The Matrescence, LLC (the “Company” or “we”) provides educational programing and content related to maternal mental health and wellness and hosts a digital platform to facilitate group discussions, forums, and message boards amongst its members (collectively, the “Services”).
In order to provide the Services, we may collect, use, share, and exchange your personal health information. Some or all of the health and health-related information we collect may be considered personal health information which is protected under the Health Insurance Portability and Accountability Act (“HIPAA”).
HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION
Described as follows are the ways we may use and disclose health information that identifies you (“Health Information” or “PHI”). Except for the following purposes, we will use and disclose Health Information only with your written permission. You may revoke such permission at any time by writing to us and stating that you wish to revoke permission you previously gave us.
Services. We may use and disclose Health Information in order to provide the Services and ensure that you are receiving appropriate educational materials and content.
Payment. We may use and disclose Health Information so that we may bill and receive payment from you or a third party for the Services you received. For example, we may give your health plan information so that they will pay for your treatment. However, if you pay for your services yourself (e.g. out-of-pocket and without any third-party contribution or billing), we will not disclose Health Information to a health plan.
Records Release to You. We will provide a copy or a summary of your Health Information in response to a request for a copy of your records made by you or medical personnel whom you have so designated to receive information involved in your care in the format requested.
Appointment Reminders, Treatment Alternatives and Health Related Benefits and Services. We may use and disclose Health Information to contact you and to remind you that you have an appointment with us. We also may use and disclose Health Information to tell you about health-related benefits and services that may be of interest to you.
Release of Health Information to Family, Friends and Associates. We will only share Health Information with non-medical personnel (such as your family, friends, and associates) you have specifically designated with permission. We also may notify your family about your location or general condition or disclose such information to an entity assisting in a disaster relief effort.
Research, Fundraising, and Marketing. Under certain circumstances, we may create de-identified information and then use and disclose this information as permitted by law, including to third parties in connection with commercial and marketing activities and clinical research studies.
As Required by Law. We will disclose Health Information when required to do so by federal, state or local law.
To Avert a Serious Threat to Health or Safety. We may use and disclose Health Information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Disclosures, however, will be made only to someone who may help prevent the threat.
Business Associates. We may disclose Health Information to our business associates that perform functions on our behalf or provide us with services if the information is necessary for such functions or services. For example, we may use another company to perform billing services on our behalf. All of our business associates are obligated to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract.
Military and Veterans. If you are a member of the armed forces, we may release Health Information as required by military command authorities. We also may release Health Information to the appropriate foreign military authority if you are a member of a foreign military.
Workers’ Compensation. We may release Health Information for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
Public Health Risks. We may disclose Health Information for public health activities. These activities generally include disclosures to prevent or control disease, injury or disability; report births and deaths; report child abuse or neglect; report reactions to medications or problems with products; notify people of recalls of products they may be using; a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.
Health Oversight Activities. We may disclose Health Information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
Lawsuits. If you are involved in a lawsuit or a dispute, we may disclose Health Information in response to a court or administrative order. We also may disclose Health Information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
Law Enforcement. We may release Health Information if asked by a law enforcement official if the information is: (1) in response to a court order, subpoena, warrant, summons or similar process; (2) limited information to identify or locate a suspect, fugitive, material witness, or missing person; (3) about the victim of a crime even if, under limited circumstances, we are unable to obtain the person’s agreement; (4) about a death we believe may be the result of criminal conduct; and (5) in an emergency to report a crime, the location of the crime or victims, or the identity, description or location of the person who committed the crime.
Coroners, Medical Examiners and Funeral Directors. We may release Health Information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We also may release Health Information to funeral directors as necessary for their duties.
Inmates or Individuals in Custody. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release Health Information to the correctional institution or law enforcement official. This release would be if necessary: (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) the safety and security of the correctional institution.
Other Uses. We may be allowed or required to share your information in other ways that contribute to the public good. We have to meet many conditions in the law before we can share your information for these purposes. Such reasons may include help with public health and safety issues, compliance with the law, response to organ and tissue donation requests, working with a medical examiner or funeral director, answering workers’ compensation, law enforcement, and other government requests, and responding to lawsuits and legal actions. For more information, see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
You have the following rights regarding Health Information we have about you:
Right to Inspect and Copy. You have a right to inspect and obtain a copy of your Health Information. To inspect and obtain a copy of this Health Information, you must make your request, in writing, to our office.
Right to Amend. If you feel that Health Information we have is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for Company. To request an amendment, you must make your request, in writing, to our office.
Right to an Accounting of Disclosures. You have the right to request a list of certain disclosures we made of Health Information for purposes other than treatment, payment and health care operations or for which you provided written authorization. To request an accounting of disclosures, you must make your request, in writing, to our mailing address below.
Right to Request Confidential Communication. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. Such requests must be made in writing to our office. We will accommodate reasonable requests.
Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. You may obtain a copy of this notice at our web site, https://thematrescence.com. To obtain a paper copy of this notice, please request it in writing.
Right to Electronic Records. You have the right to receive a copy of your electronic health records in electronic form.
Right to Breach Notification. You have the right to be notified if there is a Breach of privacy such that your Health Information is disclosed or used improperly or in an unsecured way.
CHANGES TO THIS NOTICE
We reserve the right to change this notice and make the new notice apply to Health Information we already have as well as any information we receive in the future.
If you believe your privacy rights have been violated, you may file a complaint with our office or with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. All complaints must be made in writing. You will not be penalized for filing a complaint.
California Privacy Rights
Email: firstname.lastname@example.org Phone: 417-880-4968