Common use of Uses and Disclosures of Protected Health Information Clause in Contracts

Uses and Disclosures of Protected Health Information. Under federal law, we are permitted to use and disclose protected health information for the purposes of treatment, payment, and health care operations.  Treatment. We do not provide treatment.  Payment. Payment refers to activities involving the collection of premium and payment of claims. Examples of uses and disclosures under this section include: (1) sharing protected health information with other insurers to determine coordination of benefits, the administration of claims, determining coverage, and providing benefits; and (2) sharing protected health information with thi rd party administrators for the processing of claims.  Operations. Operations refers to the business functions necessary for us to operate, such as quality assurance activities, audits, and complaint responses. Examples of uses and disclosures under this section include: (1) using protected health information for the purpose of underwriting and calculating premium rates; (2) using protected health information to perform legal, actuarial, and auditing services; (3) disclosing protected health information when responding to complaints; and (4) use of protected health information for general data analysis and long term management and planning. We do not use protected health information that is genetic health information for underwriting purposes. Genetic information includes information concerning the manifestation of a disease or condition of a family member while information about a condition or a disease pertaining to a specific individual is not genetic information. We may also use or disclose your protected health information for other purposes permitted or required by law, including the following:  to you, as the covered individual;  to a personal representative designated by you to receive protected health information or a personal representative designated by law such as the parent or legal guardian of child, or the surviving family members or representative of the estate of a deceased individual;  to the Secretary of Health and Human Services, or any employee thereof, as part of an investigation to determine our compliance with the HIPAA Privacy Rules;  to a business associate as part of a contracted agreement to perform services for the plan;  to a health oversight agency, such as the Insurance Commissioner's Office, to respond to inquiries or investigations of the plan, requests to audit the plan, or to obtain necessary licenses;  in response to a court order, subpoena, discovery request or other lawful judicial or administrative proceeding;  as required for law enforcement purposes; or  as required to comply with Workers' Compensation or other similar programs established by law. The examples of permitted uses and disclosures listed above are not provided as an all-inclusive list of the ways in which protected health information may be used. They are provided to describe in general the types of uses and disclosures that may be made. We do not use protected health information for fundraising activities, however, if we were to do so, you would be provided with the right to opt out of any such use. We will not use your protected health information for any of the following activities without obtaining your prior written authorization:  Marketing activities using protected health information;  Any disclosure that constitutes a sale of protected health information; or  The use or disclosure of psychotherapy notes. Other uses and disclosures of your protected health information may be made only with your written authorization unless other wise permitted or required by law. You may revoke such authorization at any time by providing written notice to us that you wish to revoke an authorization. We will honor a request to revoke as of the day it is received and to the extent that we have not already used or disclosed your protected health information in good faith with the authorization.

Uses and Disclosures of Protected Health Information. Under federal law, we are permitted to use and disclose protected health information for the purposes of treatment, payment, and health care operations.  Treatment. We do not provide treatment.  Payment. Payment refers to activities involving the collection of premium and payment of claims. Examples of uses and disclosures under this section include: (1) sharing protected health information with other insurers to determine coordination of benefits, the administration of claims, determining coverage, and providing benefits; and (2) sharing protected health information with thi rd party administrators for the processing of claims.  Operations. Operations refers to the business functions necessary for us to operate, such as quality assurance activities, audits, and complaint responses. Examples of uses and disclosures under this section include: (1) using protected health information for the purpose of underwriting and calculating premium rates; (2) using protected health information to perform legal, actuarial, and auditing services; (3) disclosing protected health information when responding to complaints; and (4) use of protected health information for general data analysis and long term management and planning. We do not use protected health information that is genetic health information for underwriting purposes. Genetic information includes information concerning the manifestation of a disease or condition of a family member while information about a condition or a disease pertaining to a specific individual is not genetic information. We may also use or disclose your protected health information for other purposes permitted or required by law, including the following:  to you, as the covered individual;  to a personal representative designated by you to receive protected health information or a personal representative designated by law such as the parent or legal guardian of child, or the surviving family members or representative of the estate of a deceased individual;  to the Secretary of Health and Human Services, or any employee thereof, as part of an investigation to determine our compliance with the HIPAA Privacy Rules;  to a business associate as part of a contracted agreement to perform services for the plan;  to a health oversight agency, such as the Insurance Commissioner's Office, to respond to inquiries or investigations of the plan, requests to audit the plan, or to obtain necessary licenses;  in response to a court order, subpoena, discovery request or other lawful judicial or administrative proceeding;  as required for law enforcement purposes; or  as required to comply with Workers' Compensation or other similar programs established by law. The examples of permitted uses and disclosures listed above are not provided as an all-inclusive list of the ways in which Your protected health information may be usedused and disclosed by your physician, our office staff and others outside of our office who are involved in your care and treatment for the purpose of providing health care services to you. They Your protected health information may also be used and disclosed to pay your health care bills and to support the operation of your physician’s practice. Following are provided examples of the types of uses and disclosures of your protected health information that your physician’s office is permitted to make. These examples are not meant to be exhaustive, but to describe in general the types of uses and disclosures that may be mademade by our office. We do not use protected health information for fundraising activities, however, if we were to do so, you would be provided with the right to opt out of any such use. Treatment: We will not use and disclose your protected health information for to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of the following activities without obtaining your prior written authorization:  Marketing activities using health care with another provider. For example, we would disclose your protected health information;  Any disclosure , as necessary, to a home health agency that constitutes a sale of provides care to you. We will also disclose protected health information; or  The use or disclosure of psychotherapy notesinformation to other physicians who may be treating you. Other uses and disclosures of For example, your protected health information may be made only with your written authorization unless other wise permitted provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or required by lawtreat you. You In addition, we may revoke such authorization at any time by providing written notice to us that you wish to revoke an authorization. We will honor a request to revoke as of the day it is received and to the extent that we have not already used or disclosed disclose your protected health information from time-to-time to another physician or health care provider (e.g., a specialist or laboratory) who, at the request of your physician, becomes involved in good faith your care by providing assistance with your health care diagnosis or treatment to your physician. Payment: Your protected health information will be used and disclosed, as needed, to obtain payment for your health care services provided by us or by another provider. This may include certain activities that your health insurance plan may undertake before it approves or pays for the authorizationhealth care services we recommend for you such as: making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example, obtaining approval for a hospital stay may require that your relevant protected health information be disclosed to the health plan to obtain approval for the hospital admission.

Uses and Disclosures of Protected Health Information. Under federal law, we are permitted to use and disclose Your protected health information for the purposes may be used and disclosed by your physician, our office staff and others outside of treatment, payment, our office that are involved in your care and health care operations.  Treatment. We do not provide treatment.  Payment. Payment refers to activities involving the collection of premium and payment of claims. Examples of uses and disclosures under this section include: (1) sharing protected health information with other insurers to determine coordination of benefits, the administration of claims, determining coverage, and providing benefits; and (2) sharing protected health information with thi rd party administrators for the processing of claims.  Operations. Operations refers to the business functions necessary for us to operate, such as quality assurance activities, audits, and complaint responses. Examples of uses and disclosures under this section include: (1) using protected health information treatment for the purpose of underwriting providing health care services to you, to pay your health care bills, to support the operation of the physician's practice, and calculating premium rates; (2) using any other use required by law. Treatment: We will use and disclose your protected health information to perform legalprovide, actuarialcoordinate, or manage your health care and auditing any related services; (3) disclosing . This includes the coordination or management of your health care with a third party. For example, we would disclose your protected, health information as necessary, to a home health agency that provides care to you. For example, your protected health information when responding may be provided to complaints; and (4) use of a physician to whom you have been referred to ensure that the physician has the necessary Information to diagnose or treat you. Payment: Your protected health information will be used, as needed, to obtain payment for general data analysis and long term management and planningyour health care services. We do not use For example, obtaining approval for a hospital stay may require that your relevant protected health information that is genetic be disclosed to the health plan to obtain approval for the hospital admission. Healthcare Operations: We may use or disclose, as needed, your protected health information to support the business activities of your physician's practice. These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, licensing, and conducting or arranging for underwriting purposesother business activities. Genetic For example, we may disclose your protected health information includes information concerning to medical school students that see patients at our office. In addition, we may use a sign-in sheet at the manifestation of a disease or condition of a family member while information about a condition or a disease pertaining registration desk where you will be asked to a specific individual is not genetic informationsign your name and indicate your physician. We may also call you by name in the waiting room when your physician is ready to see you. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment. We may use or disclose your protected health information for other purposes permitted or in the following situations without your authorization. These situations include: as Required By Law, Public Health issues as required by law, including Communicable Diseases: Health Oversight: Abuse or Neglect: Food and Drug Administration requirements: Legal Proceedings: Law Enforcement: Coroners, Funeral Directors, and Organ Donation: Research: Criminal Activity: Military Activity and National Security: Workers' Compensation: Inmates: Required Uses and Disclosures: Under the following:  law, we must make disclosures to you, as you and when required by the covered individual;  to a personal representative designated by you to receive protected health information or a personal representative designated by law such as the parent or legal guardian of child, or the surviving family members or representative Secretary of the estate of a deceased individual;  to the Secretary Department of Health and Human Services, Services to investigate or any employee thereof, as part of an investigation to determine our compliance with the HIPAA Privacy Rules;  to a business associate as part requirements of a contracted agreement to perform services for the plan;  to a health oversight agency, such as the Insurance Commissioner's Office, to respond to inquiries or investigations of the plan, requests to audit the plan, or to obtain necessary licenses;  in response to a court order, subpoena, discovery request or other lawful judicial or administrative proceeding;  as required for law enforcement purposes; or  as required to comply with Workers' Compensation or other similar programs established by law. The examples of permitted uses and disclosures listed above are not provided as an all-inclusive list of the ways in which protected health information may be used. They are provided to describe in general the types of uses and disclosures that may be made. We do not use protected health information for fundraising activities, however, if we were to do so, you would be provided with the right to opt out of any such use. We will not use your protected health information for any of the following activities without obtaining your prior written authorization:  Marketing activities using protected health information;  Any disclosure that constitutes a sale of protected health information; or  The use or disclosure of psychotherapy notesSection 164.500. Other uses Permitted and disclosures of your protected health information may be made only Required Use and Disclosures Will Be Made Only with your written authorization Your Consent, Authorization or Opportunity to Object unless other wise permitted or required by law. You may revoke such authorization this authorization, at any time by providing written notice to us that you wish to revoke an authorization. We will honor a request to revoke as of the day it is received and time, in writing, except to the extent that we have not already used your physician or disclosed your protected health information the physician's practice has taken on action in good faith with reliance on the use or disclosure indicated in the authorization.

Uses and Disclosures of Protected Health Information. Under federal law, we are permitted to use and disclose Your protected health information for the purposes may be used and disclosed by your physician, our office staff and others outside of treatment, payment, our office that are involved in your care and health care operations.  Treatment. We do not provide treatment.  Payment. Payment refers to activities involving the collection of premium and payment of claims. Examples of uses and disclosures under this section include: (1) sharing protected health information with other insurers to determine coordination of benefits, the administration of claims, determining coverage, and providing benefits; and (2) sharing protected health information with thi rd party administrators for the processing of claims.  Operations. Operations refers to the business functions necessary for us to operate, such as quality assurance activities, audits, and complaint responses. Examples of uses and disclosures under this section include: (1) using protected health information treatment for the purpose of underwriting providing health care services to you, to pay your health care bills, to support the operation of the physician's practice, and calculating premium rates; (2) using any other use required by law. Treatment: We will use and disclose your protected health information to perform legalprovide, actuarialcoordinate, or manage your health care and auditing any related services; (3) disclosing . This includes the coordination or management of your health care with a third party. For example, we would disclose your protected, health information as necessary, to a home health agency that provides care to you. For example, your protected health information when responding may be provided to complaints; and (4) use of a physician to whom you have been referred to ensure that the physician has the necessary Information to diagnose or treat you. Payment: Your protected health information will be used, as needed, to obtain payment for general data analysis and long term management and planningyour health care services. We do not use For example, obtaining approval for a hospital stay may require that your relevant protected health information that is genetic be disclosed to the health plan to obtain approval for the hospital admission. Healthcare Operations: We may use or disclose, as needed, your protected health information in order to support the business activities of your physician's practice. These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, licensing, and conducting or arranging for underwriting purposesother business activities. Genetic For example, we may disclose your protected health information includes information concerning to medical school students that see patients at our office. In addition, we may use a sign-in sheet at the manifestation of a disease or condition of a family member while information about a condition or a disease pertaining registration desk where you will be asked to a specific individual is not genetic informationsign your name and indicate your physician. We may also call you by name in the waiting room when your physician is ready to see you. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment We may use or disclose your protected health information for other purposes permitted or in the following situations without your authorization. These situations include: as Required By Law, Public Health issues as required by law, including Communicable Diseases: Health Oversight: Abuse or Neglect: Food and Drug Administration requirements: Legal Proceedings: Law Enforcement: Coroners, Funeral Directors, and Organ Donation: Research: Criminal Activity: Military Activity and National Security: Workers' Compensation: Inmates: Required Uses and Disclosures: Under the following:  law, we must make disclosures to you, as you and when required by the covered individual;  to a personal representative designated by you to receive protected health information or a personal representative designated by law such as the parent or legal guardian of child, or the surviving family members or representative Secretary of the estate of a deceased individual;  to the Secretary Department of Health and Human Services, Services to investigate or any employee thereof, as part of an investigation to determine our compliance with the HIPAA Privacy Rules;  to a business associate as part requirements of a contracted agreement to perform services for the plan;  to a health oversight agency, such as the Insurance Commissioner's Office, to respond to inquiries or investigations of the plan, requests to audit the plan, or to obtain necessary licenses;  in response to a court order, subpoena, discovery request or other lawful judicial or administrative proceeding;  as required for law enforcement purposes; or  as required to comply with Workers' Compensation or other similar programs established by law. The examples of permitted uses and disclosures listed above are not provided as an all-inclusive list of the ways in which protected health information may be used. They are provided to describe in general the types of uses and disclosures that may be made. We do not use protected health information for fundraising activities, however, if we were to do so, you would be provided with the right to opt out of any such use. We will not use your protected health information for any of the following activities without obtaining your prior written authorization:  Marketing activities using protected health information;  Any disclosure that constitutes a sale of protected health information; or  The use or disclosure of psychotherapy notesSection 164.500. Other uses Permitted and disclosures of your protected health information may be made only with your written authorization Required Use and Disclosures Will Be Made Only With Your Consent, Authorization or Opportunity to Object unless other wise permitted or required by law. You may revoke such authorization this authorization, at any time by providing written notice to us that you wish to revoke an authorization. We will honor a request to revoke as of the day it is received and time, in writing, except to the extent that we have not already used your physician or disclosed your protected health information the physician's practice has taken on action in good faith with reliance on the use or disclosure indicated in the authorization.. Patient Initials Date

Uses and Disclosures of Protected Health Information. Under federal law, we are permitted to use and disclose protected health information for the purposes of treatment, payment, and health care operations.  Treatment. We do not provide treatment.  Payment. Payment refers to activities involving the collection of premium and payment of claims. Examples of uses and disclosures under this section include: (1) sharing protected health information with other insurers to determine coordination of benefits, the administration of claims, determining coverage, and providing benefits; and (2) sharing protected health information with thi rd party administrators for the processing of claims.  Operations. Operations refers to the business functions necessary for us to operate, such as quality assurance activities, audits, and complaint responses. Examples of uses and disclosures under this section include: (1) using protected health information for the purpose of underwriting and calculating premium rates; (2) using protected health information to perform legal, actuarial, and auditing services; (3) disclosing protected health information when responding to complaints; and (4) use of protected health information for general data analysis and long term management and planning. We do not use protected health information that is genetic health information for underwriting purposes. Genetic information includes information concerning the manifestation of a disease or condition of a family member while information about a condition or a disease pertaining to a specific individual is not genetic information. We may also use or disclose your protected health information for other purposes permitted or required by law, including the following:  to you, as the covered individual;  to a personal representative designated by you to receive protected health information or a personal representative designated by law such as the parent or legal guardian of child, or the surviving family members or representative of the estate of a deceased individual;  to the Secretary of Health and Human Services, or any employee thereof, as part of an investigation to determine our compliance with the HIPAA Privacy Rules;  to a business associate as part of a contracted agreement to perform services for the plan;  to a health oversight agency, such as the Insurance Commissioner's Office, to respond to inquiries or investigations of the plan, requests to audit the plan, or to obtain necessary licenses;  in response to a court order, subpoena, discovery request or other lawful judicial or administrative proceeding;  as required for law enforcement purposes; or  as required to comply with Workers' Compensation or other similar programs established by law. The examples of permitted uses and disclosures listed above are not provided as an all-inclusive list of the ways in which Your protected health information may be usedused and disclosed by your physician, our office staff and others outside of our office who are involved in your care and treatment for the purpose of providing health care services to you. They Your protected health information may also be used and disclosed to pay your health care bills and to support the operation of your physician’s practice. Following are provided examples of the types of uses and disclosures of your protected health information that your physician’s office is permitted to make. These examples are not meant to be exhaustive, but to describe in general the types of uses and disclosures that may be mademade by our office. We do not use protected health information for fundraising activities, however, if we were to do so, you would be provided with the right to opt out of any such use. Treatment: We will not use and disclose your protected health information for to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of the following activities without obtaining your prior written authorization:  Marketing activities using health care with another provider. For example, we would disclose your protected health information;  Any disclosure , as necessary, to a home health agency that constitutes a sale of provides care to you. We will also disclose protected health information; or  The use or disclosure of psychotherapy notesinformation to other physicians who may be treating you. Other uses and disclosures of your Your protected health information may be made only with your written authorization unless other wise permitted provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or required by lawtreat you. You In addition, we may revoke such authorization at any time by providing written notice to us that you wish to revoke an authorization. We will honor a request to revoke as of the day it is received and to the extent that we have not already used or disclosed disclose your protected health information from time-to-time to another physician or health care provider (e.g., a specialist or laboratory) who, at the request of your physician, becomes involved in good faith your care by providing assistance with your health care diagnosis or treatment to your physician. Payment: Your protected health information will be used and disclosed, as needed, to obtain payment for your health care services provided by us or by another provider. This may include certain activities that your health insurance plan may undertake before it approves or pays for the authorizationhealth care services we recommend for you such as: making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities.