THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This Notice of Privacy Practices applies to the employees and independent providers of DCW Providers (IL) PLLC; DCW Providers, P.C.; DCW Providers NJ P.C.; and Maven Clinic Administrators. The practices and entities that are subject to this Notice are collectively known as “Maven” (“us,” “we,” or “our”). The providers who deliver services through Maven are independent professionals practicing within several groups of independently owned professional practices.
Maven Clinic Co. operates the websites located at https://www.mavenclinic.com/ and other websites, products, services, and mobile applications with links to this Notice of Privacy Practices, including without limitation the Maven webpages and applications (collectively, the “Sites” or “Websites”, unless otherwise specified). Individuals who use the Sites and access services through the Sites are referred below as “Users”, “Members”, “you”, “your”, or “yours”.
This Notice of Privacy Practices (the “Notice”) will tell you about the ways in which we may use and disclose medical or billing records or other health information we use to make decisions about you (“Protected Health Information” or “PHI”). We also describe your rights and certain obligations we have regarding the use and disclosure of your PHI and how you can access your PHI.
Your Information. Your Rights. Our Responsibilities.
We understand that information about you and your health is sensitive, and we are committed to safeguarding your PHI. By PHI, we mean protected health information as defined under federal law (the Health Insurance Portability and Accountability Act, or HIPAA, and its implementing regulations). We also strongly believe that individuals should control their own health information, and in that regard you have certain rights with respect to your health information.
Except as described in this Notice, we will not disclose PHI without your authorization.
Get an electronic or paper copy of your medical record.
- You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
- We will provide a copy or a summary of your health information within the time required by applicable state regulations.
Ask us to correct your medical record.
- You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
- We may say “no” to your request, but we will tell you why in writing within sixty (60) days.
Request confidential communications.
- You have a right to request we communicate with you confidentially about your PHI and contact you in a specific way or to send mail to a different address. All reasonable requests will be honored.
Ask us to limit what we use or share.
- You can ask us not to use or share certain health information for treatment, payment, or our healthcare operations. We are not required to agree to your request, and we may say “no” if it affects your care.
- If you pay for a healthcare service 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 honor your request unless a law requires us to share that information.
Get a list of those with whom we’ve shared information.
- You can ask for an accounting of the times we’ve shared your health information for six (6) years prior to the date you ask, who we shared it with, when we shared it, and purpose of sharing. Ask us how to do this.
- We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within twelve (12) months.
Get a copy of this privacy notice.
- If you receive this notice on our website or by e-mail, you are entitled to receive a paper copy of this Notice, even if you agreed to receive such notice electronically.
File a complaint if you feel your rights are violated.
- If at any time you believe we have violated your rights, you can file a complaint with us by contacting us at email@example.com.
- You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. Upon request, we will provide the correct address to file a complaint with OCR.
- We will not retaliate against you for filing a complaint.
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 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
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 PHI without your written authorization:
- Marketing purposes
- Sale of your information
- Most sharing of psychotherapy notes
Uses and Disclosures Without Your Written Authorization
In certain situations, we must obtain your written authorization in order to use and/or disclose your PHI. However, unless the PHI is Highly Confidential Information (as defined in the next sentence) and the applicable law regulating such information imposes special restrictions on us, we may use and disclose your PHI without your written authorization for the purposes described below. “Highly Confidential Information” means certain health information that is given special privacy protection by federal and state law and may include substance use disorder treatment program records, mental health records, and other health information that is given special privacy protection under state or federal laws other than HIPAA. In order for us to disclose any Highly Confidential Information for a purpose other than those permitted by law, we must obtain your authorization.
We may use or share your PHI without your authorization in the following ways:
- Treatment. We can use your PHI and share it with other professionals who are treating you and for care coordination purposes. We may also share your information with your health plan for care coordination purposes offered through their care management programs. For example, we may share your information with other healthcare providers such as doctors, nurses and laboratories, to meet your healthcare needs.
- Payment and Billing. We can use and share your PHI to bill and get payment from your insurance, health plan, or other entities responsible for paying for your health care. For example, we give information about you to your health insurance plan so it will pay for your services.
- Healthcare Operations. We can use and share your PHI for our health care operations, including to run our clinical practice, improve your care, and contact you when necessary. For example, we use PHI about you to manage your care and our services.
- Disclosure to Relatives, Close Friends, and Other Caregivers. We may use or disclose your PHI to a family member, other relative, a close personal friend or any other person identified by you when you are present for, or otherwise available prior to, the disclosure, if: (1) we obtain your agreement or provide you with the opportunity to object to the disclosure and you do not object; or (2) we reasonably infer that you do not object to the disclosure. If you are not present for or unavailable prior to a disclosure (e.g., when we receive a telephone call from a family member or other caregiver), we may exercise our professional judgment to determine whether a disclosure is in your best interests. If we disclose information under such circumstances, we would disclose only information that is directly relevant to the person’s involvement with your care.
- Public Health Activities. We may disclose your PHI: (1) to report health information to public health authorities for the purpose of preventing or controlling disease, injury or disability; (2) to report child abuse and neglect to a government authority authorized by law to receive such reports; (3) to report information about products under the jurisdiction of the U.S. Food and Drug Administration; (4) to alert a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition; and (5) to report information to your employer as required under laws addressing work-related illnesses and injuries or workplace medical surveillance.
- Victims of Abuse, Neglect or Domestic Violence. We may disclose your PHI if we reasonably believe you are a victim of abuse, neglect or domestic violence to a government authority authorized by law to receive reports of such abuse, neglect, or domestic violence.
- Health Oversight Activities. We may disclose your PHI to an agency that oversees the healthcare system and is charged with responsibility for ensuring compliance with the rules of government health programs such as Medicare or Medicaid.
- Help with health and safety issues. We may disclose PHI to the extent necessary to avert a serious and imminent threat to your health or safety, or the health or safety of others.
- Law Enforcement. We may disclose PHI to a law enforcement official investigating a suspect, fugitive, material witness, crime victim or missing person, as required by law or in compliance with a court order.
- Military and National Security. We may disclose to authorized federal officials medical information required for lawful intelligence, counterintelligence, and other national security activities.
- Legal Proceedings. We may disclose PHI in response to a court or administrative order, subpoena, discovery request, or other lawful process.
- As Required by Law. We may use and disclose your PHI when required to do so by any applicable federal, state, or local law.
- Research. We may use and disclose your PHI for research purposes pursuant to a valid authorization from you or when an institutional review board or privacy board has waived the authorization requirement. Under certain circumstances, your PHI may be disclosed without your authorization to researchers preparing to conduct a research project, for research on decedents, or as part of a data set that omits your name and other information that can directly identify you.
- Decedents. We may disclose your PHI to a coroner or medical examiner as authorized by law.
- Workers’ Compensation. We may disclose your PHI as authorized by and to the extent necessary to comply with state law relating to workers’ compensation or other similar programs.
- Business Associates. Certain aspects and components of our services are performed through contracts with outside persons or organizations, such as auditing, outcomes data collection, information technology infrastructure, email communications, etc. At times it may be necessary for us to provide your protected health information to one or more of these outside persons or organizations who assist us with our health care operations. In all cases, we require these associates to appropriately safeguard the privacy of your information.
Uses and Disclosures Requiring Your Written Authorization
Except for the purposes described above, we only use or disclose your PHI when you give us your written authorization. For example:
- Marketing. We must obtain your written authorization prior to using your PHI or disclosing your PHI for purposes that are marketing under the HIPAA privacy rules. For example, we will not accept any payments from other organizations or individuals in exchange for making communications to you about treatments, therapies, health care providers, settings of care, case management, care coordination, products or services unless you have given us your authorization to do so or the communication is permitted by law. However, we may provide refill reminders or communicate with you about a drug or biologic that is currently prescribed to you so long as any payment we receive for making the communication is reasonably related to our cost of making the communication. In addition, we may market to you in a face-to-face encounter and give you promotional gifts of nominal value without obtaining your written authorization.
- Sale of Protected Health Information. We will not sell your PHI without your written authorization.
- We are required by law to maintain the privacy and security of your PHI.
- We will let you know promptly if a breach occurs that has compromised the privacy or security of your information.
- We must follow the duties and privacy practices described in the version of this Notice currently in effect and give you a copy of it.
- 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.
For more information, see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
Changes to the Terms of This Notice
We may change the terms of this Notice at any time, and the changes will apply to all PHI that we maintain, including medical information we created or received prior to making such changes. If we change this Notice, we will post the new notice on our Websites. You also may obtain any new notice by contacting us using the contact information set forth below.
For all inquiries, requests for records, special requests, or to file a complaint, please send a written request to:
Attn: Privacy Officer
160 Varick Street, 6th Floor
New York, NY 10013