At Mystic Health, we believe it’s important that you fully understand your rights when it comes to your health information. Here is a detailed explanation of the rights you have and our responsibilities in helping you protect your information:
Requesting a Copy: You have the right to request an electronic or paper copy of your medical record and other health information we have about you. This can include lab results, doctor’s notes, and treatment history.
How to Access: Simply ask us how to do this, and we will provide the requested records within 30 days of your request.
Cost: We may charge a reasonable, cost-based fee to cover the costs of providing these records.
Requesting Corrections: If you believe that any part of your medical record is incorrect or incomplete, you can ask us to correct it.
Response Time: We will respond to your request within 60 days. If we are unable to make the requested correction, we will provide a written explanation as to why.
Customized Communication: You have the right to ask us to contact you in a specific way, such as using a different phone number, email address, or sending mail to an alternate address to protect your privacy.
Our Promise: We will agree to all reasonable requests regarding how we communicate with you.
Limiting Sharing: You can ask us not to use or share certain health information for treatment, payment, or operational purposes.
Exceptions: While we are not required to agree to all requests, we will do our best to accommodate your preferences when it does not interfere with your care.
Out-of-Pocket Payments: If you fully pay for a service out of pocket, you can request that we do not share that information with your health insurance provider for payment or operational reasons. We are required to honor this request unless the law requires otherwise.
Request a List: You have the right to ask for a detailed list (accounting) of when and with whom we’ve shared your health information over the last six years, starting from the date you make the request.
What’s Included: This list will exclude any disclosures made for treatment, payment, healthcare operations, or certain other exceptions such as those you specifically asked us to make.
Frequency and Cost: We will provide one accounting per year at no cost. If you request additional accountings within the same 12-month period, we may charge a reasonable, cost-based fee.
Paper Copy: You have the right to ask for a paper copy of this privacy notice at any time, even if you have agreed to receive it electronically. We will provide you with a copy promptly upon request.
Medical Power of Attorney: If you have designated someone to make healthcare decisions for you (such as through medical power of attorney), that person has the right to act on your behalf and make choices about your health information.
Verification: We will verify that this person has the necessary authority before allowing them to access your information or make decisions for you.
Filing a Complaint: If you believe your privacy rights have been violated, you can file a complaint directly with us. You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights.
To file a complaint with the Department of Health and Human Services, you can visit [hhs.gov](http://www.hhs.gov) or send a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201. You may also call 1-877-696-6775.
No Retaliation: We will not retaliate against you for filing a complaint.
For certain types of health information, you have the option to decide how we use and share it. If you have a clear preference for how your health information is shared, let us know, and we will follow your instructions.
In These Cases, You Have the Right to Tell Us To:
Important: If you are unable to express your preferences due to a medical emergency, we may share your information if we believe it is in your best interest. This also applies if sharing your information can help lessen a serious threat to your health or safety.
In this section, we explain the different ways we typically use or share your health information to support your treatment, manage our operations, or bill for services provided. We handle your information responsibly and in compliance with legal standards to ensure your privacy and safety.
How it works: We use your health information and share it with healthcare professionals involved in your treatment. For instance, if you're receiving care from multiple providers, we may need to share your information with other doctors or specialists to ensure the best possible care.
Example: A doctor treating you for an injury might share your health details with another healthcare professional to coordinate your treatment plan and monitor your overall health condition.
How it works: We use your health information to operate our practice, improve the quality of care, and manage communications with you as needed.
Example: Your health information might be used to manage your treatment services, ensure smooth operations at our clinic, or contact you for follow-up appointments.
How it works: We share your health information to bill and receive payments from health plans or other entities responsible for covering the costs of your care.
Example: After providing a medical service, we may share your health information with your insurance company to ensure that your care is properly billed and paid for
In addition to the usual ways we use your health information for treatment, operations, and billing, there are certain situations where we may be required to share your health information to contribute to public health and safety or meet legal obligations. Below are some examples of these situations.
We may share your health information in specific circumstances to help protect public health or ensure safety. These situations include:
Complying with the Law: In situations where federal or state laws require us to share your information, we must do so. This may include sharing information with the Department of Health and Human Services to show that we are complying with federal privacy laws.
There are certain situations where we are required or allowed to share your health information in connection with legal and government requests. Here’s how we handle these situations:
We can share health information with medical examiners or funeral directors when an individual dies. This helps them complete their responsibilities, such as identifying the deceased, determining the cause of death, or handling other related duties.
We may use or share your health information in the following legal and government-related circumstances:
For Workers' Compensation Claims: We can disclose your health information to support claims under workers' compensation or similar programs.
For Law Enforcement Purposes: We may share information with law enforcement officials in specific situations, such as complying with a court order or reporting certain injuries.
With Health Oversight Agencies: We may share your information with agencies that oversee the healthcare system to ensure compliance with laws, such as audits or investigations.
For Special Government Functions: In cases related to national security, military activities, or protective services for high-level officials, we may share your information as required by law.
If you are involved in a lawsuit or a legal dispute, we may share your health information in response to a court or administrative order, or if we receive a legal request, such as a subpoena. However, we will only share the information necessary to fulfill the legal requirement.
As a healthcare provider, we have a set of important responsibilities when it comes to protecting your health information. Below is a breakdown of these responsibilities:
We are required by law to maintain the privacy and security of your protected health information (PHI). We take this responsibility seriously and have policies and safeguards in place to ensure that your information is secure.
If there is ever a breach that may have compromised the privacy or security of your health information, we will notify you promptly. This allows you to take any necessary steps to protect yourself and your information.
We must follow the duties and privacy practices described in this notice. This means that we are bound by the commitments we've outlined here and must always act in accordance with them.
We will not use or share your health information in any way that is not described in this notice unless you provide us with written permission. If you decide to give us permission to use your information in a certain way, you can always change your mind later. Just let us know in writing if you wish to revoke your consent.
For additional details about your privacy rights, you can visit the following link: [www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html](http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html)
We may occasionally update the terms of this notice. Any changes we make will apply to all the health information we have about you, both past and present. If we make changes, we will provide a new notice in our office, on our website, and upon your request. We will make sure you are informed of any significant changes to how your information is handled.
This notice applies to the following organization:
Houman Farzin M.D. Inc. dba Mystic Health
Email: info@mystic.health
Privacy Officer: Kabir Ali
These Terms of Service were last updated on Friday, 9 September, 2024