Dynamics also may disclose PHI in response to a subpoena, discovery request, or other lawful request by someone else involved in the request or to allow the individual to obtain an order protecting the information requested.
• Law Enforcement Impulse Dynamics may release PHI if asked by a law enforcement official if the information is: (1) in response to a court order, subpoena, warrant, summons or similar process; (2) limited to information to identify or locate a suspect, fugitive, material witness, or missing person; (3) about the victim of a crime even if, under certain very limited circumstances, Impulse Dynamics is unable to obtain the individual’s agreement; (4) about a death that Impulse Dynamics believes may be the result of criminal conduct; (5) about criminal conduct on Impulse Dynamics’ premises; and (6) in an emergency to report a crime, the location of the crime or victims, or the identity, description or location of the person who committed the crime.
USES AND DISCLOSURES THAT REQUIRE IMPULSE DYNAMICS TO GIVE THE INDIVIDUAL AN OPPORTUNITY TO OBJECT/OPT OUT:
• Third Parties involved in the Individual’s Care or Payment for Individual’s Care. Unless the individual objects, Impulse Dynamics may disclose to a member of the individual’s family, a relative, a close friend or any other person the individual identifies, the individual’s PHI that directly relates to that third party’s involvement in the individual’s health care. If the individual is unable to agree or object to such a disclosure, Impulse Dynamics may disclose such information as necessary if Impulse Dynamics determines that it is in the individual’s best interest based on Impulse Dynamics’ professional judgment.
INDIVIDUAL’S RIGHTS REGARDING PHI:
The following uses and disclosures of the individual’s PHI will be made only with the individual’s written authorization:
1. Uses and disclosures of PHI for marketing purposes;
2. Disclosures that constitute a sale of the individual’s PHI; and
3. Disclosures of psychotherapy notes.
Other uses and disclosures of PHI not covered by this Notice of Privacy Company or the laws that apply to Impulse Dynamics will be made only with the individual’s written authorization. If the individual gives us authorization, the individual may revoke it at any time by submitting a written revocation to the Impulse Dynamics Privacy Officer and we will no longer disclose PHI under the authorization. But disclosure that Impulse Dynamics made in reliance on an individual’s authorization before the individual revoked it will not be affected by the revocation.
INDIVIDUAL’S RIGHTS REGARDING PHI:
• Right to Inspect and Copy. The individual has a right to inspect and copy PHI that may be used to make decisions about the individual’s care or payment for the individual’s care. This includes medical and billing records, other than psychotherapy notes. To inspect and copy the individual’s PHI, the individual must make their request, in writing, to the Department in which their care was provided.
• Impulse Dynamics has up to 30 days to make the individual PHI available to the individual and Impulse Dynamics may charge the individual a reasonable fee for the costs of copying, mailing or other supplies associated with the individual’s request. Impulse Dynamics may not charge the individual a fee if the individual needs the information for a claim for benefits under the Social Security Act or any other state or federal needs-based benefit program. Impulse Dynamics may deny the individual’s request in certain limited circumstances. If Impulse Dynamics does deny the individual’s request, the individual has the right to have the denial reviewed by a licensed healthcare professional that was not directly involved in the denial of the individual’s request, and Impulse Dynamics will comply with the outcome of the review.
• Right to Get Notice of a Breach. Impulse Dynamics is committed to safeguarding the individual’s PHI. If a breach of the individual’s PHI occurs, Impulse Dynamics will notify the individual in accordance with state and federal law.
• Right to Amend, Correct or Add an Addendum. If the individual feels that the PHI Impulse Dynamics has is incorrect, incomplete, or the individual wishes to add an addendum to the individual’s records, the individual has the right to make such request for as long as the information is kept by or for the Impulse Dynamics office. The individual must make their request in writing to the Department that is in possession of the individual’s records. In the case of claims that the information is incorrect, incomplete, or if the record was not created by Impulse Dynamics, Impulse Dynamics may deny the individual’s request. However, if the Impulse Dynamics denies any part of the individual’s request, Impulse Dynamics will provide the individual with a written explanation of the reasons for doing so within 60 days of the individual’s request.
• Right to an Accounting of Disclosures. Individuals have the right to request a list of certain disclosures Impulse Dynamics made of PHI for purposes other than treatment, payment, health care operations, and certain other purposes consistent with law, or for which the individual provided written authorization. To request an accounting of disclosure, individuals must make their request, in writing, to the Department that is in possession of the individual’s records . The individual may request an accounting of disclosures for up to the previous six years of services provided before the date of the individual’s request. If more than one request is made during a 12-month period, Impulse Dynamics may charge a cost-based fee.
• Right to Request Restrictions. Individuals have the right to request a restriction or limitation on the PHI Impulse Dynamics uses or discloses for treatment, payment, or health care operations. Individuals also have the right to request a limit on the PHI we disclose to someone involved in the individual’s care or the payment for the individual’s care, like a family member or friend. For example, the individual could ask that Impulse Dynamics not share information about a particular diagnosis or treatment with the individual’s spouse. To request a restriction, the individual must make their request, in writing, to the Department that is in possession of the individual’s records.
• Right to Request Confidential Communications. Individuals have the right to request that Impulse Dynamics communicate with them about medical matters in a certain way or at a certain location. For example, the individual can ask that Impulse Dynamics only contact individuals by mail or at work. To request confidential communications, individuals must make their request, in writing, to the Department that is in possession of the individual’s records . The individual’s request must specify how or where the individual wishes to be contacted. Impulse Dynamics will accommodate reasonable requests.
• Right to Choose Someone to Act for the Individual. If the individual gives someone medical power of attorney or if someone is the individual’s legal guardian, that person can exercise the individual’s rights and make choices about the individual’s PHI. Impulse Dynamics will use our best efforts to verify that person has authority to act for the individual before Impulse Dynamics takes any action.
• Right to a Paper Copy of This Notice of Privacy Practices. Individuals have the right to a paper copy of this Notice of Privacy Practices. Individuals may ask Impulse Dynamics to give the individual a copy of this Notice of Privacy Practices at any time.
CHANGES TO THIS NOTICE OF PRIVACY PRACTICES:
Impulse Dynamics reserves the right to change this Notice of Privacy Practices and make the new Notice of Privacy Practices apply to PHI Impulse Dynamics already has as well as any information Impulse Dynamics receives in the future. Impulse Dynamics will post a copy of Impulse Dynamics’ current Notice of Privacy Company at our office. The Notice of Privacy Practices will contain the effective date on the first page, in the top right-hand corner. Individuals will be sent information regarding the changes via email or via mail on how they can obtain a new copy. Individuals will be asked to sign off on the new Notice of Privacy Practices at the individual’s next scheduled appointment.
Applicable Regulations
45 C.F.R. § 164.520
