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.
BaySport respects your privacy and understands that your personal health information is sensitive. According the Health Insurance Portability and Accountability Act of 1996 (HIPAA), we cannot disclose your “protected health information” to others unless we have your permission – or unless the law authorizes or requires us to do so. The Health Information Technology for Economic and Clinical Health (HITECH) Act also requires us to notify you when the security or privacy of your health information is breached. Depending on the type of breach and how many individuals are affected, this may also involve notifying the media and/or government enforcement agencies, and keeping a log of all breach incidents.
Uses and Disclosures
Treatment. Your health information may be used by staff members or disclosed to other health care professionals for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. For example, results of laboratory tests and procedures will be available in your medical record to all health professionals who may provide treatment or who may be consulted by staff members.
Payment. Your health information may be used to seek payment from your health plan, from other sources of coverage such as an automobile insurer, or from credit card companies that you may use to pay for services. For example, information on the services you received may be used to support budgeting and financial reporting, and activities to evaluate and promote quality.
Health care operations. Your health information may be used as necessary to support the day-to-day activities and management of BaySport, Inc. If your health screen is sponsored by a third party, BaySport may be directed by the sponsor to share your test results with other third parties that are involved with the health screening program. Any third parties that receive your tests results will be contractually obligated to comply with the Health Insurance Portability and Accounting Act of 1996. If this is the case, you will be notified of the same in the informed consent that you sign prior to your participation. For example, information on the services you received may be used to support financial reporting, benefits program administration, and/or activities to evaluate and promote quality.
Law enforcement. Your health information may be disclosed to law enforcement agencies, without your permission, to support government audits and inspections, to facilitate law-enforcement investigations, and to comply with government mandated reporting.
Public health reporting. Your health information may be disclosed to public health agencies as required by law. For example, we are required to report certain communicable diseases to the state’s public health department.
Other uses and disclosures require your authorization. Disclosure of your health information or its use for any purpose other than those listed above requires your specific written authorization. If you change your mind after authorizing a use of disclosure of your information you may submit a written revocation of the authorization. However, your decision to revoke the authorization will not affect or undo any use of disclosure of information that occurred before you notified us of your decision.
Additional Uses of Information
Appointment reminders. Your health information will be used by our staff to send you appointment reminders.
Information about treatments. Your health information may be used to send you information on the treatment and management of your medical condition that you may find to be of interest. We may also send you information describing other health-related goods and services that we believe may interest you.
You have certain rights under the federal privacy standards. These include:
We are required by law to maintain the privacy of your protected health information and to provide you with this notice of privacy practices.
We also are required to abide by the privacy policies and practices that are outlined in this notice.
Right to Revise Privacy Practices
As permitted by law, we reserve the right to amend or modify our privacy policies and practices. These changes in our policies and practices may be required by changes in federal and state laws and regulations. Whatever the reason for these revisions, we will provide you with a revised notice on your next office visit. The revised policies and practices will be applied to all protected health information that we maintain.
Requests to Inspect Protected Health Information
As permitted by federal regulation, we require that requests to inspect or copy protected health information be submitted in writing. You may obtain a form to request access to your records by contacting the Front Office Manager or the Corporate Office.
If you would like to submit a comment or complaint about our privacy practices, you can do so by sending a letter outlining your concerns to:
BaySport, Inc., Attn: Privacy Officer, 14830 Los Gatos Blvd, Suite 101, Los Gatos, CA 95032 | 408.395.7300
If you believe that your privacy rights have been violated, you should call the matter to our attention by sending a letter describing the cause of your concern to the same address. You will not be penalized or otherwise retaliated against for filing a complaint.
This Notice is effective on May 1, 2003.
Revision Date: August 28, 2015
©2016 BaySport, Inc. All rights reserved.
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