| HIPAA - D2Hawkeye Notice of Privacy Practices |
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NOTICE EFFECTIVE DATE: April 14, 2003 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. This Notice of Privacy Practices applies to the healthcare components of D2Hawkeye CONTACT INFORMATION If you have any questions about this notice, please contact Privacy Officer, D2Hawkeye, 130 Turner Street, Seventh Floor, Waltham, Massachusetts 02453, telephone: 781-693-3700, E-mail address: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it . OUR PLEDGE REGARDING YOUR MEDICAL INFORMATION We understand that information about you and your health is personal and we are committed to protecting this information. A record of your protected health information (PHI) is maintained at D2Hawkeye in order to provide your health plan or administrator with quality services and to comply with certain legal requirements. This notice applies to the record of your PHI maintained by D2Hawkeye. This notice will tell you how we may use and disclose your health information. It also describes your rights and certain obligations we have regarding the use and disclosure of this information. HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION he following categories describe different ways that we may use and disclose health information. For each category we will explain what we mean and in some instances provide an example. Not every use or disclosure will be listed. However, all of the ways we are permitted to use and disclose health information will fall within one of the following categories. Healthcare Operations We may use and disclose your health information for operational purposes for use by D2Hawkeye staff to fulfill contractual obligations with your health plan or administrator. For example, your health information may be used by our staff to assess the performance of vendors contracted by your plan or administrator. Also, your information could be used to measure medical quality and outcomes and to determine how your health plan or administrator may continually improve the quality and effectiveness of the services they provide. At times, we may remove identifiers from your health information so others may use the anonymous information to study healthcare delivery. As Required by Law We will disclose your health information when required to do so by federal, state or local law. To Avert a Serious Threat to Health or Safety We will disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of another person or the general public. Government If you are a member of the armed forces, we may disclose your health information as required by military command authorities. We may release your health information to authorized federal officials for national security activities authorized by law. Public Health Risks We may disclose your health information for a number of public health activities. These include disclosures:
Health Oversight We may disclose your health information to a health oversight agency for health oversight activities authorized by law, which may include audits, investigations, inspections and licensure. These activities are necessary for the government to monitor the healthcare system, government programs and compliance with civil rights laws.
Lawsuits and Disputes If you are involved in a lawsuit or a 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, search warrant, discovery request or other lawful process by someone else involved in the dispute. Law Enforcement We may disclose your health information if asked to do so by a law enforcement official
Coroners/Medical Examiners/Funeral Directors We may disclose your health information to a coroner, medical examiner or funeral director to assist them in performing their duties. OTHER USES OR DISCLOSURES Uses or disclosures of your health information other than those identified in this notice will be made only with your written authorization. You may revoke that authorization at any time. YOUR HEALTH INFORMATION RIGHTS You have the following rights regarding your health information:
All requests must be submitted in writing. D2Hawkeye has the right to refer you to your health plan or administrator to comply with these requests. COMPLAINTS If you believe your privacy rights have been violated, you may file a complaint with D2Hawkeye or with the Secretary of the Department of Health and Human Services. All complaints must be submitted in writing. D2Hawkeye will investigate all complaints promptly and thoroughly. You will not be retaliated against for filing a complaint. D2HAWKEYE'S OBLIGATIONS TO YOU D2Hawkeye will:
CHANGES TO THIS NOTICE We reserve the right to change this notice and its practices. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice on our Web site at http://www.d2hawkeye.com/.
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