Supplemental PHI Privacy Policy, Notice and Patient Rights

This Supplemental PHI Privacy Policy and Notice describes how medical information about you may be used and disclosed and how you can get access to this information.

Your Rights

You have the right to:

Get a copy of your health and claims records.
Correct your health and claims records.
Request confidential communication.
Ask us to limit the information we share.
Get a list of those with whom we’ve shared your information.
Get a copy of this privacy notice.
Choose someone to act for you.
Add individuals to your Circle of Support (“COS”).
File a complaint if you believe your privacy rights have been violated.

Your Choices

You have some choices in the way that we use and share information as we:

Answer coverage questions from your family and friends.
Provide disaster relief.
Market our services and sell your information.

Our Uses and Disclosures

We may use and share your information as we:

Help manage the health care treatment you receive.
Run our organization.
Pay for your health services.
Work with organizations that administer your health plan.
Help with public health and safety issues.
Do research.
Comply with the law.
Work with a medical examiner or funeral director.
Address workers’ compensation, law enforcement, and other government requests.
Respond to lawsuits and legal actions.

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get a copy of health and claims records

You can ask to see or get a copy of your health and claims records and other health information we have about you.
We will provide a copy or a summary of your health and claims records, usually within thirty (30) days of your request.
We may charge a reasonable, cost-based fee.

Ask us to correct health and claims records

You can ask us to correct your health and claims records if you think they are incorrect or incomplete. Ask us how to do this.
We may say “no” to your request, but, we’ll tell you why in writing within sixty (60) days.

Request confidential communications

You can ask us to contact you in a specific way (home, mobile, office phone, or text) or to send mail to a different address.
We will consider all reasonable requests, and must say “yes” if you tell us that you would be in danger if we do not.

Ask us to limit what we use or share

You can ask us not to use or share certain health information for treatment, payment, or our operations.
We are not required to agree to your request, and we may say “no” if we believe that it would affect your care.

Get a list of those with whom we’ve shared information

You can ask for a list (accounting) of the times we’ve shared your health information for six (6) years prior to the date you ask, who we shared it with, and why.
We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make).
We’ll provide one accounting per year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice

You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you

If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
We will use customary steps to make sure that any such person has this authority and can act for you before we take any action.

File a complaint if you feel your rights are violated

You can complain if you feel we have violated your rights by contacting us using the contact information provided below.
You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
We will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

Share information with your family, close friends, or others involved in payment for your care. • Share information in a disaster relief situation.
If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In these cases, we never share your information unless you give us written permission:

Marketing purposes.
Sale of your information.

Our Uses and Disclosures

How do we typically use or share your health information?

Help manage the health care treatment you receive.

Run our organization.
Pay for your health services.
Work with organizations that administer your plan.

How else can we use or share your health information?

We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see:

www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

Help with public health and safety issues

We can share health information about you for certain situations such as:

Preventing disease.
Helping with product recalls.
Reporting adverse reactions to medications.
Reporting suspected abuse, neglect, or domestic violence.
Preventing or reducing a serious threat to anyone’s health or safety.

Do research

We can use or share your information for health research.

Comply with the law

We will share information about you if State or Federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with Federal privacy law.

Work with a medical examiner or funeral director

We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Address workers’ compensation, law enforcement, and other government requests

We can use or share health information about you:

For workers’ compensation claims.
For law enforcement purposes or with a law enforcement official.
With health oversight agencies for activities authorized by law.
For special government functions such as military, national security, and presidential protective services.

Respond to lawsuits and legal actions

We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Our Responsibilities

We are required by law to maintain the privacy and security of your protected health information (PHI).
We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
We must follow the duties and privacy practices described in this notice and give you a copy of it.
We will not use or share your information other than as described here, unless you tell us, in writing, that we can.
If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, on our website, and we will mail a copy to you.

Mailing Address:

MapHabit, Inc.
Attention: Privacy Officer
75 5th Street
Suite 3225
Atlanta, GA 30308

Email Address: privacy@maphabit.com