NOTICE OF PRIVACY PRACTICES

Effective Date: October 4, 2019

 

This notice describes how we may use and disclose health information about you.  Please review it carefully. If you have any questions about this notice, please contact info@monogramhealthcare.com or 1-855-212-2273.

 

We at Monogram Health understand that information about you and your health is personal, and we are committed to safeguarding your health information.  This notice describes how we may use and disclose your health information in connection with your participation in our chronic kidney disease and end-stage renal disease care management programs (collectively, the “Program”). 

 

We reserve the right to change the terms of this notice, and to make new notice provisions effective for all your health information that we maintain.  We may do so by sharing the revised notice by posting on our website, and by making copies of the revised notice available on request.  We will follow the procedures in the notice that is currently in effect.

 

How Monogram May Use and Disclose Your Health Information

 

The following categories describe different ways in which we may use and disclose your health information, without your written authorization.

  • For Program Services.  We may use and disclose your health information to provide you with Program services.  For example, we may share your health information with your primary care providers or appropriate network physician, or your health plan, as part of our care management activities.  We may also share your health information in order to coordinate different aspects of care that you need.  We may disclose your health information to people who provide services in connection with your medical care. 

  • Payment for Services.  We may use and disclose your health information so that the Program services you receive from us may be billed to your health plan.

  • For Health Care Operations.  We may use and disclose your health information for our health care operations, such as quality assessment and improvement activities, case management, business planning, customer services, and other activities.  These uses and disclosures are necessary for our general operations, and to assure the quality of our services.  For example, we may use your health information to review our services and to evaluate our performance, and to decide whether certain services are effective.

 

In some limited situations the law allows or requires us to use or disclose your health information without your written authorization for purposes other than Program services, payment, or health care operations.  Subject to applicable law, we may use or disclose your health information as described below.

  • As Required By Law.  We will disclose your health information when required to do so by applicable law.  We will notify you of these uses and disclosures, if notice is required by law.

  • Victims of Abuse, Neglect, or Domestic Violence.  We may disclose your health information to a government authority if we reasonably believe you are a victim of abuse, neglect, or domestic violence.  We will disclose this type of information only to the extent required by law, if you agree to the disclosure, or if the disclosure is allowed by law and we believe it is necessary to prevent or lessen a serious and imminent threat to you or another person.

  • Judicial and Administrative Proceedings.  If you are involved in a lawsuit or dispute, we may disclose your health information in response to a court or administrative order.  We may also disclose your health information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made, either by us or by the requesting party, to tell you about the request or to obtain an order protecting the information requested.

  • Appointment Reminders, Treatment Alternatives, Benefits and Services.  In the course of providing Program services to you, we may use your health information to contact you with a reminder that you have an appointment for services.  We may also use your health information in order to discuss possible treatment alternatives or health-related benefits and services that may be of interest to you. 

  • Subcontractors.  We may disclose your health information to subcontractors who perform services on our behalf.  However, if we disclose your health information to a subcontractor, we will have a written contract with our subcontractor that ensures that our subcontractor also protects the privacy of your health information.

  • Law Enforcement.  We may release your health information to law enforcement officials for certain reasons, such as in response to an order or warrant of a court, or to assist in the identification or location of an individual, victims of crime, or decedents, or if necessary to report a crime that occurred on our premises.

  • HIPAA Compliance. We may disclose your health information to the Secretary of the U.S. Department of Health and Human Services in order to assess our compliance with law regarding the privacy and security of health information.

  • Completely De-identified Information.  Unless we otherwise have agreed not to do so, we may use and disclose your health information if any information that has the potential to identify you has been removed so that the health information is completely de-identified.

  • Incidental Disclosures.  While we will take reasonable steps to safeguard the privacy of your health information, certain disclosures of your health information may occur during or as an unavoidable result of our otherwise permissible uses or disclosures of your health information. 

 

Unless you object, or request that only a limited amount or type of information be shared, we may disclose your health information without your authorization with a family member, relative, friend, or other person identified by you, to the extent relevant to that person’s involvement in your care.   If you would like to object to use and disclosure of your health information in these circumstances, please contact us at info@monogramhealthcare.com or 1-855-212-2273.

 

 

Your Rights Regarding Your Health Information

 

You have the following rights regarding your health information, which you may exercise by request to us (in some cases, we will ask you to put your request in writing, and in some cases we will ask you to contact your health plan instead):

  • Right to Inspect and Copy.  You have the right to inspect and copy your health information.  

  • Right to Amend.  If you feel that your health information we have about you is incorrect or incomplete, you may ask for it to be amended.  

  • Right to an Accounting of Disclosures.  You have the right to request a list of the disclosures we have made of your health information about you.  Many routine disclosures we make will not be included in this list; however, the accounting will include many non-routine disclosures.  You may ask for disclosures made up to six years before your request.  The first list you request within a 12-month period will be free.  

  • Right to Request Restrictions.  You have the right to request restrictions on our use and disclosure of your health information for services and health care operations.  We will consider your request, but in most cases are not required to agree to it.  We will let you know if your requested restriction might limit our ability to carry out Program services and thus limit your participation in the Program. 

  • Right to Request Confidential Communications.  You have the right to request that we communicate with you about medical matters in a certain way, for confidentiality purposes.  We will accommodate all reasonable requests.  If you do not specify how you wish to be contacted, we may communicate with you by mail, telephone, fax, email, or text.

  • Right to a Paper Copy of this Notice.  You have the right to a paper copy of this notice at any time by contacting us.

  • Right to be Notified Following a Breach of Unsecured your Health Information.  If you are affected by a breach of your unsecured your health information, you have the right to, and will, receive notice of such breach.

 

Other Uses and Disclosures

 

We will obtain your written authorization before using or disclosing your health information for purposes other than those provided for above (or as otherwise permitted or required by law).  Uses and disclosures of your health information that require your written authorization include most uses and disclosures of your health information for marketing purposes, and disclosures that constitute a sale of your health information.  If you provide us with written authorization, you may revoke that authorization in writing at any time.  Upon receipt of the written revocation, we will stop using or disclosing your health information, except to the extent that we have already taken action in reliance on your authorization.

 

You May File a Complaint About Monogram Privacy Practices

 

If you believe your privacy rights have been violated, you may file a complaint with us.  To file a complaint with us, please contact info@monogramhealthcare.com or 1-855-212-2273. If you file a complaint, we will not take any action against you or change your services in any way.

 

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