This notice describes how information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
This Notice of Privacy Practices is being provided to you on behalf of The Institute for Reproductive Health with respect to reproductive medical services provided at the Institute for Reproductive Health’s facilities (collectively referred to herein as “We” or “Our”). We understand that your medical information is private and confidential. Further, we are required by law to maintain the privacy of “protected health information.” Protected health information includes any individually identifiable information that we obtain from you or others that relates to your past, present or future physical or mental health, the health care you have received, or payment for your health care.
Although your health record is the physical property of the Institute for Reproductive Health, you have the right to:
• request a restriction on certain uses and disclosures of your information as provided by applicable law
• obtain a paper copy of this Notice of Privacy Practices upon request
• inspect and copy your health record as provided for by applicable law
• request an electronic copy of your electronic health record
• request to amend your health record as provided by applicable law
• obtain an accounting of disclosures of your health information as provided by applicable law.
• request communications of your health information by alternative means or at alternative locations
• revoke your authorization to use or disclose health information except to the extent that action has already been taken
• request a restriction of disclosure of your healthy information to your health insurer for services for which you pay “out of pocket” in full
• transmit copies of your health information to third parties when requested by you, in writing
We are required to:
• maintain the privacy of your health information
• provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about you
• abide by the terms of this notice
• notify you if we are unable to agree to a requested restriction
• accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations
• where required by law, notify you if there has been a breach of your unsecured health information
We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change, we will post the revised Notice of Privacy Practices on our website at www.cincinnatifertility.com as well as at our offices and provide you with a hard copy upon request.
We will not use or disclose your health information without your authorization, except as described in this notice unless an exception to confidentiality applies (i.e., mandatory reporting of child, elder, or vulnerable adult abuse, danger to self or others). We will not sell your health information (unless permitted by law) or use or disclose such information for paid marketing (for which we receive payment from a third party) without your authorization. If we obtain your authorization, you may revoke it at any time, and this revocation will take effect except where we have already relied upon your authorization.
We will use and disclose your health information for treatment. For example: information obtained by a nurse, physician or other member of your healthcare team will be recorded in your record and used to determine the course of treatment that should work best for you. Your physician will document in your record his/her expectations of the members of your healthcare team. Members of your healthcare team will then record the actions they took and their observations. In that way the physician will know how you are responding to treatment. We will also provide your physician or a subsequent healthcare provider with copies of various reports that should assist him/her in treating you once you are discharged from this practice.
We will use and disclose your health information for payment. For example: A bill may be sent to you or a third-party payor, such as an insurance company or health plan, for the purposes of receiving payment for treatment and services that you receive. The information on the bill may contain information that identifies you, your diagnosis, and treatment or supplies used during treatment.
We will use and disclose your health information for our health care operations. For example: Members of the clinical staff, the risk or quality improvement manager, or members of the quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the healthcare and the reproductive medicine service we provide.
Business Associates: There are some services provided at the Institute for Reproductive Health through contacts with business associates. For example: certain laboratory tests. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we have asked them to do and bill you or your third-party payor for services rendered. So that your health information is protected, however, we require the business associate to appropriately safeguard your information.
Notification: We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location, and general condition.
Communication with Spouse/Family: Health professionals, using their best judgment, may disclose to your spouse, family member, or any other person you identify, health information relevant to that person’s involvement in your care or payment related to your care. We will give you an opportunity to object to these disclosures, and we will not make these disclosures if you object.
Research: We may disclose information to researchers when their research has been approved by an Institutional Review Board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.
Marketing: Where permitted by law, we may contact you to tell you about or recommend possible treatment alternatives or other medical technology and services that may be of interest to you. We may also seek your authorization to contact you with other marketing communications.
Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects or post marketing surveillance information to enable product recalls, repairs, or replacement.
Public Health: As required by law, your health information may be used or disclosed for public health activities such as assisting public health authorities or other legal authorities to prevent or control disease, injury, disability or for other health oversight activities.
Law Enforcement: We may disclose health information for law enforcement purposes as required by law, or in response to a valid subpoena. Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a workforce member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers, or the public.
Note: HIV-related information, genetic information, mental health records and other specially protected health information may be subject to certain special confidentiality protections under applicable State and Federal law. Any disclosures of these types of records will be subject to these special protections.
For More Information or to Report a Problem/Complaint:
If you believe your privacy rights have been violated, you may file a complaint with us by contacting Ricia Holscher, Practice Manager 513-924-5550.
You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services. We will not take action against you for filing a complaint about our privacy practices.
I hereby authorize the Institute for Reproductive Health to use and disclose my individually identifiable health information as described above. I understand that this authorization is voluntary. I understand that once this information is disclosed to my spouse / partner/ significant other, or the party named above, the released information may no longer be protected by federal privacy regulations.
I understand that this authorization will be effective for the lifetime of the patient unless revoked. I understand that I may revoke this authorization at any time by notifying the Institute for Reproductive Health in writing; however, if I do revoke the authorization, it will not have any effect on any actions taken by the Institute for Reproductive Health prior to their receipt of the revocation. I understand that my treatment cannot be conditioned on whether I sign this authorization.