This joint 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.
Introduction
This Joint Notice is being provided to you on behalf of Links ABA Therapy LLC (the “Practice”) and the employees and practitioners that work at the Practice with respect to services provided at the Practice (collectively referred to herein as “We” or “Our”). We understand that your medical information is private and confidential. Further, we are required by law to maintain the privacy of “protected health information” (or “PHI”), which includes any individually identifiable information that we obtain from you or others that relates to your past, present, or future physical or mental health, the health care you have received, or payment for your health care. We will share PHI with one another, as necessary, to carry out treatment, payment, or health care operations relating to the services to be rendered at the Practice.
As required by law, this notice provides you with information about your rights and our duties and privacy practices with respect to the privacy of PHI. This notice also discusses the uses and disclosures we will make of your PHI. We must comply with the provisions of this Notice as currently in effect, although we reserve the right to change the terms of this Notice from time to time. You can always request a written copy of our most current privacy notice from Avraham Jurkanski at the Practice, or you can access it on our website at http://linksaba.com/.
Permitted Uses and Disclosures
We can use or disclose your PHI for purposes of treatment, payment, and health care operations, which we describe below with some examples.
- Treatment means the provision, coordination, or management of your health care, including consultations and referrals between health care providers relating to your care. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. In addition, the doctor may need to contact a physical therapist to create the exercise regimen appropriate for your treatment.
- Payment means our activities to obtain reimbursement for the health care provided to you, including billing, collections, claims management, determinations of eligibility and coverage, and other utilization review activities. For example, we may need to provide PHI to your Third Party Payor to determine whether the proposed course of treatment will be covered or if necessary to obtain payment.
- Health care operations means the support functions of the Practice related to treatment and payment, such as quality assurance activities, case management, responding to comments and complaints, compliance programs, audits, business planning, development, and administrative activities. For example, we may use your PHI to evaluate the performance of our staff when caring for you. We may also combine PHI about many patients to decide what additional services we should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose PHI for review and learning purposes. In addition, we may remove information that identifies you so that others can use the de-identified information to study health care and health care delivery without learning who you are.
Other Uses and Disclosures of PHI
We may also use your PHI in the following ways:
- To provide appointment reminders for treatment or medical care.
- To tell you about or recommend possible treatment alternatives or other health-related benefits and services.
- To your family or friends or any other individual identified by you to the extent directly related to such person’s involvement in your care or the payment for your care. We may use or disclose your PHI to notify, or assist in the notification of, a family member, or another person responsible for your care, of your location or general condition. If you are available, we will give you an opportunity to object to these disclosures, and we will not make these disclosures if you object. If you are not available, we will determine whether a disclosure to your family or friends is in your best interest, based upon our professional judgment.
- When permitted by law, we may coordinate our uses and disclosures of PHI with public or private entities authorized by law or by charter to assist in disaster relief efforts.
- We will allow your family and friends to act on your behalf to pick up filled prescriptions, medical supplies, X-rays, and similar forms of PHI when we determine, in our professional judgment, that it is in your best interest to make such disclosures.
- We may use or disclose your PHI for research purposes, subject to the requirements of applicable law. For example, a research project may involve comparisons of the health and recovery of all patients who received a particular medication. When required, we will obtain written authorization from you before using your health information for research.
- We will use or disclose PHI about you when required to do so by applicable law.
- In accordance with applicable law, we may disclose your PHI to your employer if we are retained to conduct an evaluation relating to medical surveillance of your workplace or to evaluate whether you have a work-related illness or injury. You will be notified of these disclosures by your employer or the Practice as required by applicable law.
Note: Incidental uses and disclosures of PHI sometimes occur and are not considered to be a violation of your rights. Incidental uses and disclosures are by-products of otherwise permitted uses or disclosures which are limited in nature and cannot be reasonably prevented.
Special Situations
Subject to the requirements of applicable law, we will make the following uses and disclosures of your PHI:
- Organ and Tissue Donation: If you are an organ donor, we may release PHI to organ procurement or transplant agencies as necessary to facilitate organ or tissue donation and transplantation.
- Military and Veterans: If you are a member of the Armed Forces, we may release PHI about you as required by military command authorities.
- Worker’s Compensation: We may release PHI for programs that provide benefits for work-related injuries or illnesses.
- Public Health Activities: We may disclose PHI about you for public health activities, including disclosures to prevent or control disease, injury, or disability; to report births and deaths; to report child abuse or neglect; to persons subject to the jurisdiction of the Food and Drug Administration (FDA) for activities related to FDA-regulated products or services and to report reactions to medications or problems with products; to notify a person who may have been exposed and may be at risk of a disease.
- Health Oversight Activities: We may disclose PHI to federal or state agencies that oversee our activities (e.g., providing health care, seeking payment, and civil rights).
- Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, we may disclose PHI subject to certain limitations.
- Law Enforcement: We may release PHI if asked to do so by a law enforcement official in response to a court order, warrant, or summons; to identify or locate a suspect, fugitive, material witness, or missing person; about the victim of a crime under certain limited circumstances; about a death we believe may be the result of criminal conduct; about criminal conduct on our premises; or in emergency circumstances, to report a crime.
- Coroners, Medical Examiners, and Funeral Directors: We may release PHI to a coroner, medical examiner, or funeral director as necessary to carry out their duties.
- National Security and Intelligence Activities: We may release PHI about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law for protection to the President or foreign heads of state.
- Inmates: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release PHI about you to the correctional institution or law enforcement official. This release would be necessary to provide you with health care, protect your, and others, health and safety, or for the safety and security of the correctional institution.
- Serious Threats: As permitted by applicable law and standards of ethical conduct, we may use and disclose PHI if we, in good faith, believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public or is necessary for law enforcement authorities to identify or apprehend an individual.
Note: HIV-related information, genetic information, alcohol and/or substance abuse records, mental health records, and other specially protected health information may enjoy certain special confidentiality protections under applicable state and federal law. Any disclosures of these types of records will be subject to these special protections.
Other Uses of Your Health Information
Certain uses and disclosures of PHI will be made only with your written authorization, including uses and/or disclosures: (a) of psychotherapy notes (where appropriate); (b) for marketing; and (c) that constitute a sale of PHI under the Privacy Rule. Other uses and disclosures of PHI not covered by this notice or the laws that apply to us will be made only with your written authorization. You have the right to revoke that authorization at any time, provided that the revocation is in writing, except to the extent that we already have taken action in reliance on your authorization.
Your Rights Regarding Your Health Information
You have the following rights with respect to your PHI:
- Right to inspect and copy: You have the right to inspect and copy medical information that may be used to make decisions about your care or payment for your care. We may deny your request to inspect and copy in certain very limited circumstances. To inspect and copy your medical information, you must submit your request in writing to Avraham Jurkanski. If you request a copy of the information, we may charge a fee for the costs of copying, mailing, or other supplies associated with your request.
- Right to amend: If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the Practice. To request an amendment, your request must be made in writing and submitted to Avraham Jurkanski. In addition, you must provide a reason that supports your request. We may deny your request if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
- Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
- Is not part of the medical information kept by or for the Practice;
- Is not part of the information that you would be permitted to inspect and copy; or
- Is accurate and complete.
- Right to an accounting of disclosures: You have the right to request an “accounting of disclosures.” This is a list of the disclosures we made of medical information about you. To request this list of disclosures, you must submit your request in writing to Avraham Jurkanski. Your request must state a time period that may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper or electronically). The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved, and you may choose to withdraw or modify your request at that time before any costs are incurred.
- Right to request restrictions: You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment, or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery you had. We are not required to agree to your request unless the requested restriction relates to a disclosure to a health plan for purposes of carrying out payment or health care operations (and is not otherwise required by law) and the PHI relates to a health care item or service for which the health care provider involved has been paid out-of-pocket in full. Should we agree to your request, we will comply unless the information is needed to provide you emergency treatment. To request restrictions, you must make your request in writing to Avraham Jurkanski. In your request, you must tell us what information you want to limit; whether you want to limit our use, disclosure, or both; and to whom you want the limits to apply, for example, disclosures to your children.
- Right to request confidential communications: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing to Avraham Jurkanski. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
- Right to be notified of a breach: You have the right to be notified in the event that we (or a Business Associate) discover a breach of unsecured PHI.
- Right to a paper copy of this notice: You have the right to a paper copy of this notice, even if you have agreed to receive this notice electronically. You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this notice, please contact Avraham Jurkanski.
Complaints
If you believe that your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. To file a complaint with us, please contact Avraham Jurkanski at Links ABA Therapy LLC, 302 Twinridge Lane, STE C, Richmond, VA 23235. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
Contact Person
If you have any questions or would like further information about this notice, please contact the Practice Privacy Officer at 732-523-1650.
This notice is effective as of December 6, 2019
