Family Clinic in Cleveland, Ohio

Privacy Officer: Abedalhakeem Abukhalil
Mailing Address: 14529 Puritas Ave, Cleveland, OH 44135
Telephone: 216-431-3733

About This Notice

We are required by law to maintain the privacy of your Protected Health Information (PHI) and to provide you with this Notice outlining our privacy practices. You have specific rights regarding the privacy of your PHI, and this Notice explains those rights and our obligations. We are bound by the terms of this Notice.

What Is Protected Health Information?

Protected Health Information refers to any information that identifies you, which we gather from you, other healthcare providers, or healthcare-related entities. It includes data about:

1. Your past, present, or future physical or mental health conditions.
2. The healthcare services provided to you.
3. The payment for your healthcare services.

How We May Use and Disclose Your Protected Health Information

We may use and disclose your Protected Health Information (PHI) in various situations, as outlined below:

• For Treatment
  We may use or disclose your PHI to provide medical treatment and services, as well as to coordinate and manage your care. For example, your PHI may be shared with specialists or other healthcare providers (e.g., laboratories) to ensure they have the necessary information to diagnose, treat, or provide services to you.
• For Payment
  We may use or disclose your PHI for billing and payment purposes. This includes actions your health insurance may take before approving or paying for recommended services, such as determining eligibility, reviewing medical necessity, and conducting utilization reviews. We may need to share details of your treatment with your health plan to ensure coverage and payment.
• For Health Care Operations
  We may use or disclose your PHI for operational purposes, such as reviewing the quality of care provided and evaluating the performance of our staff. We may also disclose information to healthcare professionals (e.g., physicians, nurses, medical students) for educational or training purposes.
• Appointment Reminders, Treatment Alternatives, and Health-Related Services
  We may use and disclose your PHI to contact you for appointment reminders or to inform you of potential treatment options, alternatives, or other health-related services that may be beneficial to you.
• Minors
  We may disclose the PHI of minors to their parents or guardians unless restricted by law.
• Research
  We may use and disclose your PHI for research, subject to approval by an institutional review board or privacy board. This approval ensures that your information is used in a way that protects your privacy. In some cases, researchers may access PHI to prepare for studies, but without removing or copying any information. We may also disclose a limited data set for research if a data use agreement is in place to protect your privacy.
• As Required by Law
  We will disclose your PHI when required by international, federal, state, or local law.
• To Prevent Serious Health or Safety Threats
  We may use or disclose PHI when necessary to prevent a serious threat to health or safety, either your own or someone else’s, but only to those who can help prevent the threat.
• Business Associates
  We may disclose PHI to business associates who perform services for us, such as billing, transcription, or consulting. These associates are obligated to protect the privacy and security of your PHI.
• Organ and Tissue Donation
  If you are an organ or tissue donor, we may disclose PHI to organizations involved in organ procurement or transplantation to facilitate the process.
• Military and Veterans
  For military personnel, we may disclose PHI as required by military authorities or, if applicable, to foreign military officials.
• Workers’ Compensation
  We may disclose PHI for workers’ compensation or similar programs that provide benefits for work-related injuries or illnesses.
• Public Health Risks
  We may disclose PHI for public health purposes, including:
  • Reporting FDA-regulated product quality or safety issues.
  • Preventing or controlling disease or injury.
  • Reporting births, deaths, or child abuse.
  • Reporting adverse medication reactions.
  • Notifying people of product recalls.
  • Informing individuals about exposure risks to diseases.
• Abuse, Neglect, or Domestic Violence
  We may disclose PHI if we believe a patient has been a victim of abuse, neglect, or domestic violence, with the patient’s consent or if required by law.
• Health Oversight Activities
  We may disclose PHI to health oversight agencies for authorized activities, including audits, investigations, and compliance monitoring.
• Data Breach Notification
  We may use or disclose PHI to provide legally required notifications of unauthorized access to or disclosure of health information.
• Lawsuits and Disputes
  In the event of a lawsuit or dispute, we may disclose PHI in response to a court or administrative order, subpoena, or legal process as long as efforts have been made to notify you or obtain an order protecting the information.
• Law Enforcement
  We may disclose PHI for law enforcement purposes when required by law or in compliance with legal requirements.
• Military Activity and National Security
  We may disclose PHI for military, national security, or intelligence activities or to law enforcement custody for legal duties under the law.
• Coroners, Medical Examiners, and Funeral Directors
  We may disclose PHI to coroners, medical examiners, or funeral directors for their duties.
• Inmates
  If you are an inmate or under the custody of law enforcement, we may disclose PHI to the correctional institution or law enforcement for necessary healthcare, health and safety, or institutional security purposes.

Uses and Disclosures That Require Us to Give You an Opportunity to Object and Opt-Out

• Individuals Involved in Your Care: We may disclose your PHI to family members or others involved in your care unless you object.
• Disaster Relief: We may disclose your PHI to disaster relief organizations to coordinate care or notify your family of your condition.
• Fundraising Activities:We may use your PHI for fundraising, with the option to opt out.

Your Written Authorization Is Required for Other Uses and Disclosures

We will only use or disclose your PHI for the following with your written authorization:

• Most uses of psychotherapy notes.
• Marketing purposes.
• Disclosures that constitute the sale of your PHI.

You may revoke your authorization at any time, but the revocation will not affect disclosures made before you revoked it.

Your Rights Regarding Your Protected Health Information

You have the following rights concerning your Protected Health Information (PHI), subject to certain limitations:

• Right to Inspect and Copy
  You have the right to review and obtain a copy of your PHI that is used to make decisions about your care or payment for your care. We are required to provide access within 30 days and may charge a reasonable fee for copying, mailing, or other associated costs. We do not charge for requests related to claims for benefits under the Social Security Act or other state or federal needs-based programs. In some cases, we may deny your request. If this happens, you can have the denial reviewed by an independent licensed healthcare professional, and we will comply with the outcome.
• Right to a Summary or Explanation
  You may request a summary or explanation of your PHI instead of receiving the entire record. If you choose this option, we may charge you the associated fees.
• Right to an Electronic Copy of Electronic Medical Records
  If your PHI is maintained electronically (such as in an electronic health record), you can request an electronic copy or have it sent to another entity. We will strive to provide the record in your preferred format if possible. If not, we will offer the information in a standard electronic format or a readable hard copy. A reasonable fee may apply for the labor involved in transmitting the record.
• Right to Get Notice of a Breach
  You have the right to be notified if there is a breach of your unsecured PHI.
• 5. Right to Request Amendments
  If you believe any of your PHI is incorrect or incomplete, you can request an amendment. The request must be made in writing to the Privacy Officer, including the reason for the amendment. If we deny your request, you can file a statement of disagreement, and we will provide a rebuttal.
• Right to an Accounting of Disclosures
  You may request a list of disclosures of your PHI that were made for purposes other than treatment, payment, or healthcare operations. This does not include disclosures made to you, to a family member involved in your care, or for certain notifications. The first request within a 12-month period is free; subsequent requests may incur a reasonable fee.
• Right to Request Restrictions
  You can request limitations on the use or disclosure of your PHI for treatment, payment, or healthcare operations. You may also request a limit on disclosures to individuals involved in your care or payment. Requests must be made in writing to the Privacy Officer. We are not required to honor your request, except in specific cases, such as when the restriction pertains to a service for which you have paid out-of-pocket in full.
• Out-of-Pocket Payments
  If you paid for a specific service out-of-pocket, you can request that your PHI regarding that service not be disclosed to your health plan for payment or operations. We will honor this request.
• Right to Request Confidential Communications
  You have the right to request that we communicate with you in a manner that preserves your privacy, such as contacting you at a specific address or phone number. Requests must be made in writing, specifying how and where we should communicate with you. We will accommodate all reasonable requests without asking for a reason.
• Right to a Paper Copy of This Notice
  You are entitled to receive a paper copy of this Notice, even if you have agreed to receive it electronically. You may request a copy at any time.

How to Exercise Your Rights

To exercise any of your rights, please contact our Privacy Officer at the address or number listed above. We will respond within the timeframes required by law.

Changes to This Notice

We reserve the right to revise this Notice of Privacy Practices. Any changes will apply to your PHI even if it was created before the change. An updated version of this Notice will be posted at our practice, and a copy will be available upon request.

Complaints

If you believe your privacy rights have been violated, you have the right to file a complaint either with us or with the Secretary of the U.S. Department of Health and Human Services.

• To file a complaint with us: Contact our Privacy Officer at the address listed at the beginning of this Notice. All complaints must be submitted in writing and should be filed within 180 days of when you became aware or should have been aware of the suspected violation. Rest assured, there will be no retaliation for filing a complaint.
• To file a complaint with the Secretary of the U.S. Department of Health and Human Services:
  Mail your complaint to:
  Secretary of the U.S. Department of Health and Human Services
  200 Independence Ave, S.W.
  Washington, D.C. 20201

You can also call (202) 619-0257 or toll-free at (877) 696-6775, or visit the website of the Office for Civil Rights at www.hhs.gov/ocr/hipaa/ for more information.
As with complaints filed with us, there will be no retaliation for filing a complaint.