Notice of Privacy Practices

HMRI Notice of Privacy Practices

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.

HMRI is a research organization, and we generally do not provide direct treatment to individuals. We occasionally may provide treatment that relates to research, usually as indirect treatment to research subjects. Research subjects should read the research protocol for more information on their rights when participating in a research study. This notice of privacy practices (this Notice) applies to health information created or received by the physicians, employees, students, trainees, and volunteers at HMRI.

Your Rights

When it comes to your health information, you have the right to:

Get an electronic or paper copy of the medical record about you – When agreeing to participate in a research study, research subjects may be asked to wait to see information about them until after the research is over. Contact us or look at the information given to you when you consented to be in the research study if you have any questions. When you have this right:

  • You may ask to see or get an electronic or paper copy of health information we have about you. Ask us how.
  • We will provide a copy or a summary of health information about you if you make a written request. We’re permitted to charge you a reasonable, cost-based fee for providing the copy or summary.
  • There are some exceptions that apply to research-related health information.

Ask us to correct your medical record

  • You may ask us to change health information that you think is incorrect or incomplete. Ask us how.
  • We may say “no” to your request, but if we do, we’ll tell you why in writing.
  • If we say no to your request, then you have the right to submit a written “addendum,” of no more than 250 words, about any statement in your record that you believe is incomplete or incorrect. If you tell us, we will attach the addendum to your medical record and include it whenever we share the statement you are concerned about. We may attach a “rebuttal statement.”

Request confidential communications

You may ask us to contact you in a specific way (for example, to call you on your home or office phone) or to send mail to a different address. We will say “yes” to reasonable requests, but we may have some limits.

Ask us to limit what we use or share

  • You may ask us not to use or share certain health information for treatment, payment, or our operations. For the most part, we are not required to agree to your request.
  • If you pay for a health care service or item out-of-pocket in full, then you may ask us not to share that information with your health insurer for payment or operations purposes. We will say “yes” unless a law requires us to share the information.
  • If you ask us not to use or share health information in certain ways or with certain individuals (for example, with your research team), you may no longer be eligible to participate in the research study.
  • We may use general contact information for fundraising. We will give you clear “opt-out” choices.

Get a list of those with whom we’ve shared information

  • You may ask for a list of the times we’ve shared your health information, the names of the people we shared it with, and why. Ask us how.
  • We will give you a list of disclosures except for those about treatment, payment, and operations, and certain other disclosures (such as any you asked us to make). We’ll provide one “accounting of disclosures” a year for free, but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
  • For some disclosures made for research purposes, we may give you the name and a description of the protocol and other limited information. If this applies to you, we will help you get more information.

Get a copy of this Notice

You may request a copy of this this Notice when you visit our facilities, even if you agreed to receive the Notice electronically. A current copy of this Notice also is available on our website at www.hmri.org. We generally will not provide a copy of this Notice if we are not directly treating you, unless you ask for the Notice.

Choose someone to act for you

Another person may exercise your rights and make choices about health information about you, such as if you have given someone medical power of attorney to make health care decisions for you or if someone is your legal guardian or conservator. We will check that the person has authority to act for you before we take any action in response to that person’s instructions.

File a complaint or ask questions

  • You may ask questions or complain by contacting our Privacy Officer, Robert Kloner, at 10 Pico Avenue, Pasadena, CA 91105-3104, or by phone at 626-397-5840, or by email at rkloner@HMRI.org.
  • You also may file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights.
  • We will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you may tell us your choices about what we share. You have both the right and choice to tell us to:

  • Share information with your family, close friends, or others involved in your care or payment for care.
  • Share information in a disaster relief situation.

If you do not tell us your preference, we may share information about you if we believe it is in your best interest.

Uses and Disclosures

We may use or share health information about you in the following ways.

  • For treatment purposes. Health information about you may be disclosed to doctors, nurses, and other providers who are caring for you. For example, a researcher may share health information about you with your primary care physician.
  • To run our organization, improve your care, and contact you when necessary. For example, we may review health information to come up with ways to be more efficient.
  • To bill and be paid for our services. For example, we may give information about you to your health insurance plan so it will pay for services.
  • For health research in limited situations. Most of the time, we will ask for your authorization before using or sharing information for research.
  • For public health and safety, such as: preventing disease; helping with product recalls; reporting adverse reactions to medications; reporting suspected abuse, neglect, or domestic violence; and preventing or reducing a serious threat to anyone’s health or safety.
  • As required by state or federal law.
  • In response to a court or administrative order or subpoena.
  • With a coroner, medical examiner, or funeral director if someone dies.
  • For organ donation.
  • 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.
  • With third parties who provide services to us, as long as they sign a contract promising to protect the information.

We are allowed or required to share information in other ways – usually in ways that contribute to the public good. We have to meet many conditions in the law before we may use or share information for these purposes. Otherwise, we will get your permission to use or share information. Also, we generally will ask for your written permission to use or share information about you: for marketing purposes; when we will receive remuneration for, or “sell,” information; and that are psychotherapy notes.

Our Responsibilities

  • We are required by law to maintain the privacy and security of health information about you.
  • We will let you know promptly if a breach occurs that may have compromised the privacy or security of health information about you.
  • We must follow the duties and privacy practices described in this Notice.
  • We will not use or share information about you other than as described in this Notice or as permitted or required by law 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.

Changes to this Notice

We may change this Notice, and the changes will apply to all information we have about you. The new Notice will be available upon request, in our facilities, and on our website (www.hmri.org).

 

 

Originally effective April 14, 2003. Last updated December 17, 2014.