Notice of Privacy Practices
This Notice is effective November 21, 2021, and replaces all earlier versions.
YOU ARE BEING PROVIDED WITH THE NOTICE AS A USER OF THE PPS HEALTH (DBA: BLUESTONE) APP, INCLUDING FOR OBTAINING A HEALTH RISK ASSESSMENT RELATED TO COVID-19.
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
The terms of this Notice of Privacy Practices (“Notice”) applies to PPS Health (dba Bluestone), where it is a Covered Entity, as defined by HIPAA. Bluestone is committed to protecting individual’s privacy and the confidentiality of protected health information. This Notice describes how we may use and share your protected health information as well as your rights related to this information, in accordance with HIPAA.
USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION.
Treatment: We may use and disclose your protected health information for your treatment purposes and to provide you with treatment-related health services, including to assess your susceptibility to COVID-19, COVID-19 testing, telehealth, or wellness monitoring. For example, we may disclose your protected health information to doctors, nurses, technicians, or other personnel, involved in your assessment or health services.
Payment: We may use and disclose your protected health information to obtain reimbursement for the treatment and services you receive from us or another entity involved with the services. Payment activities include billing, collections, and determinations of eligibility to obtain payment from you, an insurance company, or another third party. If state or federal law requires us to obtain a written authorization from you prior to disclosing health information for payment purposes, we will ask you to sign an authorization form.
Health Care Operations: We may use and disclosure your protected health information for our health care operations. For example, we may use the information to assess the care and outcomes in your case and similar cases. These uses and disclosures are necessary to make sure you receive quality care and to operate and manage our business. We also may share information with other entities that have a relationship with you for their health care operation activities.
Other Uses and Disclosures: We may also use and disclose your protected health information for the following permitted purposes:
- Required by Law: For any purpose required by law.
- Individuals Involved in Your Care or Payment for Your Care: To your family or friends or any other individual identified by you when they are involved in your care or in the payment for your care.
- Public Health and Disaster Relief: For public health activities such as to prevent or control disease or injury, report births and deaths, report abuse or neglect, or report reactions to medications or problems with a product or to assist with a disaster relief effort.
- To Avert a Serious Threat to Health or Safety: As permitted by applicable law and standards of ethical conduct, to prevent or lessen a serious or imminent threat to the health or safety of a person or the public.
- Law Enforcement and Correctional Institutions: To assist law enforcement officials with their law enforcement duties including, responding to a court order, subpoena, summons or similar process, identifying or locating a suspect. If you are an inmate of a correctional institution, we may disclose to the institution or law enforcement officials so that their applicable duties can be carried out under the law.
- Health Oversight Activities: To a government oversight agency conducting audits, investigations, or other oversight activities.
- Coroners, Medical Examiners and Funeral Directors: To coroners, medical examiners, and funeral directors as necessary for them to carry out their duties.
- Organ and Tissue Donation: If necessary to arrange an organ or tissue donation from you or a transplant for you.
- Military and Veterans: If you are a member of the Armed Forces, domestic or foreign, we may release your health information to military command authorities as authorized or required by law.
- National Security and Intelligence Activities: We may release your health information to authorized federal officials for intelligence, counterintelligence, or other national security activities that are authorized by law.
- Protective Services for the President and Others: We may disclose your health information to authorized federal officials so that they may provide protection to the President, other authorized persons or foreign heads of state, or to conduct special investigations.
- Workers’ Compensation: For programs that provide benefits for work-related injuries or illnesses, in accordance with applicable law.
- Research: Under certain circumstances, for research purposes, subject to the requirements of applicable law. All research projects are subject to protocols to continue to protect health information. When required, we will obtain authorization from you prior to using your health information for research.
RIGHTS THAT YOU HAVE REGARDING YOUR PROTECTED HEALTH INFORMATION.
Access to Your Protected Health Information: With certain exceptions, you have the right to copy and/or inspect much of the protected health information that we retain on your behalf, in accordance with applicable federal and state law. For protected health information that we maintain in any electronic designated record set, you may request a copy of such health information in an electronic format. Requests for access must be made in writing: you may obtain a “User Access to Health Information Form” by sending an email to firstname.lastname@example.org. You may be charged a reasonable fee for the cost of copying and mailing your records. If you are denied a request for access, you have the right to have the denial reviewed in accordance with the requirements of applicable law.
Amendments to Your Protected Health Information: You have the right to request in writing that protected health information that we maintain about you be amended or corrected. We are not obligated to make requested amendments, but we will give each request careful consideration. All amendment requests, must be in writing and must state the reasons for the amendment/correction request. You may obtain an “Amendment Request Form” by sending an email to email@example.com. If your request is denied, we will provide you with a written denial in accordance with applicable law.
Accounting for Disclosures of Your Protected Health Information: You have the right to receive an accounting of certain disclosures made by us of your protected health information. Requests must be made in writing: “Accounting Request Forms” are available via email to firstname.lastname@example.org.
Restrictions on Use and Disclosure of Your Protected Health Information: You have the right to request restrictions on uses and disclosures of your protected health information. We are not required to grant your request, except in the case where the disclosure is to a health plan for purposes of carrying out payment or health care operations, is not otherwise required by law, and the information pertains solely to a health care item or service for which you have paid in full. The medical records custodian can be reached via email at email@example.com.
Right to Request Confidential Communications: You have the right to request that we communicate with you about your health matters by alternative means or to alternative locations. To make such a request, you must submit your request in writing to email at firstname.lastname@example.org.
Right to Notice of Breach: We will notify you in the event a breach occurs involving your unsecured protected health information and inform you of what steps you may need to take to protect yourself.
Paper Copy of this Notice: You have a right, even if you have agreed to receive notices electronically, to obtain a paper copy of this Notice. To do so, please submit a request to the Privacy Officer at the address below.
OTHER USES OF YOUR HEALTH INFORMATION.
Other uses and disclosures of your protected health information, not described in this Notice, will be made only with your prior authorization, including for marketing activities, sale of health information, and disclosure of psychotherapy notes, all as defined under HIPAA. You have the right to revoke your authorization at any time, in writing.
CHANGE TO THIS NOTICE.
We reserve the right to change this Notice and make the revised Notice effective for health information we already have about you as well as any information we receive in the future. We will post the current Notice, including the effective date. If we amend this Notice, we will provide the revised version on our website, and we will provide you with a copy of the Notice that is currently in effect, upon your request.
If you believe your privacy rights have been violated, you can file a complaint in writing with the Privacy Officer. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services. There will be no retaliation for filing a complaint.
If you have questions, need further assistance regarding or would like to submit a request pursuant to this Notice, you may contact the PPS Health Privacy Officer by phone at 818-330-5512 or at the following address: 15477 Ventura Blvd., Suite 101, Sherman Oaks, CA 91403. b