This Notice of Privacy Practices (“Notice”) shall apply to the following entities, collectively referred to as “PicnicCare”: PicnicCare, PC, PicnicCare Florida, PA, PicnicCare Kansas, PA, and PicnicCare New Jersey, PC.
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.
We can change the terms of this notice, and the changes will apply to all health information we have about you. The new notice will be available upon request and on our web site
Our Commitment to You
PicnicCare is committed to maintaining the privacy of your health information. As part of our services or during your treatment with us, physicians, nurses, and other personnel may collect information about your health history and current health status. This Notice explains how that information, called “Protected Health Information” (PHI), may be used and disclosed to others. The terms of this Notice apply to health information produced or obtained by PicnicCare.
Our Legal Duties
The HIPAA Privacy Law requires us to provide this Notice to you regarding our privacy practices, our legal duties to protect your health information and your rights concerning health information about you. We are required to follow the privacy practices described in this Notice whenever we use or disclose your PHI. Other companies or persons that perform services on our behalf, called Business Associates, must also protect the privacy of your information. Business Associates are not allowed to release your information to anyone else unless specifically permitted by law.
Uses and Disclosures of Protected Health Information
What Health Information We Collect
As part of our services or during your treatment with us, physicians, nurses, and other personnel may collect information about your health history and current health status. The information we collect is generally protected health information as defined under HIPAA. We collectively refer to this information as health information in this Notice.
How We Use and Disclose Your Health Information
The HIPAA Privacy Law permits PicnicCare to make uses and disclosures of your health information for purposes of treatment, payment and health care operations. We may use or disclose your health information for the purposes outlined in this Notice.
- Treatment: We will use and may share health information about you for your health care and treatments or coordinate/manage your treatment. For example, a nurse or medical assistant will obtain treatment information about you and record it in a medical record. Alternatively, one of our physicians may use information about you for a consultation with or referral to another physician to diagnose your illness and determine which treatment option, such as surgery or medication, will best address your health needs.
- Payments: We may use and disclose health information about you to obtain payment for the care and services we have provided. We may use and disclose health information about your treatment and services to bill and collect payment from you, your insurance company or a third-party payer. For example, we may need to give your insurance company your health information before it approves or pays for the health care services we recommend for you. The insurance company may use that health information to determine eligibility or coverage for insurance benefits, review services provided to you for health necessity, and undertake utilization review activities.
- Healthcare Operations: We may use and share health information about you for PicnicCare’s health care operations, which include planning, management, quality assessment, and improvement activities for the treatments that we deliver. For example, we may use your health information to evaluate the skills of our physicians, nurses, and other health care providers in caring for you. We also may use your health information to review quality and health outcomes.
- Health-Related Benefits, Services and Treatment Alternatives: We may also contact you about new or alternative treatments or other health care services. For example, we may offer to mail you newsletters, coupons, or announcements.
- Appointment Reminders: We may use and disclose health information to contact you for appointment reminders and to communicate necessary information about your appointment. These communications may be over SMS, email or phone.
- Health Information Exchange: Unless you opted out of participation in a health information exchange (HIE), as permitted by law your health information may be shared through an HIE to coordinate your care, avoid duplicating care, and making more informed decisions.
- Law Enforcement: In certain circumstances, we may be legally required to share certain personal information held by us, which may include your health information. We may disclose your health information to a law enforcement official if required or allowed by law
- People Assisting in Your Care: In certain limited situations, PicnicCare may disclose essential health information to people such as family members, relatives, or close friends who are helping care for you or helping you pay your health care bills. We will disclose information to them only if these people need to know the health information to help you. For example, we may provide limited information to a family member so that they may pick up a prescription for you. Generally, we will ask you prior to making disclosures if you agree to such disclosures. If you are unable to make health-related decisions or it is an emergency, PicnicCare will determine if it would be in your best interest to disclose pertinent health information about you to the people assisting in your care. We also may provide your protected health information to a disaster relief organization to allow your family to be notified about your condition and whereabouts in a disaster.
- Research: PicnicCare may use or disclose health information about you for research purposes. We will meet the specified conditions under HIPAA prior to sharing your health information for research purposes.
- Health Oversight Activities: We may disclose health information to a health oversight agency for activities that are required by federal, state or local law. Oversight activities include investigations, inspections, industry licensures, and government audits.
- Public Health Risks: As authorized by law, we may disclose health information about you to public health or legal authorities whose official responsibilities generally include the following:
- To prevent or control disease, injury or disability;
- To report births and deaths;
- To report child abuse or neglect;
- To report reactions to medications or problems with products;
- To notify people of recalls of products they may be using;
- To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and
- To notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence.
- Serious Threat to Health or Safety: Consistent with applicable laws, we may disclose your health information if the disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
- Organ and Tissue Donation: Consistent with applicable law, we may release your health information to organ procurement organizations or others engaged in the transplantation of organs to enable a possible transplant.
- Specialized Government Functions: If you are a member of the military or a veteran, we will disclose health information about you as required by command authorities; or if you give us your written permission. We may also disclose your health information for other specialized government functions such as national security or intelligence activities.
- Workers Compensation: If you are seeking compensation due to a work-related injury, we may release health information about you.
- Employers: We may release health information to your employer if we provide health treatment to you at the request of your employer, and the health care services are provided either to conduct an evaluation relating to medical surveillance of the workplace or to evaluate whether you have a work-related illness or injury.
- Lawsuits and Disputes: If you are involved in a lawsuit, dispute, or other judicial proceedings, we may disclose health information about you in response to a court order or subpoena, other lawful processes, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
- Coroners, Medical Examiners, and Funeral Directors: We may release your health information to a coroner, medical examiner, or funeral director.
- Correctional Facilities: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may disclose health information about you to the correctional institution or law enforcement official only as required by law or with your written permission. We may release your health information for your health and safety, for the health and safety of others, or for the safety and security of the correctional institution.
- Required by Law: The Secretary of the Department of Health and Human Services (HHS) or other regulator may investigate privacy violations. If your health information is requested as part of an investigation, we are required to share your information with HHS or another regulator.
Circumstances Which Require Your Written Consent Prior to Disclosure
For any purpose other than the ones described above, we may only use or share your health information when you give us your written consent or authorization to do so. For example, you will need to sign an authorization form before sending your health information to your life insurance company. You may revoke your authorization, at any time, in writing, except to the extent that we have taken action in reliance on the authorization. We may not use or disclose your health information without an authorization that is valid as per HIPAA Privacy Rule -
- Marketing: We must also obtain your written authorization before using your health information to send you any marketing materials. The only exceptions to this requirement are that:
- We can provide you with marketing materials in a face-to-face encounter or a promotional gift of minimal value if we so choose
- 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
- Sale: For any disclosure of your health information, which constitutes a sale of health information.
- Sensitive Health Information: Federal and state law requires special privacy protections for certain sensitive health information about you, including any part of your health information that is about:
- Child abuse and neglect
- Domestic abuse of an adult with a disability
- Mental illness or developmental disability treatment or services
- Substance use disorder diagnosis, treatment, or referral
- HIV/AIDS testing, diagnosis, or treatment
- Sexually transmitted disease
- Sexual assault
- Genetic testing
- In Vitro Fertilization (IVF)
- Information maintained in psychotherapy notes
Generally, unless otherwise permitted or required by law, before we share your sensitive health information for a purpose other than those permitted by law, we must obtain your written consent or authorization.
- Other Uses: Other uses and disclosures of your health information, not described above or not otherwise allowed by law and regulation, will be made only with your written consent or authorization.
Your Rights Regarding Your Health Information
You have certain rights regarding your health information, which are explained below. Unless otherwise specified below, you may exercise these rights by submitting a request in writing to hello@picniccare.com.
- Right to be notified of a breach: You have the right to be notified if you are affected by a breach of unsecured personal information.
- Right to inspect and copy: If you would like to inspect or receive a copy of your PHI that is contained in a designated record set (e.g., health and billing records), we are required to provide you access to such information within 30 days after receipt of your request (with up to a 30-day extension if required with notice). We may charge you a reasonable fee set under HIPAA and applicable state law to cover duplication, mailing and other costs incurred by us in complying with your request. We can also provide you with your PHI in a mutually agreeable readable electronic form and format upon your request.
We may deny your request for access to your personal information as permitted by HIPAA. For example, we may deny your request if we believe the disclosure will endanger your life or that of another person. Depending on the circumstances of the denial, you may have a right to have this decision reviewed.
- Right to Request Restrictions on Use and Disclosure: You have the right to request a restriction or limitation on certain uses and disclosures of your health information. To request restrictions, you must make your request in writing to hello@picniccare.com. In your request, you must tell us:
- What information you wish to limit
- Whether you wish to limit our use, disclosure, or both
- To whom you want the limits to apply – for example, if you want to prohibit disclosures for insurance payment, health care operations, to persons involved in your care, or to your spouse.
You or your personal representative must sign it.
We will agree to a restriction for disclosures to a health plan if (1) the disclosure is for the purpose of carrying out insurance payment or health care operations and (2) the PHI pertains solely to a health care item or service for which you, or a person other than the health plan on your behalf, has paid us in full. For other types of restrictions, we are not required to agree to your request, but we will attempt to accommodate reasonable requests when appropriate. We retain the right to terminate an agreed-to restriction if we believe such termination is appropriate. In the event of a termination by us, we will notify you of such termination. You also have the right to terminate, in writing or orally, any agreed-to restriction. If we agree to the requested restriction, we may not use or disclose your personal information in violation of that restriction unless it is needed to provide emergency treatment or certain other circumstances permitted or required by law.
- Right to Request Amendment: If you believe that any health information we have about you is incorrect or incomplete, you have the right to ask us to change the information for as long as PicnicCare maintains the information. To request an amendment to your health information, your request must be in writing, signed, and submitted to PicnicCare.
If we deny your request, we will provide you with a written explanation. You may respond with a statement of disagreement that will be maintained with your records. We will respond to your request within 60 days (with up to a 30-day extension if needed with notice).
- Right to Receive Confidential Communications: You have the right to request that we communicate with you about your health information in a confidential manner or at a specific location. For example, you may ask that we only contact you via mail to a post office box. You must submit your request in writing to PicnicCare. We will not ask you the reason for your request. Your request must specify how or where you wish to be contacted. We will accommodate all reasonable requests.
- Right to Receive an Accounting of Certain Disclosures: With some exceptions, you have the right to receive an accounting of certain disclosures we have made, if any, of your health information. Your accounting request must be in writing and signed by you or your personal representative and submitted to PicnicCare. Your request must specify the time in which the disclosures were made. You may receive one free accounting in any 12-month period. We will charge you a reasonable, cost-based fee for additional requests for an accounting of disclosures within the same 12-month period.
This right only applies to disclosures for purposes other than treatment, payment or health care operations as described in this Notice. It also excludes disclosures we may have made to you, your family members or friends involved in your care. The right to receive this information is subject to certain exceptions, restrictions and limitations as allowed by HIPAA.
- Right to Obtain a Copy of this Notice: You have the right to receive a paper copy of this Notice upon request, even if you have agreed to receive the Notice electronically. You may ask us to give you a copy of this Notice at any time.
Contact Us
If you believe that we have violated your privacy rights, you may file a complaint with us by notifying us at privacy@picniccare.com. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services if you feel that your rights have been violated. There will be no retaliation from PicnicCare for making a complaint.
Privacy Officer
350 Frank H Ogawa Plz, FL 7
Oakland, CA 94612
Telephone: (415)-801-0572
Email: privacy@picniccare.com
