Activate Healthcare, LLC
Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION MAY BE USED AND DISCLOSED BY ACTIVATE HEALTHCARE, LLC, AND HOW IT MAY BE ACCESSED BY ACTIVATE PATIENTS.
PLEASE REVIEW IT CAREFULLY.
I. Purpose of This Notice of Privacy Practices
This Notice describes the health information privacy practices of Activate Healthcare, LLC, and the physicians, nurses, health coaches and other personnel who work in Activate Clinics or who provide Activate Services. It applies at all Activate locations.
II. Activate’s Privacy Obligations
Under the federal Health Insurance Portability and Accountability Act of 1996 and the implementing regulations, the Health Information Technology for Economic and Clinical Health (HITECH) chapter of the American Recovery and Reinvestment Act of 2009 (ARRA) and its implementing regulations and other applicable state and federal laws (Collectively, the “Laws”), as a provider of clinic services, Activate is required by law to maintain the privacy of its patient’s health information (“Protected Health Information” or “PHI”) and to provide each patient with this Notice of Privacy Practices regarding Protected Health Information. When Activate uses or discloses Protected Health Information, it is required to abide by the terms of its privacy as reflected in this Notice as it may be amended or updated from time to time.
The Laws divide uses and disclosures of PHI into those which can be done without patient authorization and those which require patient authorization. Section III describes uses and disclosures that can be done without patient authorization. Section IV describes uses and disclosures that can be made only with written patient authorization.
III. Permissible Uses and Disclosures Without A Written Authorization
A. Uses and Disclosures For Treatment, Payment and Health Care Operations. Activate may use and disclose PHI under federal law in order to provide treatment, receive payment or engage in healthcare operations as described below:
Treatment. Activate may use and disclose PHI to provide diagnosis and treatment to a patient. Consistent with that use and disclosure, Activate may contact provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest and to disclose PHI to other providers involved in a patient’s treatment.
Payment. Activate may use and disclose PHI to obtain payment for services that Activate provides, for example to your health plan. The ARRA provides, however, that you may pay for the services and request that your PHI not be disclosed to the health plan for that service.
Health Care Operations. Activate may use and disclose your PHI for health care operations, which include administration, management and activities that improve the quality and cost effectiveness of care. Activate may also disclose PHI to another health care facility when such PHI is required for them to engage in treatment, payment or health care operations.
B. Disclosure to Relatives, Close Friends and Other Caregivers. Activate may use or disclose PHI to a patient’s family member, other relative, a close personal friend or any other person identified by a patient without a written authorization only when such patient is present for, or otherwise available prior to, the disclosure, if Activate (1) obtains and documents the patient’s assent; (2) provides the patient with a confidential opportunity to object to the disclosure and the patient does not object; or (3) reasonably infer from the circumstances and in the Activate physician’s professional judgment that the patient does not object to the disclosure.
If a patient is not present, or the opportunity to agree or object to a use or disclosure cannot practicably be provided because of incapacity or an emergency circumstance, Activate personnel may exercise professional judgment to determine whether a disclosure is in the best interest of the patient. If Activate discloses information to a family member, other relative or a close personal friend without an authorization, Activate would disclose only information that Activate believe is directly relevant to the person’s involvement with the health care or payment related to the patient’s health care. Activate may also disclose PHI in order to notify (or assist in notifying) such persons of a patient’s location, general condition or death.
C. Public Health Activities. Activate may disclose PHI in order to comply with public health requirements, including but not limited to: (1) to report certain diseases, conditions or other findings to public health authorities for the purpose of preventing or controlling disease, injury or disability; (2) to report child abuse and neglect to public health authorities or other government authorities authorized by law to receive such reports; (3) to report information about products and services under the jurisdiction of the U.S. Food and Drug Administration; (4) to alert a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition (under specifically limited circumstances); and (5) to report suspected abuse or neglect to a governmental authority, including a social service or protective services agency, authorized by law to receive reports of such abuse or neglect.
D. Health Oversight Activities. Activate may disclose PHI to a health oversight agency that oversees the health care system and is charged with responsibility for ensuring compliance with the rules of government health programs such as Medicare or Medicaid and civil rights laws.
E. Judicial and Administrative Proceedings. Activate may disclose PHI in the course of a judicial or administrative proceeding in response to a legal order or other lawful process.
F. Law Enforcement Officials. Activate may disclose PHI to the police or other law enforcement officials as required or permitted by law or in compliance with a court order or a grand jury or administrative subpoena.
G. Uses or Disclosures Required By Law. Activate may use and disclose your PHI when required to do so by any other law not already referred to in the preceding categories.
IV. Uses and Disclosures Requiring Written Authorization
This Section IV describes the circumstances pursuant to which Activate must obtain an individual’s written authorization to use or disclose PHI.
Activate only may use or disclose PHI when it receives a written authorization for such use or disclosure for any purpose other than the ones described above in Section III, and as described below.
A. HIV/AIDS Related Information. Activate shall only disclose PHI related to HIV or AIDs with the express authorization of the Individual, and for those reasons listed above.
B. Behavioral Health Information. Consistent with State and Federal laws, Activate will only disclose Behavioral Health Information pursuant to a valid written authorization. The confidentiality of alcohol and drug abuse patient records maintained by Activate is protected by federal and state law and regulations. Activate may not disclose drug and alcohol medical records without a patient’s written authorization.
V. Rights Regarding Your Protected Health Information
A. For Further Information; Complaints. Further information, concerns or complaints about Activate’s privacy practices, or about any violations of patient privacy rights or disagreements with a decision that Activate made regarding access to PHI, should be addressed to the Activate Privacy Office, at the following address:
Activate Healthcare, LLC
9302 North Meridian Street
Indianapolis, IN 46260
Voice Phone (317) 557-7328
A patient may also file written complaints with the Office of Civil Rights of the U.S. Department of Health and Human Services, at the following address:
Office for Civil Rights
U.S. Department of Health and Human Services
233 N. Michigan Ave., Suite 240
Chicago, IL 60601
Voice Phone (312)886-2359
Activate will not retaliate against any person who reports a privacy issue or files a complaint with the Director of OCR/HHS or with the Privacy Officer.
B. Right to Request Restrictions. A patient may request restrictions on Activate’s use and disclosure of PHI (1) for treatment, payment and health care operations, (2) to individuals (such as a family member, other relative, close personal friend or any other person identified by the patient) involved with care or with payment related to care, or (3) to prevent or limit the notification of such individuals regarding a patient’s location and general condition. While Activate will consider all requests for restrictions carefully, Activate is not required to agree to a requested restriction.
C. Right to Receive Confidential Communications. A patient may request, and Activate will accommodate, any reasonable written request to receive his or her PHI by alternative means of communication or at alternative locations. Requests should be made to the Privacy Office in writing.
D. Right to Revoke Your Authorization. A patient may revoke his or her Authorization, except to the extent that Activate have taken action in reliance upon it, by delivering a written revocation statement to the Privacy Office identified above.
E. Right to Inspect and Copy Health Information. A Patient may request access to medical record files and billing records maintained by Activate in order to inspect and request copies of the records. Under limited circumstances, Activate may deny access to a portion of such records. Record requests must be made in writing to the Privacy Office. Activate will charge $1.00 per page, for the first 100 pages, and $0.25 per page after that, up to a maximum of $200.00 per record, plus postage costs if mailing is requested.
F. Right to Amend Records. Each patient has the right to request that Activate amend Protected Health Information maintained in Activate’s medical record file or billing records, by making such a request in writing to the Privacy Office. Activate will comply with such requests unless Activate believes that the amendment is inaccurate or would result in an inaccurate or incomplete record.
G. Right to Receive An Accounting of Disclosures. Upon written request to the Privacy Office, Activate will provide a patient with an accounting of certain disclosures of PHI made by Activate during any period of time prior to the date of said request to the Effective Date, provided such period does not exceed six years.
H. Right to Receive Paper Copy of this Notice. Upon request, Activate will provide a paper copy of this Notice.
VI. Effective Date and Duration of This Notice
A. Effective Date. This Notice is and shall remain effective until replaced.
B. Right to Change Terms of this Notice. Activate may change the terms of this Notice at any time. If Activate change this Notice, Activate may make the new notice terms effective for all Protected Health Information that Activate maintain, including any information created or received prior to issuing the new notice. Copies of any amended notice will be available from the Privacy Office.
We may collect Personally Identifiable Information (PII) from Users in a variety of ways, including, but not limited to, when Users register on our
site, visit our site, fill out a form, respond to a survey, subscribe to a newsletter, and in connection with other activities, services, features or
resources we make available on our site.
Users may be asked to provide, as appropriate, their name, mailing address, email address, phone number, demographics (age, sex, and etc.).
Users may, however, visit our site anonymously. We will collect PII from Users only if they voluntarily submit such information to us. Users can
always refuse to supply PII, except that it may prevent them from engaging in certain Site related activities.
We may collect non-PII about Users whenever they interact with our Site. Non-PII may include the user's geographic region, browser type and
version, time of day of connection, and technical information about Users' means of connection to our Site, such as the IP address, the Internet
service provider (ISP) used, and other similar information.
Our Site uses appropriate data collection, storage and processing practices, and security measures designed to protect against unauthorized
access, alteration, disclosure, or destruction of your personal information, username, password, transaction information, and data stored on our
Site. Any sensitive and private data exchanged between the Site and its Users is done using an SSL-secured communication channel, encrypted
and protected using public key encryption and digital signatures.
We have customer support systems in place, which may include the following:
- Web form
- Toll free number
We may use third party service providers to help us operate our business and the Site, or administer activities on our behalf, such as sending out
newsletters or surveys.
We may share your information with these third parties for those limited purposes, provided that you have given us your permission:
- Call Rail
- Google Analytics
Users may find advertising or other content on our Site that links to the sites and services of our partners, suppliers, advertisers, sponsors,
licensors and other third parties. We do not control the content or links that appear on these sites and are not responsible for the practices
employed by websites linked to or from our Site. In addition, these sites or services, including their content and links, may change frequently.
These sites and services may have their own privacy policies and customer service policies. Browsing and interaction on any other website,
including websites which have a link to our Site, is subject to that website's own terms and policies.
We may share your information to defend our company's rights and properties, or to comply with legitimate law enforcement purposes. Users are
advised that ownership transfer or data destruction may occur in the event of a merger, bankruptcy or cessation of operation.
Users may opt-out from receiving mailings from Activate Healthcare. If a user wishes to unsubscribe, they may follow the instructions included in
the emails, unsubscribe at http://https://www.activatehealthcare.com
We may contact clients or customers of Activate Healthcare for various reasons including responding to inquiries, payment processing, notification
of errors, or incident. We may contact our clients and customers by email and newsletters.
Activate Healthcare may collect and use users' personal information for the following purposes:
To improve customer service
Information you provide helps us respond to your customer service requests and support needs more efficiently.
To improve our Site
Activate Healthcare may use feedback you provide to improve our products and services.
For marketing with third parties
Activate Healthcare may use the email address you provide for marketing purposes with third parties.
To send periodic emails
Activate Healthcare may use the email address you provide to send Users periodic information, including updates pertaining to their account or an
order. User email addresses may also be used to respond to inquiries, questions, and/or other requests. If User decides to opt-in to our mailing
list, they will receive emails that may include company news, updates, related product or service information, etc. If at any time the User would like
to unsubscribe from receiving future emails, we include detailed unsubscribe instructions at the bottom of each email, the User may contact us via
our website, or the User may contact us via phone.
Our Site may use "cookies" to enhance the User experience. The User's web browser places cookies on their hard drive for record-keeping
when cookies are being created. If cookies are blocked, please note that some parts of the Site may not function properly.
Changes To This Policy
We encourage Users to frequently check this page for any changes, to stay informed about how we are helping to protect the personal information
This document was last updated on Nov 27, 2017 8:46:50 PM