NOTICE OF PRIVACY PRACTICES

The Sleep Clinic, LLC

Effective Date: April 1^st, 2023

This Notice of Privacy Practices (“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.

THIS NOTICE OF PRIVACY PRACTICES APPLIES TO THE FOLLOWING ORGANIZATION(S):

The Sleep Clinic, LLC is a sleep medicine clinic located in the state of Maryland. We are committed to protecting the privacy of your Protected Health Information (PHI).

OUR LEGAL OBLIGATIONS:

We are required by law to maintain the privacy of your PHI, to provide you with notice of our legal duties and privacy practices, and to abide by the terms of this Notice. We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

USES AND DISCLOSURES OF MEDICAL INFORMATION:

We may use and disclose medical information about you for treatment payment and healthcare operations. Examples of how we may use and disclose your medical information include:

• Treatment: We may use and disclose medical information about you to provide you with medical treatment or services. We may also disclose medical information about you to your health care providers who are involved in your care.
  • For example, a doctor treating you for an injury asks another doctor about your overall health condition.
• Payment: We may use and disclose medical information about you to obtain payment for the treatment and services we provide to you. For example, we may disclose medical information about you to your insurance company or health plan to obtain reimbursement for your care.
  • For example, we give information about you to your health insurance plan so it will pay for your services.
• Healthcare operations: We may use and disclose medical information about you for our healthcare operations. This includes activities such as quality assessment and improvement, auditing, and administration.
  • For example, we use health information about you to manage your treatment and services.

We may also use and disclose medical information about you for other purposes as permitted or required by law (see list below). We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

• Help with public health and safety issues
  • We can share health information about you for certain situations such as:
    • Preventing disease
    • Helping with product recalls
    • Reporting adverse reactions to medications
    • Reporting suspected abuse, neglect, or domestic violence
    • Preventing or reducing a serious threat to anyone’s health or safety
  • Do research
    • We can use or share your information for health research.
  • Comply with the law
    • We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
  • Respond to organ and tissue donation requests
    • We can share health information about you with organ procurement organizations.
  • Work with a medical examiner or a funeral director
    • We can share health information where they corner, medical examiner, or funeral director when an individual dies.
  • Address workers’ compensation, law enforcement, and other government requests
    • We can use or share health information about you:
      • For workers’ compensation claims
      • For law enforcement purposes or with a law enforcement official
      • With health oversight agencies for activities authorized by law
      • For special government functions such as military, national security, and presidential Protective Services
    • Respond to lawsuits and legal actions
      • We can share health information about you in response to a court or administrative order, or in response to a subpoena.

YOUR RIGHTS

You have the right to:

• Request restrictions on certain uses and disclosures of your medical information.
  • You can ask us not to use or share certain health information for treatment, payment, or our operations.
    • We are NOT required to agree to your request, and we may say “no” if it would affect your care.
  • If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer.
    • We will say “yes” unless a law requires us to share that information.
  • Receive confidential communications of your medical information.
    • You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
    • We will say “yes” to all reasonable requests.
  • Inspect and copy your medical information.
  • Amend your medical information.
    • You can ask us to correct health information about you that you think is incorrect or incomplete.
    • We may say “no” to your request, but we’ll tell you why in writing within 60 days.
  • Receive an accounting of disclosures of your medical information.
    • You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
    • We will include all the disclosures except for those about treatment, payment, and healthcare operations, and certain other disclosures (such as any you asked us to make). Will provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
  • Obtain a paper or electronic copy of this Notice upon request.
    • You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
  • Obtain a paper or electronic copy of your medical records upon request.
    • We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee for this.
  • Choose someone to act for you.
    • If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
    • We will make sure the person has this authority and can act for you before we take any action.

YOUR CHOICES

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

• In these cases, you have both the right and choice to tell us to:
  • Share information with your family, close friends, or others involved in your care
  • Share information in a disaster relief situation
  • Include your information in a hospital directory
  • Contact you for fundraising efforts
  • If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
• In these cases we never share your information unless you give us written permission:
  • Marketing purposes
  • Sale of your information
  • Most sharing of psychotherapy notes
• In the case of fundraising:
  • We may contact you for fundraising efforts, but you can tell us not to contact you again.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with us or with the secretary of the Department of Health and Human Services. All complaints must be submitted in writing. We will not retaliate against you for filing a complaint.

            US Department of Health and Human Services Office for Civil Rights

            200 Independence Avenue, SW

            Washington, D.C. 20201

            1-877-696-6775

            www.hhs.gov/ocr/privacy/hipaa/complaints/

CONTACT INFORMATION

If you have any questions or would like further information about our privacy practices, please contact us at:

The Sleep Clinic, LLC

10110 Molecular Drive, STE 209

Rockville, MD 20850

Phone: (301) 291-5671

Email: hello@thesleepclinicmd.com

CHANGES TO THE TERMS OF THIS NOTICE

We reserve the right to change our privacy practices and this notice at anytime. Revised notices will be posted in our office and on our website, if applicable.