This Notice describes how personal health information about you may be used and disclosed and how you can obtain access to this information. Please review it carefully. This Notice is effective July 1, 2023.

Who We Are and Our Obligations 

This Notice describes the privacy practices of Family Health Center of Marshfield, Inc., its associates and its employees and will be referred to as “we” or “our” below. 

We are committed and required by law to protect patient privacy. We follow federal and state law, whichever is the more protective, to maintain the privacy of your health information and provide you with this Notice of our privacy practices. When we use or disclose your health information, we are required to follow the privacy practices described in this Notice (or other Notice in effect at the time of the use or disclosure).  

We reserve the right to change the privacy practices described in this Notice at any time. Changes to our privacy practices would apply to all health information we maintain. If we change our privacy practices, we will post the new Notice on our website and/or make it available to you.   

Use and Disclose of Your Health Information With Your Written Authorization  

Use or Disclosure with Your Authorization. For any purpose, other than the ones described below, we may use or disclose your health information only when you provide us your written authorization to do so. For example, we cannot send your health information to your life insurance company or sell your health information without your authorization.  

Marketing. We must obtain your written authorization prior to using your health information to send any marketing materials or a promotional gift of very small value to you unless provided in a face-to-face encounter. We may communicate with you about products or services relating to your treatment, to coordinate or manage your care, or provide you with information about different treatments, providers or care settings.  

Uses and Disclosures of Your Highly Confidential Information. Specific authorization is required by you prior to the disclosure of any highly confidential information. This Highly Confidential Information may include the subset of your health information 1) in psychotherapy notes; 2) about treatment of mental illness, developmental disability, alcoholism, or drug dependence; 3) about HIV test results; or 4) about child abuse or neglect. With the exception for certain purposes described below, we will generally obtain your written authorization for uses or disclosures of Highly Confidential Information. Exception to this is if we are allowed by law to disclose your Highly Confidential Information for certain purposes without your written authorization. For example, we may disclose information to other health care providers involved in your treatment.  

Federal laws have restrictive requirements for health information regarding treatment of substance use disorders. We must obtain your authorization before we disclose your substance use disorder health information for a purpose other than those permitted by law. The only exception to disclosure of such information, without your authorization, is in limited circumstances as regulated by federal law. For instance, in the case of your medical emergency, we may disclose your patient identifying information without your prior consent.  

Use or Disclosure of Your Health Information Without Your Written Authorization  

Treatment. We may use or disclose your health information to provide treatment and other services to you. Providers and other professionals involved in your care may use the information in your medical record to determine best course of treatment, such as medication or surgery. In addition, we may use your health information to send appointment reminders or to send information that may be of interest to you regarding treatment alternatives or other health-related benefits and services.  

Payment. We may use and disclose your health information to obtain payment for services that we provide to you. We may forward information of your treatment for an insurance company to pay for your treatment.  Information may include a bill that identifies you, your diagnosis, and the treatment provided to you. We may also disclose your health information to another health care provider or health plan for its payment activities. 

Health Care Operations. We may need to use your health information to improve the quality or cost of care we deliver. These quality and cost improvement activities may include using your health information to evaluate the quality of our health care services.  

Disclosures to Business Associates. We may disclose your health information to persons or organizations who have a contract with us to provide services for us to carry out treatment, payment or health care operations, such persons or organizations are our business associates. For example, we may disclose your health information to an agency that accredits health care organizations or to a collection agency to collect payment of medical bills.  

Family Health Center of Marshfield, Inc. is part of an organized health care arrangement including participants in OCHIN. A current list of OCHIN participants is available at www.ochin.com. As a business associate of Family Health Center of Marshfield, Inc., OCHIN supplies information technology and related services to Family Health Center of Marshfield, Inc., and other OCHIN participants. OCHIN also engages in quality assessment and improvement activities on behalf of its participants. For example, OCHIN coordinates clinical review activities on behalf of participating organizations to establish best practice standards and assess clinical benefits that may be derived from the use of electronic health record systems. OCHIN also helps participants work collaboratively to improve the management of internal and external patient referrals. Your personal health information may be shared by Family Health Center of Marshfield, Inc., with other OCHIN participants or a health information exchange only when necessary for medical treatment or for the health care operations purposes of the organized health care arrangement. Health care operation can include, among other things, geocoding your residence location to improve the clinical benefits you receive. 

The personal health information may include past, present and future medical information as well as information outlined in the Privacy Rules. The information, to the extent disclosed, will be disclosed consistent with the Privacy Rules or any other applicable law as amended from time to time. You have the right to change your mind and withdraw this consent, however, the information may have already been provided as allowed by you. This consent will remain in effect until revoked by you in in writing. If requested, you will be provided a list of entities to which your information has been disclosed.   

Disclosures to Relatives, Close Friends and Other Caregivers. There may be situations we may disclose important health information to people such as your family members, relatives, or close friends who are helping to care for you or helping you pay your medical bills. The information disclosed may include the information that we believe is directly relevant to their involvement in your care or payment for your medical bills, and may include your location, general condition or death. We will ask you if you agree to such a disclosure, unless you are unable to function or there is an emergency. If you are unable to function or there is an emergency, we will disclose your health information if we determine it would be in your best interest. We may disclose applicable health information to family members and others who were involved in a decedent’s care or payment for care prior to the patient’s death, unless doing so is contrary to the decedent’s prior expressed preference made known to us. In addition, we may disclose your health information to organizations authorized to handle disaster relief efforts so those who care for you can receive information about your location or health status.  

Contacting You. We may use your health information to communicate with you such as about appointments, surveys, or other communications. We may contact you by mail, telephone, email, or text message when you provide your address, telephone number, email address, or mobile phone number. Electronic communications may not be secure. You have the right to opt out at any time from text and/or email messages by responding to the message or calling 800-942-5420.  

Public Health Activities. We may disclose your health information, if required or allowed by law, for the following public health activities: (1) for the purpose of preventing or controlling disease, injury or disability; (2) about products and services under the jurisdiction of the U.S. Food and Drug Administration; (3) alert exposure to a communicable disease or risk contracting or spreading a disease or condition; or (4) report information to your employer addressing work-related illnesses and injuries or workplace safety, as is required by law. 

Victims of Abuse, Neglect or Domestic Violence. We may disclose your health information if we reasonably believe you are a victim of abuse, neglect or domestic violence. Reporting of such information is required or allowed by law, to a governmental authority, including a social service or protective services agency.  

Health Oversight Activities. We may disclose your health information, if required or allowed by law, to a government agency legally responsible for overseeing the health care system and is responsible for ensuring compliance with the rules of government health programs such as Medicare or Medicaid.  

Judicial and Administrative Proceedings. We may disclose your health information, as required or allowed by law, in the course of a judicial or administrative proceeding in response to a legal order or other lawful process.  

Law Enforcement Officials. We may disclose your health information, as required or allowed by law, to the police or other law enforcement officials  

Coroners, Medical Examiners and Funeral Directors. We may disclose your health information, as required or allowed by law, to a coroner, medical examiner or funeral director.  

Organ and Tissue Donation. We may disclose your health information to organizations that facilitate organ, eye or tissue donation, banking or transplantation.  

Health or Safety. We may use or disclose your health information to prevent or lessen a serious and imminent threat to the health or safety of a person or the general public.  

Specialized Government Functions. We may use and disclose your health information for authorized national security activities or to units of the government with special functions, such as the U.S. military or the U.S. Department of State under certain circumstances.  

Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may disclose your health information to the correctional institution or law enforcement official for certain purposes. For example, we may disclose your health information to a correctional institution to provide you with health care.  

Workers’ Compensation. We may disclose your health information to the extent necessary to comply with workers’ compensation law or similar laws.  

To Comply With the Law. We may use and disclose your health information when required to do so by any other law not already referred to in this section.  

Your Rights Regarding Your Health Information

Right to Request Restrictions on Certain Uses and Disclosures of Your Health Information. You may ask for restrictions on how your health information is used or to whom your health information is disclosed such as for treatment, payment and health care operations, those involved in your care, or those involved in disaster relief efforts. We do consider all requests for restrictions, however, are not required to agree to your request. To request restrictions on how we use and disclose your health information for the purposes described above, we ask that your request be made in writing. Health Information Management staff can provide you with the applicable form. We will mail you a written response.   

Right to Receive Confidential Communications of Your Health Information. We will accommodate any reasonable request that we communicate your health information in different ways or places. We may ask you to put your request in writing.  

Right to Cancel Authorization to Use or Disclose Your Health Information. You may cancel an authorization you have provided to us except to the extent that we have already relied upon it. To cancel an authorization, we ask that your request be made in writing. Health Information Management staff can provide you with the applicable form.   

Right to Inspect and Copy Your Health Information. You may request access to your health information in order to review or request copies of such information. In certain situations, we may deny you access to a portion of your health information (for example, mental health records or information gathered for judicial proceedings) as allowed by law. To review or obtain copies of your health information, we ask that your request be submitted in writing. Health Information Management staff can provide you with the applicable form. You have the right to request that the copy be provided in an electronic form or format. If the form and format are not readily producible, we will work with you to create a reasonable electronic form or format. If you decline the available electronic formats, we will provide you with a paper copy.  

You should note that, if you are a parent or legal guardian of a minor (child under age 18), certain portions of the minor’s health information may not be accessible to you (for example, records relating to substance use treatment, HIV test results, or if the minor is emancipated).  

Right to Request to Correct Your Health Information. You may ask us to amend your health information. We will consider all requests for corrections, however, may deny your request for legitimate reasons (for example, if your health information is accurate and complete or we did not create the health information you believe is incorrect).  A request for amendment of your health information must be submitted in writing.  

Right to Receive a Record of Disclosures of Your Health Information. You may ask for a list of certain disclosures of your health information made by us, in the six years prior to the date of your request. This list must include the date of each disclosure, who received the health information disclosed, a brief description of the health information disclosed, and why the disclosure was made. This list will not include disclosures made to you, or for purposes of treatment, payment, health care operations, or for certain other purposes. To request a list of such disclosures, please contact the Health Information Management department.  

Right to Notification of Breach. You have the right to be informed of a breach of your protected health information. We will notify you if a breach occurs involving your unsecured protected health information within 60 days of the discovery. 

Right to Receive Paper Copy of this Notice. You may request a paper copy of this Notice at any time, even if you earlier agreed to receive this notice electronically.  

Complaints  

If you believe your privacy rights have been violated, you may file a complaint with the Federal Department of Health and Human Services and Family Health Center of Marshfield, Inc. We will not retaliate against you for filing such a complaint. All complaints must be submitted in writing. To file a complaint, please contact ourPrivacy Office, Family Health Center of Marshfield, Inc., 1000 N. Oak Ave., Marshfield, WI 54449.  

Questions  

If you have any questions about your privacy rights or the information in this Notice, you may contact our Privacy Office at 800-942-5420.  

Family Health Center of Marshfield, Inc. complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, sex, age, physical or mental disability, or religion.