Who this notice covers
This notice applies to the physician-owned professional entities that provide your clinical care — Pellmoor Medical Group, S.C.; Pellmoor Medical Group Indiana, P.C.; Pellmoor Medical Group NY, P.C. — and to Pellmoor Health Technologies, LLC acting as their business associate. These entities participate in an organized health care arrangement and share protected health information as necessary for your treatment, payment, and health care operations.
Our legal duties
We are required by law to:
- Maintain the privacy and security of your protected health information;
- Give you this notice of our legal duties and privacy practices;
- Follow the terms of the notice currently in effect;
- Notify you promptly if a breach occurs that may have compromised the privacy or security of your information.
How we may use and disclose your health information without your authorization
Treatment
We use your information to provide, coordinate, and manage your care — for example, sharing your labs with your treating clinician, sending a prescription to your chosen pharmacy, or referring you to a specialist.
Payment
We use your information to bill and collect payment for services. Because we do not accept insurance, we do not submit claims to any health plan, and we do not disclose your information to insurers for payment purposes unless you specifically ask us to provide you with documentation you intend to submit yourself.
Health care operations
We use your information for quality assessment, clinical protocol review, chart audits, credentialing, training, business planning, and compliance activities.
As required by law
Including public health reporting, reporting suspected abuse or neglect, responding to certain court orders and subpoenas, reporting to the Food and Drug Administration about product safety, and reporting to state prescription drug monitoring programs as mandated for controlled substances.
To avert a serious threat
We may disclose information when necessary to prevent a serious and imminent threat to your health or safety or the health or safety of others.
Other permitted disclosures
- To health oversight agencies for audits, investigations, and licensure activity;
- For workers' compensation purposes where state law requires;
- To coroners, medical examiners, and funeral directors;
- For research, only with Institutional Review Board approval or where the information has been properly de-identified;
- To persons involved in your care, when you agree or when you are not present and we determine in our professional judgment that it is in your best interest.
Uses and disclosures that always require your written authorization
- Marketing. We will not use your health information to market anything to you without your written authorization, and we do not accept payment from third parties to communicate with you about their products.
- Sale of information. We do not sell protected health information. Any sale would require your authorization.
- Psychotherapy notes, where such notes exist.
- Most other uses not described in this notice.
You may revoke an authorization in writing at any time, except to the extent we have already acted on it.
Your rights
Right to access and receive a copy
You may inspect and obtain a copy of your medical and billing records. We provide electronic copies through your patient portal at no charge, in a readily producible electronic format, and we will send a copy to a third party you designate in writing. We will respond within 30 days.
Right to request an amendment
If you believe information in your record is incorrect or incomplete, you may ask us to amend it. We may deny the request in certain circumstances, and if we do we will explain why in writing and you may submit a statement of disagreement that becomes part of your record.
Right to an accounting of disclosures
You may request a list of certain disclosures we have made of your health information in the six years before your request.
Right to request restrictions
You may ask us to restrict certain uses or disclosures. We are not required to agree to every request, but we must agree to a request to restrict disclosure to a health plan for a service you paid for in full out of pocket. Since we bill no health plans at all, this protection applies to your entire record with us by default.
Right to confidential communications
You may ask us to contact you at a particular address or by a particular method. We will accommodate reasonable requests.
Right to a paper copy of this notice
You may request a paper copy at any time, free of charge, even if you agreed to receive it electronically.
Right to be notified of a breach
We will notify you without unreasonable delay and no later than 60 days after discovering a breach of your unsecured protected health information.
Right to choose someone to act for you
A person with medical power of attorney or a legal guardian may exercise your rights and make choices about your information. We will verify that authority before acting.
Additional protections under state law
Where state law is more protective than HIPAA, we follow state law. This includes, among others, the New York SHIELD Act and Public Health Law Article 27-F protections for HIV-related information, the Illinois Mental Health and Developmental Disabilities Confidentiality Act, the Illinois Genetic Information Privacy Act, and the Illinois Biometric Information Privacy Act.
Record retention
We retain adult medical records for at least the minimum period required by the state in which care was provided: Illinois 10 years, Indiana 7 years, and New York 6 years. We retain HIPAA compliance documentation for at least 6 years.
Changes to this notice
We may change this notice and apply the changes to information we already hold. The current version is always posted at pellmoorhealth.com/legal/notice-of-privacy-practices with its effective date.
Complaints
Contact our Privacy Officer at privacy@pellmoorhealth.com. You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue SW, Washington, D.C. 20201, or at hhs.gov/ocr/privacy/hipaa/complaints, or by calling 1-877-696-6775. We will not retaliate against you for filing a complaint, and filing one will not affect your care.