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Notice of Privacy Practices at The Palomino Group
 
HIPAA Effective Date: April 14, 2003
Notice Effective Date: July 10th, 2007

The Palomino Group respects you right to confidentiality pertaining to your private health information. This notice describes how medical information about you may be used and disclosed and how you can get access to this information as mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). HIPAA, a federal law requires us to make sure your protected health information (PHI) is kept private and protected.

This notice is for your information and it is not necessary for you to take any action, unless you would like to exercise any of your rights that will be explained in this document.

The Palomino Group reserves the right to edit or change the content of this Notice. The Palomino Group guarantees that upon modification of this Notice, we will post the new Notice to our website within 60 days. If we make any changes to this notice, the changes will affect all protected health information we have access to.

What is Protected Health Information?

Protected Health Information (PHI) as defined by HIPAA is:
“Any information, either oral or recorded in any form or medium that -

  1. “is created or received by a healthcare provider, health plan, public health authority, employer, life insurer, school or university, or healthcare clearinghouse, and:”
  2. “relates to the past, present or future physical or mental health or condition of an individual, the provision of healthcare to an individual, or the past, present or future payment for the provision of healthcare to an individual.”

PHI is information that we have created or received about your past, present or future health or medical condition. This information could be used to identify you. It also includes information about medical treatment you have received and about payment for healthcare you have received. It includes, but is not limited to your name, age, address and social security number. We must tell you how, when and why we use and/or share your PHI.

How and when can we use or disclose your PHI?

HIPAA and other laws allow or require us to use or disclose your PHI for many reasons. Sometimes we are not required to get your written consent. For other reason, we may need you to agree in writing that we can use or disclose your PHI. In this Notice, we have listed reasons where we are allowed to use your PHI without getting your permission. This list of reasons is not all inclusive.

  • To receive treatment
    PHI may be released to those that provide your treatment or that are involved with your medical care. These people may be doctors, nurses, or other healthcare professionals.
  • To obtain payment for your treatment
    PHI may be released to obtain payment for treatment and services you receive. For example: this information may be on a claim form submitted to your insurance company.
  • General operations of our business
    PHI may be released to operate our business. For example: to review and improve the quality of our services.
  • To meet legal requirements
    PHI may be released to government or law enforcement agencies when federal, state, or local laws require us to do so. Information may be shared when we are ordered to by a court, administrative proceeding, or other legal proceeding.
  • To report public health activities
    PHI may be released to government officials that collect public health information, or conduct public health investigations, surveillance, or interventions. For example: we must share PHI about some diseases with local and state health departments.
  • To avoid harm
    PHI may be released to avoid a serious health or safety issue of a person or the public, we provide PHI to law enforcement or people who may be able to stop or lessen the harm as in the case of domestic violence, child abuse, or neglect.
  • For workers’ compensation purposes
    PHI may be released to comply with laws relating to workers; compensation or other similar programs, established by law, that provide benefits for work-related injuries or illness without regard to fault.
  • To coroners, medical examiners or funeral directors
    PHI may be released to coroners, medical examiners or funeral directors for the purpose of identifying a deceased person, determining a cause of death, or other duties as authorized by law.
  • For specialized government functions
    PHI may be released to authorized federal officials. PHI required for lawful military and veteran activities, protective services for the President and others, medical suitability determinations, correctional institutions and other law enforcement custodial situations, for intelligence, counter-intelligence, and other national security activities and in some situations to agencies administering a government program.
Some disclosures will require your written authorization.

In some situations we will ask for your written authorization to release PHI. You have the right to revoke your written authorization at any time, by submitting the change in writing. The address to send your authorization is located at the end of this document. The change will be effective the date of receipt of the written notification. You cannot change your decision about information already released with your authorization.

Will this information be released to family, friends or others?

A family member or friend may be helping you manage your medical care. For example: you may be talking to a provider about a medical issue and your mother is helping you. We may discuss your PHI with you in front of her. We will not discuss your PHI with any one if you tell us not to.

There may be a time when you are not able to make health care decisions for yourself. If our professional judgment is that sharing your PHI with your friend is what is best for you, we will do so.

What are your rights with respect to your PHI?
You have the right to:

  • Restrict how your PHI is used
  • Limit your PHI released
  • Obtain a paper copy of this Notice upon request
  • Obtain a copy and inspect PHI on file about you Amend or change your PHI on file
  • Request communications about your PHI at alternative locations (work, home) and through alternative means (telephone, fax)
  • Revoke your authorization of release of PHI (except information already disseminated with proper authorization)
  • To receive an accounting of disclosures of your PHI(within a six (6) year window or back to April 14, 2004, whichever is later)
The Palomino Group’s Commitment:
  • To maintain the protection of your private health information by maintaining all physical, electronic and procedural safeguards that comply with federal an state regulations to guard your PHI
  • To disclose the minimum PHI needed to perform our duties
  • To provide you with this Notice and again, of any changes to this Notice
  • To abide by all terms of this Notice
  • To obtain a written authorization for all situations listed within this Notice that require written authorization
  • To provide information pertaining to all PHI information released (who, what, when)
If you wish to register a complaint about our privacy practices, request further information or request a paper copy of this notice:

If you wish to register a complaint about a potential violation of privacy rights, you may send a written complaint within 180 days of the alleged violation to the address listed below, or you may get further information about matters covered by this notice by mailing to:

The Palomino Group
Policy Authority
25248 Lincoln Drive
Isanti, MN 55040
(763) 444-6525
info@palominogroup.com

Additionally, if you believe your privacy rights have been violated, you may also file a complaint with the Secretary of the United States, Department of Health & Human Services. You will not be penalized for filing a complaint about our privacy practices. The contact information is:

U.S. Dept. of Health & Human Services
Office for Civil Rights
601 East 12th Street- Room 248
Kansas City, MO 64106
(816)426-7278; (816)426-7065 (TDD); (816)426-3686 (Fax)