Notice of Privacy Practices

NOTICE OF PRIVACY PRACTICES

YOUR INFORMATION.
YOUR RIGHTS.
OUR RESPONSIBILITIES.

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GAIN ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.

YOUR RIGHTS

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get an electronic or paper copy of your medical/health record.

  • You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
  • We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your medical/health record.

  • You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
  • We may say “no” to your request, but we’ll tell you why in writing within 30 days.
  • If we disagree, we will document the information you would like included, as well as the reasons we disagree.

Request confidential communications.

  • You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
  • We will say yes to all reasonable requests.

Ask us to limit what we use or share.

  • You can ask us not to use or share certain health information for treatment, payment, or our operations.
    • We are not required to agree to your request, and we may say “no.”
  • If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer.
    • We will say “yes” unless a law requires us to share that information.
  • If you consent to disclosure of your health information and subsequently change your mind, you may revoke your consent at any time. To do so, utilize the contact information at the end of this notice.

Get a list of those with whom we’ve shared information.

  • You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
  • We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We will provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice.

  • You can ask for a paper copy of this notice any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you.

  • If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
    We will make sure the person has this authority and can act for you before we take any action.

File a complaint if you feel your rights are violated.

  • You can complain if you feel we have violated your rights by contacting us using the information on the final page.
  • You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
  • We will not retaliate against you for filing a complaint.

YOUR CHOICES

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

  • Share information with your family, close friends, or others involved in your care. If you unexpectedly become acutely ill, and you are not able to tell us your preference, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases we never share your information unless you give us written permission:

  • Marketing purposes
  • Sale of your information
  • Fundraising efforts

Our Uses and Disclosures

How do we typically use or share your health information? Your information is only accessible to Promerica Health/EMG3 employees, contractors, and business associates. All employees, contractors, and business associates are required to follow HIPAA guidelines and this policy. They are bound to use the information only for their work with Promerica Health/EMG3 and not in any other way.

We typically use or share your health information in the following ways.

Treat You/Health Promotion

  • We can use your health information to provide information on diet and exercise or wellness programs. We will recommend that you share your health information with your personal provider. If we provide your information to your personal provider, we will obtain your consent.

Run our organization.

  • We can use and share your health information to run our organization, improve your care, and contact you when necessary. If a need arises, we will contact you regarding your screening results.

Bill for your services.

  • We may use and share your health information to bill and obtain payment from health plans or other entities.
  • In the case of an employer sponsored health and wellness program, we do not share personal health information with your employer (except under unlikely circumstances with your written consent).
  • As part of a health incentive/disincentive program, information such as nicotine/cotinine levels is sometimes shared with third party administrators, but only with your written consent.

How else can we use or share your health information? We are allowed or required to share you information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see:

www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html

Help with public health and safety issues.

  • We can share health information about you for certain situations such as:
    • Preventing disease
    • Helping with product recalls
    • Reporting adverse reactions to medications
    • Reporting suspected abuse, neglect, or domestic violence
    • Preventing or reducing a serious threat to anyone’s health or safety

Do research.

  • We can use or share your information for health research.

Comply with the law, lawsuits, and legal actions.

  • We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
  • We will disclose your information as required by a court order, including the order of an administrative tribunal. Only the specific information requested will be provided.
  • We will disclose your information in response to a subpoena only if reasonable attempts are made to notify you so that you may object OR reasonable attempts are made to obtain a qualified protected order for the information from the court.
  • Aggregated, non-personal information will be analyzed for the purpose of reporting and improving the services Promerica Health/EMG3 offers. Depending on the circumstances, Promerica Health/EMG3 may or may not charge third parties for reported aggregate data.
  • If all or part of Promerica Health/EMG3 is sold, merged, or otherwise transferred to another entity, your personal information may be transferred as part of that transaction. If this happens, you will be notified of the change in corporate structure and of the Privacy Policy that will oversee your private information.

Respond to organ and tissue donation requests.

  • Although an unlikely situation, we can share health information about you with organ procurement organizations.

Work with a medical examiner or funeral director.

  • Although an unlikely situation, we can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Address workers’ compensation, law enforcement, and other government requests.

  • We can use or share health information about you:
    • For workers’ compensation claims;
    • For law enforcement purposes or with a law enforcement official;
    • With health oversight agencies for activities authorized by law; and
    • For special government functions such as military, national security, and presidential protective services.

Our Responsibilities

  • We are required by law to maintain the privacy and security of your protected health information.
  • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
  • We must follow the duties and privacy practices described in this notice and provide a copy of it.
  • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

For more information see:

www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html

This Notice of Privacy Practices applies to the following entities:

Promerica Health and EMG3 act as an affiliated healthcare entity under HIPAA, and as such, offer joint notice. Both Promerica Health and EMG3 share the same address and the companies work together for the operations of health and wellness programs, with Promerica Health providing primarily clinical & health activities and EMG3 providing data management, equipment, logistical and other operational support.

Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.

How to send requests/questions/complaints:

  • Email privacy@promericahealth.com;
  • Call 207.828.4700 and ask to speak to the Compliance Officer; or
  • By mail:
    Promerica Health/EMG3
    Attention: Compliance Officer
    380 US Route 1
    Falmouth, Maine 04105

Date Effective: 8/12/2015