HIPAA Notice of Privacy Practices 

THIS NOTICE DESCRIBES HOW MEDICALINFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TOTHIS INFORMATION.  PLEASE REVIEW ITCAREFULLY. 

Waymark Care is committed toprotecting the confidentiality of its patients’ medical information.  This Notice of Privacy Practices (“Notice”)describes how we may use and disclose your medical information and your rightsconcerning your medical information. This Notice is provided to you pursuant to the Health InsurancePortability and Accountability Act of 1996 and its implementing regulations (“HIPAA”).

OUR RESPONSIBILITIES

We are required to (i) maintain theprivacy of your medical information as required by law; (ii) provide you withthis Notice stating our legal duties and privacy practices with respect to yourmedical information; (iii) abide by the terms of this Notice; and (iv) notifyyou following a breach of your medical information that is not secured inaccordance with certain security standards.

We reserve the right to change theterms of this Notice and to make the provisions of the new Notice effective forall medical information that we maintain. If we change the terms of this Notice, the revised Notice will be madeavailable upon request and posted online. Copies of the current Notice may be obtained by contacting our PrivacyOfficer.

USES AND DISCLOSURES WITHOUT YOURAUTHORIZATION

The following categories describedifferent ways that we use and disclose medical information.  For each category of uses or disclosures, wewill explain what we mean and try to give an example.  Not every use or disclosure in a category islisted.  However, all of the ways we arepermitted to use and disclose medical information fall within one of thecategories. 

Treatment:  We may use and disclose your medicalinformation to provide, coordinate and/or manage your treatment, health care,or other related services.  For example,we may disclose medical information about you to your primary care doctor oranother provider who is involved in your care. We may also use your medical information to remind you about an upcomingappointment.

Payment:  We may use and disclose your medicalinformation as needed to bill or obtain payment for the treatment and servicesprovided.  For example, we may contactyour health plan to determine whether it will authorize payment for ourservices or to determine the amount of your co-payment or co-insurance.

Healthcare Operations:  We may use or disclose your medical informationin order to carry out our general business activities or certain businessactivities.  These activities include,but are not limited to, training and education; quality assessment/improvementactivities; risk management; claims management; legal consultation; licensing;and other business planning activities. For example, we may use your medical information to evaluate the qualityof care we are providing.

Family and Friends:  We may disclose your medical information to afamily member or friend who is involved in your medical care or to someone whohelps pay for your care.  We may also useor disclose your medical information to notify (or assist in notifying) afamily member, legally authorized representative or other person responsiblefor your care of your location, general condition or death.  If you are a minor, we may release yourmedical information to your parents or legal guardians when we are permitted orrequired to do so under federal and applicable state law.

Third Parties:  We may disclose your medical information tothird parties with whom we contract to perform services on our behalf.  If we disclose your information to theseentities, we will have an agreement with them to safeguard your information.  Examples of these third parties include, butare not limited to, accreditation agencies, management consultants, qualityassurance reviewers, collection agencies, transcription services, etc.

Required by Law:  We may use or disclose your medicalinformation to the extent the use or disclosure is required by law.  Any such use or disclosure will be made incompliance with the law and will be limited to what is required by the law.

Public Health Activities:  We may disclose your medical information forpublic health activities.  Theseactivities generally include the following:

• To prevent or control disease,injury or disability
• To report child abuse or neglect
• To report reactions to medicationsor problems with products
• To notify people of recalls ofproducts they may be using 
• To notify a person who may havebeen exposed to a disease or may be at risk for contracting or spreading adisease or condition
• To notify the appropriategovernment authority if we believe you have been the victim of abuse, neglector domestic violence.  We will only makethis disclosure if you agree or when otherwise required by law to make thedisclosure.

Health Oversight Activities:  We may disclose your medical information to ahealth oversight agency for activities authorized by law.  These oversight activities include, forexample, audits; investigations, proceedings or actions; inspections; anddisciplinary actions; or other activities necessary for appropriate oversightof the health care system, government programs and compliance with applicablelaws. 

Law Enforcement:  We may disclose your medical information tolaw enforcement in very limited circumstances, such as to identify or locatesuspects, fugitives, witnesses or victims of a crime, to report deaths from acrime, and to report crimes that occur on our premises.  

Judicial and AdministrativeProceedings:  We may disclose informationabout you in response to an order of a court or administrative tribunal asexpressly authorized by such order.  

To Avert a Serious Threat to Healthor Safety: We may use or disclose your medical information when necessary toprevent a serious and imminent threat to your health or safety or the healthand safety of the public or another person. Any disclosure would only be to someone able to help prevent the threatof harm.

Disaster Relief Efforts:  We may use or disclose your medicalinformation to an authorized public or private entity to assist in disasterrelief efforts.  You may have the opportunityto object unless it would impede our ability to respond to emergencycircumstances.

Coroners, Medical Examiners andFuneral Directors:  We may disclosemedical information consistent with applicable law to coroners, medicalexaminers and funeral directors only to the extent necessary to assist them incarrying out their duties.

Organ and Tissue Donation:  We may disclose medical informationconsistent with applicable law to organizations that handle organ, eye ortissue donation or transplantation, only to the extent necessary to help facilitateorgan or tissue donation or transplantation.

Research:  Under certain circumstances, we may also useand disclose information about you for research purposes.  All research projects are subject to aspecial approval process through an appropriate committee 

Workers’ Compensation:  We may disclose your medical information asauthorized by law to comply with workers’ compensation laws and other similarprograms established by law.

Military, Veterans, NationalSecurity and Other Government Purposes: If you are a member of the armed forces, we may release your medicalinformation as required by military command authorities or to the Department ofVeterans Affairs.  We may also discloseyour medical information to authorized federal officials for intelligence andnational security purposes to the extent authorized by law. 

Correctional Institutions: If youare or become an inmate of a correctional institution or are in the custody ofa law enforcement official, we may disclose to the institution or lawenforcement official information necessary for the provision of health servicesto you, your health and safety, the health and safety of other individuals andlaw enforcement on the premises of the institution and the administration andmaintenance of the safety, security and good order of the institution.

OTHER USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION 

If we wish to use or disclose yourmedical information for a purpose not set forth in this Notice, we will seekyour authorization.  Specific examples ofuses and disclosures of medical information requiring your authorizationinclude: (i) most uses and disclosures of your medical information formarketing purposes; (ii) disclosures of your medical information thatconstitute the sale of your medical information; and (iii) most uses anddisclosures of psychotherapy notes (private notes of a mental healthprofessional kept separately from a medical record).  You may revoke an authorization in writing atany time, except to the extent that we have already taken action in reliance onyour authorization.

YOUR MEDICAL INFORMATION RIGHTS

Inspect and/or obtain a copy ofyour medical information.  You have theright to inspect and/or obtain a copy of your medical information maintained ina designated record set.  If we maintainyour medical information electronically, you may obtain an electronic copy ofthe information or ask us to send it to a person or organization that youidentify.  To request to inspect and/orobtain a copy of your medical information, you must submit a written request toour Privacy Officer.  If you request acopy (paper or electronic) of your medical information, we may charge you areasonable, cost-based fee.

Request a restriction on certainuses and disclosures of your medical information.  You have the right to ask us not to use ordisclose any part of your medical information for purposes of treatment,payment or healthcare operations.  Whilewe will consider your request, we are only required to agree to restrict adisclosure to your health plan for purposes of payment or healthcare operations(but not for treatment) if the information applies solely to a healthcare itemor service for which we have been paid out of pocket in full.  If we agree to a restriction, we will not useor disclose your medical information in violation of that restriction unless itis needed to provide emergency treatment. We will not agree to restrictions on medical information uses ordisclosures that are legally required or necessary to administer ourbusiness.  To request a restriction, youmust submit a written request to our Privacy Officer.

Request confidentialcommunications.  You have the right torequest that we communicate with you in a certain way or at a certainlocation.  For example, you can ask thatwe only contact you at work or by mail. To request a confidential communication of your medical information, youmust submit a written request to our Privacy Officer stating how or when youwould like to be contacted.  We will notrequire you to provide an explanation for your request.  We will accommodate all reasonable requests.

Request an amendment to yourmedical information.  If you believe thatany information in your medical record is incorrect or if you believe importantinformation is missing, you may request that we amend the existinginformation.  To request such anamendment, you must submit a written request to our Privacy Officer. 

Request an accounting of certaindisclosures.  You have the right toreceive an accounting of certain disclosures we have made of your medicalinformation.  To request an accounting,you must submit a written request to our Privacy Officer.  The first accounting you request within a12-month period will be provided free of charge.  We may charge you for any additional requestsin that same 12-month period. 

Obtain a paper copy of thisNotice.  You have the right to obtain apaper copy of this Notice upon request, even if you agreed to accept thisNotice electronically.  To obtain a papercopy of this Notice, contact our Privacy Officer.

STATE LAW

We will not use or share yourinformation if state law prohibits it. Some states have laws that are stricter than the federal privacyregulations, such as laws protecting HIV/AIDS information or mental healthinformation.  If a state law applies tous and is stricter or places limits on the ways we can use or share your healthinformation, we will follow the state law. If you would like to know more about any applicable state laws, pleaseask our Privacy Officer.

QUESTIONS, CONCERNS OR COMPLAINTS

If you have any questions or wantmore information about this Notice or how to exercise your medical informationrights, you may contact our Privacy Officer by mail at: Attn: Privacy Officer,2021 Fillmore Street, Suite 1059, San Francisco, CA 94115.

If you believe your privacy rightshave been violated, you may file a complaint with our Privacy Officer or withthe Office for Civil Rights: Centralized Case Management Operations, U.S.Department of Health and Human Services, 200 Independence Avenue, S.W., Room509F HHH Bldg., Washington, D.C. 20201 or OCRComplaint@hhs.gov.  We will not retaliate against you for filinga complaint.