Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION, AND HOW TO FILE A COMPLAINT CONCERNING A VIOLATION OF THE PRIVACY OR SECURITY OF YOUR HEALTH INFORMATION OR OF YOUR RIGHTS CONCERNING YOUR INFORMATION. PLEASE REVIEW IT CAREFULLY.

YOU HAVE A RIGHT TO A COPY OF THIS NOTICE (IN PAPER OR ELECTRONIC FORM) AND TO DISCUSS IT WITH THE HIPAA PRIVACY OFFICER AT PHONE: 405.447.0300 or EMAIL: DPerryman@astribe.com IF YOU HAVE ANY QUESTIONS.

By law, Absentee Shawnee Tribal Health System (ASTHS) must protect your health information, give you this Notice, and follow the current notice. This Notice is followed by all ASTHS employees, any health care professional who provides treatment to you at ASTHS, and any student or intern at ASTHS.

ASTHS reserves the right to change this Notice and to make the revised Notice effective for health information it receives in the future. Revised Notices will be posted and available at each location where services are provided and on ASTHS’s website.

Under HIPAA, Protected Health Information (“Health Information”) is information that individually identifies you and pertains to your past, present, or future health status.

Your Health Information will not be used or disclosed except as described in this Notice. In certain situations, we must obtain written authorization in order to use and/or disclose your Health Information. Authorization may be revoked at any time, except to the extent action has already been taken in reliance of it.

YOUR RIGHTS

You and your Personal Representatives (who you designate or are appointed by law or other legal process) have the following rights regarding your Health Information in our record.

1.Right to Inspect and Copy: You have the right to inspect and copy your Health Information as provided by law. This right does not apply to psychotherapy notes and certain other information. Your request must be made in writing. ASTHS has the right to charge you the amounts allowed by law for copies and supplies, plus postage, payable prior to the release of the requested Health Information. ASTHS may deny your request in certain circumstances. You may request an appeal of a denial under certain circumstances. A copy of your Health Information will be provided to you, usually within thirty (30) days of your request.

2.Right to Amend or Correct your Medical Record: If you feel that the information we have about you is incorrect or incomplete, you have the right to request an amendment to your Health Information. You must submit your request in writing and state the reason(s) for the amendment. ASTHS may deny your request for an amendment under certain circumstances. ASTHS will inform you in writing when the amendment is denied and the reason for the denial within sixty (60) days of ASTHS receiving your formal written request for the amendment. If ASTHS denies your amendment request, you have a right to file a statement of disagreement which can be included in your medical record for future use and disclosure.

3.Right to Confidential Communications: You have the right to ask ASTHS to contact you in a specific way (for example, home, office, or cell phone) or to send mail to a different address. ASTHS will try to accommodate reasonable requests.

4.Right to an Accounting: You have the right to obtain a statement of certain disclosures of your Health Information to third parties (an accounting), except those disclosures made for treatment, payment, or health care operations, authorized by you or pursuant to the Notice. An accounting may include a list of times we shared your health information, who we shared it with, and why we shared it. You may request an accounting, in writing, and provide the specific time period requested. You may request an accounting for up to six (6) years prior to the date of your request. If you request more than one (1) accounting in a 12-month period, ASTHS may charge you for the cost involved and you may choose to modify or withdraw your request before any costs are incurred.

5.Right 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. However, we are not required to agree with your request, and we may say “no,” for example, if it could affect your care. If we agree to your request, we may still share this information in the event that you need emergency treatment or as otherwise authorized by law. 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.

6.Right to a Copy of This Privacy Notice: You can ask for a copy of this Notice at any time, even if you have agreed to receive it electronically. We will provide you with a paper copy promptly.

7.Right to Have Someone to Act for You: If someone has authority to act as your personal representative, such as if someone has your medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.

8.Right to be Notified: You have a right to be notified of breaches that may have compromised the privacy or security of your health information.

9.Right to File a Complaint: If You Feel Your Rights are Violated: You can complain if you feel we have violated your rights by contacting our HIPAA Privacy Officer. You can file a complaint with the U.S. Department of Health and Human Services Office of Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 877.696.6775, or visiting https://www.hhs.gov/hipaa/filing-a-complaint/index.html. ASTHS will not retaliate against you for filing a complaint.

10.Additional Rights Related to Substance Use Disorder Records (“SUD”):

a.You have a right to control how your SUD records are used and disclosed, consistent with 42 CFR Part 2.

b.You have a right to receive an accounting of disclosures of your SUD records as required by law.

c.You have the right to file a complaint if you believe your SUD privacy rights have been violated.

d.You may authorize disclosures using single consent that permits future uses and disclosures for treatment, payment, and health care operations, as allowed by law.

e.You have a right to receive access to health care and not be discriminated against by ASTHS on the basis of having sought or received SUD treatment.

 

OUR USES AND DISCLOSURES

We may use or share your information in the following ways:

  1. To Treat You: ASTHS can use your health information and share it with other professionals who are treating you. For example, a doctor treating you for an injury may ask another doctor about your overall health condition.
  2. To Run Our Organization: ASTHS can use and share your health information to run our practice, improve your care, and contact you as necessary. For example, ASTHS can use your health information to contact you for the purpose of conducting patient satisfaction services.
  3. To Bill for Services: ASTHS can use and share your health information to bill and receive payment from health plans or other entities. For example, a bill sent to a third-party payor may include information identifying you, your diagnosis, procedures and supplies used. We may also tell the third-party payor about a treatment you are going to receive in order to obtain prior approval or determine whether the third-party payor will cover the treatment.
  4. For Public Health and Safety Issues: ASTHS can share health information about you for certain situations such as: preventing disease; helping with product recalls; reporting adverse reactions to medication; reporting suspected abuse, neglect, or domestic violence; preventing or reducing a serious threat to anyone’s health or safety.
  5. For Disaster Relief: ASTHS may disclose your information to disaster relief organizations in an emergency so your family can be notified about your condition or location.
  6. For Research: We can use or share your information for health research in limited circumstances where the research has been approved by a review board that has reviewed the research proposal and established protocols to ensure the privacy of medical information.
  7. Using a Limited Data Set: For research, public health, or health care operations, ASTHS may create a limited data set of your Health Information.
  8. To Comply with the Law: ASTHS will share health information about you to the extent it is required by law and the use or disclosure complies with and is limited to the relevant requirements of such law.
  9. To Respond to Lawsuits and Legal Actions: ASTHS may share health information about you in response to a court or administrative order, or in response to a subpoena.
  10. To Law Enforcement: Under certain circumstances, ASTHS may disclose health information to law officials. These circumstances include (1)  when we receive a court order, warrant, summons, or other similar process; (2) to identify or locate a suspect, fugitive, material witness, or missing person; (3) when the patient is a victim of a crime, if ASTHS is unable to obtain person’s agreement; (4) when ASTHS believes the patient’s death may be a result of criminal activity; (5) about criminal conduct at ASTHS; (6) in emergency circumstances to report a crime, the location of the crime or victims, or the identity, description, or location of the person who committed the crime; or (7) as otherwise authorized by law.
  11. In Regards to Inmates and Correctional Institutions: If you are an inmate of a correctional institution or under the custody of a law enforcement officer, ASTHS may use or disclose your health information necessary for your health and the health and safety of others to a correctional institution or to a law enforcement officer.
  12. To Address Workers’ Compensation and Other Government Requests: ASTHS may use or share health information about you for workers’ compensation claims; with health oversight agencies for activities authorized by law; and for special government functions such as military, national security, and presidential protective services.
  13. To Respond to Organ or Tissue Donation Requests: ASTHS may share health information about you with organ procurement organizations.
  14. To a Medical Examiner or Funeral Director: ASTHS may share health information with a coroner, medical examiner, or funeral director when an individual dies.
  15. To Family and Caregivers: ASTHS may disclose limited health information to a family member, friend, or other caregiver if you have indicated they are involved in your medical care or help pay for your care, general condition, or both. We may also tell your family and caregivers about your location of care, general condition, or death. We will give you an opportunity to object to certain individuals involved in your care from receiving information about you. If you are unable or unavailable to agree or object, we will use our best judgment in communicating with your family and caregivers.
  16. To Fundraise: ASTHS may contact you about fundraising activities, but you can tell us not to contact you again.

  17. For Marketing and Communications:  ASTHS may use or disclose your health information for marketing purposes when you give your written authorization. Written authorization is not required for communications that are not considered marketing such as: (1) face-to-face communications, (2) a marketing campaign that involves a promotional gift of nominal value, (3) refill reminders so long as payment received is limited to the cost of making the communication, (4) case management, (5) care coordination, (6) communications that promote health in general, and (7) communications to you concerning health-related products, benefits or services related to your treatment or alternative treatments, therapies, providers, or care settings. You may opt out of receiving certain communications by notifying ASTHS’s Privacy Officer through the contact information provided in this Notice.

  18. In a Health Information Exchange: ASTHS may make your information available electronically through an information exchange network to other providers who are involved in your care.
  19. For Other Uses: ASTHS may use and disclose health information to remind you that you have an appointment for medical care; for population-based activities related to improving health or reducing healthcare costs; for conducting training programs or reviewing competence of health care professionals; and to federal program databases (i.e., IHS, Medicare, Medicaid, etc.), as applicable.
  20. To Business Associates: ASTHS may disclose your health information to other entities that provide a service to us on our behalf that requires the release of patient health information. ASTHS will make these disclosures only if we have received satisfactory assurance that the other entity will properly safeguard your health information.
  21. For Breach Notification Purposes: ASTHS may use or disclose your health information to provide legally required notices of unauthorized access to government agencies, the media, and other individuals as required by law.
  22. SUD Record Restrictions: SUD records receive additional protections under federal law. To the extent ASTHS has your substance use disorder (SUD) patient records, subject to 42 CFR Part 2, ASTHS will not share that information for investigations or legal proceedings against you without (1) your written consent or (2) a court order and a subpoena. SUD records may only be shared without your written consent only as permitted by law; to address a medical emergency; for public health reporting as required by law; for health oversight activities authorized by law; or as otherwise permitted or required under 42 CFR Part 2.
  23. Psychotherapy Notes Restrictions: Psychotherapy notes generally require written authorization except in limited circumstances such as a legal defense of a provider or certain treatment-related uses.
  24. Sale of Health Information Restrictions: Any disclosure that involves the sale of health information requires written authorization with limited exceptions such as public health purposes or research where only reasonable cost-based fees are charged.

 

Contact Information

If you need to request medical records or exercise any of the rights laid out in this Notice, please contact our Health Information Management department:

Phone: 405.447.0300

Mail Address:  ASTHS HIM Department

                        15951 Little Axe Dr.

                        Norman, OK 73026

If you would like to have a copy of this Notice, have questions about this Notice and our privacy practices, or need to file a HIPAA complaint or report a breach of privacy, please contact the HIPAA Privacy Officer:

HIPAA Privacy Officer

Phone: 405.447.0300

Email: DPerryman@astribe.com

Mail Address: ASTHS HIPAA Privacy Officer

                        15951 Little Axe Dr.

                        Norman, OK 73026

 

You may also file a HIPAA complaint or report a breach of privacy to ASTHS Compliance:

Medical Compliance Officer

Phone: 405.447.0300

Email: nyost@astribe.com

Mail Address: ASTHS Medical Compliance Officer

                        15951 Little Axe Dr.

                        Norman, OK 73026

Report a complaint anonymously to ASTHS Compliance by calling 405.701.7135.

The United States Secretary of the Department of Health and Human Services may also be contacted for a HIPAA complaint within 180 days of you learning of the violation:

Phone: 877.696.6775

Website: https://www.hhs.gov/hippaa/filing-a-complaint/index.html

Mail Address:  200 Independence Avenue,

S.W., Washington, D.C. 20201

You will not be retaliated against for filing a HIPAA complaint.