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.

Effective November 28, 2023

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MomDoc is committed to protecting the confidentiality of information about you, and is required by law to do so. This notice describes how  we may use information about you within MomDoc and how we may disclose it to others outside MomDoc. We will notify you if there is a breach of your unsecured protected health information. This notice also describes the rights you have concerning your own health information.

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How will we use and disclose information about you?

Treatment:   MomDoc may use information about you to provide you with medical services and supplies. We may also disclose information about you to others that need the information to treat you, such as doctors, physician assistants, nurses, medical and nursing students, technicians, therapists, emergency service and medical transportation providers, medical equipment providers, and others involved in your care. For example, we will allow your physician to have access to your medical record to assist in your treatment and for follow up care. We may make your medical information available electronically through an electronic health information exchange to other health care providers and health plans that request your information for their treatment and payment purposes.

 

We may also use and disclose information about you to contact you to remind you of an upcoming appointment, to inform you about possible treatment options or alternatives, or to tell you about health-related services available to you.

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Family   Members   and   Others   Involved   in   Your   Care:  MomDoc may disclose information about you to a family member or friend who is involved in your medical care. If you do not want the facility to disclose information about you to family members or others, you must notify the registration and nursing staff at the facility. In the event of a disaster, we may disclose information about you to help locate a family member or friend in a disaster.

 

Payment:   MomDoc may use and disclose information about you to  get paid for the medical services and supplies we provide to you. For example, your health plan or health insurance company may request to see parts of your medical record before they will pay us for your treatment.

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Health Care Operations:     MomDoc may use and disclose information about you if it is necessary to improve the quality of care we provide  to patients or for health care operations. We may use information about you to conduct quality improvement activities, to obtain audit, accounting or legal services, or to conduct business management and planning. For example, we may use medical information to review our

treatment and services and to evaluate the performance of our staff in caring for you.

 

Research:   MomDoc may use or disclose information about you for research projects, such as studying the effectiveness of a treatment you received. These research projects must go through a special process that protects the confidentiality of your information.

 

Required by Law:   Federal, state, or local laws do not require patient consent to disclose information which is required to be reported. For instance, we are required to report child abuse and neglect, gunshot wounds, etc. Public policy has determined that these types of needs outweigh the patient’s right to privacy. MomDoc is also required to give information to the state workers’ compensation program for work- related injuries.

 

Public Health:  MomDoc may report certain medical information for public health purposes. For instance, we are required by law to report births, deaths, and communicable diseases to the state. We may also need to report patient problems with medications or medical products to the manufacturer and to the FDA.

 

Public Safety:    MomDoc may disclose medical information for public safety purposes in limited circumstances. We may disclose medical information to law enforcement officials or to the court in response to a search warrant or other court order. We may also disclose medical information to assist law enforcement officials in identifying or locating a person, to prosecute a crime of violence, to report deaths that may

have resulted from criminal conduct at the facility. We may also disclose information about you to law enforcement officials and others to prevent a serious threat to health or safety.

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Military     Veterans,     National     Security     and     Other     Government  Purposes:   If you are a member of the armed forces, we may release information about you as required by military command authorities or to the Department of Veterans Affairs. We may also disclose medical information to federal or state officials for intelligence and national security purposes.

 

Judicial Proceedings:    MomDoc may disclose medical information in a lawsuit where your health status is an issue. For example, MomDoc may be ordered to do so by court order or search warrant.

 

Information  with  Additional  Protection:  Certain types of medical information may have additional protection under state or federal law. For instance, medical information about communicable disease, HIV/ AIDS, drug and alcohol abuse treatment, psychotherapy notes, genetic testing, or a court-ordered mental evaluation. MomDoc may obtain your authorization to release this information except as required by law.

 

Other Uses and Disclosures:     Other uses and disclosures not described in this Notice will be made only with your written authorization such as sale of medical information You may revoke such an authorization by sending us a written request.

What are your rights?

Right to Request Information About You:     You or your legally authorized representative are entitled to on line access of documents available, review or receive paper copies, or request an electronic delivery of your health information. This includes your medical and billing information.

If you request a copy of your information, we may charge you for our costs. We will tell you in advance what this cost will be.

 

Right   to   Request   to   Amend   or   Supplement   Information   About   You   That You Believe is Incorrect or Incomplete:    If you see information about you and believe that some of the information is incorrect or incomplete, you may ask us to amend your record. You may submit a request to amend your medical information by contacting the Business Office.

 

Right  to  Get  a  List  of  Certain  Disclosures  of  Information  About  You: You have the right to request a list of certain disclosures we made of information about you. If you would like to receive such a list, contact the Business Office. We will provide the first list to you at no charge, but we may charge you for any additional lists you request during a twelve month period. We will tell you in advance what this list will cost.

 

Right  to  Request  Restrictions  on  How  MomDoc  Health  Will  Use  or Disclose   Information   About   You   for   Treatment,   Payment,   or   Health Care Operations:  You have the right to request us not to use or disclose information about you to treat you, to seek payment for care, or to operate the health care system. We are not required to agree to your request, but if we do agree, we will comply with that agreement unless that information is necessary to provide you emergency treatment.

You may request that we withhold information from your health plan for the purpose of payment or healthcare operations provided it is not

 

otherwise required by law. If you want to request a restriction to your medical information, you may contact Medical Records or for billing information, you may contact the Business Office.

 

You have the right to pay for an item or service and elect not to have this information about you submitted to your health plan. We are not required to accept your request until you have paid for this service or item. We are not required to notify other healthcare providers of these types of restrictions, this is your responsibility.

 

Right   to   Request   Confidential   Communications:       You have the right to request us to communicate with you in a way that you feel is more confidential. You can ask to speak with your health care providers in private, outside the presence of other patients. We will accommodate reasonable requests including alternative addresses or alternative means. For example, you can ask us not to call your home, but to

communicate only by mail. To do this, submit your request in writing to Medical Records.

 

Right  to  a  Copy  of  MomDoc  Health’s  Notice  of  Privacy  Practices:  You have the right to a paper copy of the Notice at any time. You may obtain a paper copy of the Notice by requesting it from the Practice location.

Changes to this notice

We may amend or revise our practices concerning how we will use or disclose patient medical information, or how we will implement patient rights concerning their information. We reserve the right to change this Notice and to make the provisions in our new notice effective for all  your information. If we change these practices, we will publish a revised Notice of Privacy Practices.

Which healthcare providers does this notice cover?

This Notice of Privacy Practices applies to MomDoc facilities and its personnel, and trainees. The Notice also applies to other health care providers that come to the facility to care for patients, medical equipment suppliers, and other health care providers not employed by MomDoc unless these health care providers give you their own Notice of Privacy Practices. MomDoc may share your medical information with other health care providers for their treatment, payment, and health care operations.

Do you have concerns or complaints?

Please tell us about any problems or concerns you have with your  privacy rights or how MomDoc uses or discloses information about you. If you have a concern, you may contact us in Administration at 480-821-3630, or with the U.S. Department of Health & Human Services Office for Civil Rights. We will not penalize you or take any retaliatory action against you in any way for filing a complaint with the federal government.

Do you have questions?

MomDoc Health is required by law to give you this Notice and to follow terms of the Notice that is currently in effect. If you have any questions about this Notice, or have further questions about how we may use and disclose information about you, please contact Administration.

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