THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY. CLICK HERE FOR THE SPANISH VERSION.
At Mary’s Center for Maternal and Child Care, Inc. (“Mary’s Center”), we are committed to treating and using Protected Health Information about you responsibly. We are required by law to maintain the privacy of your Protected Health Information, to notify you of our legal duties and privacy practices concerning your health information, and to notify affected individuals following a breach of unsecured health information. This Notice summarizes our duties and your rights concerning your information. This Notice applies to all Protected Health Information as defined by Federal regulations.
1. Uses and Disclosures We May Make Without Written Authorization. We may use or disclose your health information for certain purposes without your written authorization, including the following:
Treatment. We may use or disclose your information for the purpose of treating you. For example, we may disclose your information to another healthcare provider so they may treat you; provide appointment reminders; or provide information about treatment alternatives or services we offer.
Payment. We may use or disclose your information to obtain payment for services provided to you. For example, we may disclose information to your health insurance company or other payer to obtain payment for treatment.
Healthcare Operations. We may use or disclose your information for certain activities that are necessary to operate our practice and ensure that our patients receive quality care. For example, we may use information to train or review the performance of our staff or make decisions affecting the practice.
Other Uses or Disclosures. We may also use or disclose your information for certain other purposes allowed by 45 CFR § 164.512 or other applicable laws and regulations, including the following:
• To avoid a serious threat to your health or safety or the health or safety of others.
• As required by state or Federal law such as reporting abuse, neglect, or certain other events.
• As allowed by workers’ compensation laws for use in workers’ compensation proceedings.
• For certain public health activities such as reporting certain diseases.
• For certain public health oversight activities such as audits, investigations, or licensure actions.
• In response to a court order, warrant, or subpoena in judicial or administrative proceedings.
• For certain specialized government functions such as the military or correctional institutions.
• For research purposes if certain conditions are satisfied.
• In response to certain requests by law enforcement to locate a fugitive, victim, or witness, or to report deaths or certain crimes.
• To coroners, funeral directors, or organ procurement organizations to allow them to carry out their duties.
2. Disclosures We May Make Unless You Object. Unless you instruct us otherwise, we may disclose your information as described below.
• To a member of your family, relative, friend, or other person who is involved in your healthcare or payment for your healthcare. We will limit the disclosure of the information relevant to that person’s involvement.
• We have chosen to participate in CRIPS DC, a regional health information exchange (“HIE”) serving the District of Columbia along with other HIE. CRISP DC is also affiliated with and shares data with other HIEs, including those in Alaska, Connecticut, Maryland, and West Virginia. As permitted by law, your health information will be shared electronically with this exchange to provide faster access, and better care coordination of care and assist providers and public health officials in making more informed decisions. You may “opt-out” and disable access to your health information available through CRISP DC by calling 1-877-952-7477 or completing and submitting an Opt-Out form to CRISP DC by mail, fax or through their website at www.crispdc.org. Certain reporting required by law, such as public health reporting and Controlled Dangerous Substances information, will still be available to providers even if you opt-out.
3. Uses and Disclosures with Your Written Authorization. Other uses and disclosures not described in this Notice will be made only with your written authorization, including most uses or disclosures of psychotherapy notes, for most marketing purposes. You may revoke your authorization by submitting a written notice to the Privacy Contact identified below. The revocation will not be effective to
the extent we have already acted in reliance on the authorization.
• If you are being treated for substance use disorder by our facility, your data will not be shared through CRISP DC unless you file a consent to specifically share this information. If you elect to consent, your substance use disorder information will be shared with other clinicians who treat you, for payment of services, and other operational purposes like quality improvement and care coordination. Right now, to share your information, your consent must allow for the sharing of your information for all purposes related to treatment, payment, and operations. You can ask your clinician for more information about how to consent, what that consent means, and how you can revoke your consent.
4. Your Rights Concerning Your Protected Health Information. You have the following rights concerning your health information. To exercise any of these rights, you must submit a written request to the Privacy Officer identified below.
• You may request additional restrictions on the use or disclosure of information for treatment, payment, or healthcare operations. We are not required to agree to the requested restriction except in the limited situation in which you or someone on your behalf pays for an item or service, and you request that information concerning such item or service not be disclosed to a health insurer.
• We normally contact you by telephone, mail at your home address, and possibly by e-mail if you have given your e-mail address. You may request that we contact you by alternative means or at alternative locations. We will accommodate reasonable requests.
• You may inspect and obtain a copy of records that are used to make decisions about your care or payment for your care, including an electronic copy. We may charge you a reasonable cost-based fee for providing the records. We may deny your request under limited circumstances, e.g., if we determine that disclosure may result in harm to you or others.
• You may request that your Protected Health Information be amended. We may deny your request for certain reasons, e.g., if we did not create the record if we determine the record is accurate and complete.
• You may receive an accounting of certain disclosures we have made of your Protected Health Information. You may receive the first accounting within 12 months free of charge. We may charge a reasonable cost-based fee for all subsequent requests during those 12 months.
• You may obtain a paper copy of this Notice upon request. You have this right even if you have agreed to receive the Notice electronically.
5. Changes to this Notice. We reserve the right to change the terms of this Notice at any time, and to make the new Notice effective for all Protected Health Information that we maintain. If we materially change our privacy practices, we will post a copy of the current Notice in our reception area and on our website. You may obtain a copy of the Notice from our front desk or Privacy Officer.
6. Complaints. You may submit a complaint if you believe your privacy rights have been violated. Please file your complaint by notifying our Privacy Officer or reporting to our Speak-UP & Report Line (PH: 844.237.8634 or online: maryscenter.ethicspoint.com). All complaints must be in writing. We will not retaliate against you for filing a complaint.
7. Contact Information. If you have any questions about this Notice, or if you want to object to or complain about any use of disclosure or exercise any right as explained above, please contact:
Mary’s Center
Attn: VP of Compliance
2333 Ontario Road, NW
Washington, DC 20009
Email: privacy@maryscenter.org
8. Effective Date. This Notice is effective October 2, 2024.
