SoWell – Patient Notice of HIPAA Privacy Practices
This Notice describes how medical information about you may be used and disclosed and how you get access to such information. Please review it carefully.
SoWell’s Commitment to Your Privacy
SoWell Services, Inc., a Delaware corporation (“SoWell”) is dedicated to protecting the privacy of your protected health information (“PHI”). PHI is information about you that may be used to identify you (such as your name, social security number, email address, mobile telephone number, address, or date of birth), and that relates (a) to your past, present, or future physical or mental health or condition; (b) to the provision of healthcare to you; or (c) your past, present, or future payment for the provision of healthcare. In conducting its business, SoWell will receive and create records containing your PHI. SoWell is required by law to maintain the privacy of your PHI and provide you with notice of its legal duties and privacy practices with respect to your PHI. Healthcare providers involved in your care may have different policies or notices regarding their use and disclosure of your PHI.
SoWell must maintain the privacy of your PHI, give you this Notice of its legal duties and privacy practices, notify you if you are affected by a breach of unsecured PHI, and abide by the terms of this Notice while it is in effect. SoWell and its employees, volunteers, and other personnel must also abide by this Notice.
This current Notice will take effect on December [_], 2020 and will remain in effect until SoWell replaces it. SoWell reserves the right to change the terms of this Notice at any time, as long as the changes are in compliance with applicable law. If SoWell changes the terms of this Notice, the new terms will apply to all PHI it maintains, including PHI that was created or received before such changes were made. If SoWell changes this Notice, it will post the new Notice on its website, https://www.getsowell.com (the “Site”), and will make the new Notice available upon request. Your continued use of the Site after changes to this Notice shall constitute your consent to the new Notice.
Uses and Disclosures of PHI
- Treatment, Payment, and Healthcare Operations. SoWell is permitted to use and disclose your PHI for purpose of (a) treatment; (b) payment; and (c) healthcare operations. For example:
- Treatment: SoWell may disclose your PHI to a physician or healthcare provider for purposes of a visit or in connection with the provision of follow up treatment.
- Payment: SoWell may use and disclose your PHI to your health insurer or health plan in connection with the processing and payment of a claim and other charges.
- Healthcare operations: SoWell may use and disclose your PHI in connection with its healthcare operations, such as providing customer services and conducting quality review assessments. SoWell may engage third parties to provide various services for SoWell. If any such third party must have access to your PHI in order to perform its services, SoWell may require that third party to enter an agreement that binds the third party to the use and disclosure restrictions provided in this Notice.
- Authorization. SoWell is permitted to use and disclose your PHI upon your written authorization to the extent such use or disclosure is consistent with your authorization. You may revoke such authorization at any time. To authorize SoWell to disclose your PHI to a third party, please contact SoWell at firstname.lastname@example.org.
- As Required by Law. SoWell may use and disclose your PHI to the extent required by law.
- Special Circumstances. The following categories describe unique circumstances in which SoWell may use or disclose your PHI:
- Public Health Authorities: SoWell may disclose your PHI to public health authorities or other governmental authorities for purposes including preventing and controlling disease, reporting child abuse or neglect, reporting domestic violence, and reporting to the Food and Drug Administration regarding the quality, safety, and effectiveness of a regulated product or activity. SoWell may, in certain circumstances, disclose PHI to persons who have been exposed to communicable disease or may otherwise be at risk of contracting or spreading a disease or condition.
- Workers’ Compensation: SoWell may disclose your PHI as authorized by, and to the extent necessary to comply with, workers’ compensation programs and other similar programs relating to work-related illnesses or injuries.
- Health Oversight Activities: SoWell may disclose your PHI to a health oversight agency for authorized activities such as audits, investigations, inspections, licensing, and disciplinary actions relating to the healthcare system or government benefits programs.
- Judicial and Administrative Proceedings: SoWell may disclose your PHI in certain circumstances, as permitted by applicable law, in response to an order from a court or administrative agency, or in response to a subpoena or discovery request.
- Law Enforcement: SoWell may disclose your PHI to a law enforcement official, such as for purposes of identifying or locating a suspect, fugitive, material witness, or missing person.
- Decedents: SoWell may, under certain circumstances, disclose PHI to coroners, medical examiners, and funeral directors for purposes such as identification, determining the cause of death, and fulfilling duties relating to decedents.
- Organ Procurement: SoWell may, under certain circumstances, use or disclose PHI for the purposes of organ donation and transplantation.
- Research: SoWell may, under certain circumstances, use or disclose PHI in a limited data set that does not include direct identifiers such as your name, address, social security number, phone number, and email address, for research purposes. Such uses may include activities that are preparatory to research or informing you of research studies that may be of interest to you. You will not be enrolled in a research study without your prior voluntary informed consent, unless an institutional review board has waived the need to obtain informed consent.
- Threat to Health or Safety: SoWell may, in certain circumstances, use or disclose PHI, if necessary, to prevent or lessen a serious imminent threat to the health or safety of a person or the public.
- Specialized Government Functions: SoWell may, in certain circumstances, use and disclose PHI of persons who are, or were, in the Armed Forces for purposes such as ensuring proper execution of a military mission or determining entitlement to benefits. SoWell may also disclose PHI to federal officer for intelligence and national security purposes.
- Marketing and Sale. Most uses and disclosures of PHI for marketing purposes, and disclosures that constitute a sale of medical information, require your prior express authorization. We will obtain your written permission for (1) most uses and disclosures of PHI for marketing purposes, as defined by HIPAA; and (2) disclosures that constitute a sale of PHI, as defined by HIPAA. If you provide us permission to use or disclose your PHI, you may revoke that permission in writing at any time. If you revoke your permission, your revocation will be effective upon receipt, but will not be effective to the extent that we or others have acted in reliance upon such permission.
Your Rights Regarding Your PHI
- Confidential Communications. You have the right to receive confidential communications of your PHI. You may request that SoWell communicate with you through alternate means or at an alternate location, and SoWell will accommodate your reasonable requests. You must submit your request in writing to SoWell.
- Restrictions. You have the right to request restrictions on certain uses and disclosures of PHI for treatment, payment, or healthcare operations. You also have the right to request that SoWell restrict its disclosures of PHI to only certain individuals involved in your care or the payment of your care. You must submit your request in writing to SoWell. SoWell is not required to comply with your request. However, if SoWell agrees to comply with your request, it will be bound by such an agreement, except when otherwise required by law or in the event of an emergency.
- Inspection and Copies. You have the right to inspect and copy your PHI. You must submit your request in writing to SoWell. SoWell may impose a fee for the costs of copying, mailing, labor, and supplies associated with your request. SoWell may deny your request to inspect and/or copy your PHI in certain limited circumstances. If that occurs, SoWell will inform you of the reason for the denial, and you may request a review of the denial.
- Amendment. You have the right to request that SoWell amend your PHI if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is maintained by SoWell. You must submit a request in writing to SoWell and provide a reason to support the requested amendment. SoWell may, under certain circumstances, deny your request by sending you a written notice of denial. If SoWell denies your request, you will be permitted to submit a statement of disagreement for inclusion in your records.
- Accounting of Disclosures. You have a right to receive an accounting of all disclosures SoWell has made of your PHI. However, that right does not include (1) disclosures made for treatment, payment, or healthcare operations; (2) disclosures made pursuant to an authorization; and (3) certain other disclosures. You must submit your request in writing to SoWell and you must specify the time period involved (which must be for a period of less than six years from the date of disclosure). Your first accounting will be free of charge. However, SoWell may charge you for the costs involved in fulfilling any additional request made within a period of 12 months. SoWell will inform you of such costs in advance, so you may withdraw or modify your request to save costs.
- Breach Notification. You have the right to be notified in the event that SoWell discovers a breach of unsecured PHI.
- Paper Copy. You have the right to obtain a paper copy of this Notice from SoWell at any time upon request.
- Complaint. You may complain to SoWell and/or the Secretary of the Department of Health and Human Services if you believe that your privacy rights have been violated. To file a complaint with SoWell, you must submit a statement in writing to email@example.com. SoWell will not retaliate against you for filing a complaint.
- Further Information. If you would like more information about your privacy rights, please send an email to firstname.lastname@example.org.
Effective date of this Notice: December 30, 2020