HIPAA Notice of Privacy Practices

NOTICE OF PRIVACY PRACTICES

Your Information. Your Rights. Our Responsibilities

This Notice explains how your medical information may be used and disclosed, and how you can access this information. Please review it carefully.

Whenever you visit our healthcare providers or receive treatment from us, we create a record of your visit. This record may include details about your symptoms, examination or test results, diagnosis, treatment plan, and related billing information. This Notice applies to all records of your care maintained by our clinic.

Our Responsibilities

We are legally required to protect the privacy of your Protected Health Information (PHI) and to provide you with this Notice outlining our privacy practices and obligations.
We must notify any affected individuals in the event of a breach involving unsecured PHI.
We will abide by the terms of this Notice currently in effect.

Uses and Disclosures of PHI

We may use and share your PHI for the following purposes:

Treatment

We use and share your PHI with doctors, nurses, and other healthcare professionals involved in your care and treatment. For example, we may need to consult with your primary care physician regarding your treatment plan and follow-up care.

Payment

We use and share your PHI to bill and collect payment for the care and services you receive. For instance, we may provide your insurance company with details about your diagnosis so they can process reimbursement to us or to you.

Healthcare Operations

We use and share PHI for operational purposes, such as reviewing the quality of care you receive and evaluating the performance of our staff. For example, members of our medical team may evaluate records of your treatment to improve overall care quality.

We may also use or disclose your PHI in other ways, including (but not limited to):

Business associates: We may share your information with outside contractors we hire to provide specific services, provided they agree to protect your privacy.
Appointment reminders: We may use or share your information to remind you of upcoming appointments.
Service satisfaction: We may ask for feedback to assess your satisfaction with our services.
Treatment alternatives: We may inform you of possible treatment options.
Health-related benefits or services: We may tell you about health-related programs or services that may interest you.
Case management or care coordination: We may share your information with professionals involved in coordinating your care.
Fundraising efforts (if any): We may contact you for fundraising purposes, though you can opt out if you prefer not to receive these communications.
Funeral directors: We may share information consistent with applicable law to help them carry out their duties.
Training programs: We may use your information for educational purposes or to evaluate healthcare professionals’ competence.

Individuals Involved in Your Care or Payment for Your Care

We may share PHI with a family member, friend, or anyone else you identify who is involved in your medical care or payment for your care.

Research

We may disclose your information for approved research projects when an institutional review board has reviewed the proposal to ensure the privacy of your PHI and if otherwise allowed by law.

Future Communications

We may contact you through newsletters, mailings, or other methods about treatment options, health-related information, disease management, wellness programs, or community-based initiatives.

As Required by Law

We may disclose PHI to government agencies or other entities as permitted or required by law, including but not limited to:

The U.S. Food and Drug Administration

Public health or legal authorities involved in preventing or controlling disease, injury, or disability
Correctional institutions, if you are in custody
Workers’ Compensation entities
Organ and tissue donation organizations
Military command authorities
Funeral directors, coroners, and medical examiners
National security and intelligence agencies
Protective services for the President and other officials
Law Enforcement / Legal Proceedings

We may disclose PHI for law enforcement purposes as required by law, or in response to a valid court order, subpoena, or similar legal process.

Other Uses of Your PHI Requiring Authorization

Any use or disclosure of your PHI not covered by this Notice or by law—such as psychotherapy notes (if applicable), certain marketing activities, or the sale of PHI—will only occur with your written permission. You may revoke that permission at any time by submitting a written request. However, we cannot take back disclosures already made with your consent, and we must retain documentation of services we have provided to you.

Your Health Information Rights

Inspect and Copy

You have the right to review and request a copy of your PHI, including having it sent directly to another person of your choosing, subject to certain limitations. We may charge a reasonable fee to cover the cost of providing copies. If your request is denied under specific circumstances, you can request a review of the denial.

Request an Amendment

If you believe the PHI we have is incorrect or incomplete, you may request an amendment in writing, explaining why you feel the change is needed. We may deny your request if we believe the records are accurate or if certain legal restrictions apply, and we will inform you of the reason for any denial.

Request an Accounting of Disclosures

You can request a list of certain disclosures of your PHI that we have made for purposes other than treatment, payment, or healthcare operations, or for other exceptions specified by law.

Request Restrictions

You can ask us not to use or disclose certain parts of your PHI for treatment, payment, or healthcare operations. You may also ask us to limit the PHI shared with specific individuals involved in your care or payment. We are not always required to agree to your request, except when you pay for a service in full and request that the related PHI not be disclosed to your health plan for payment or operations purposes, unless otherwise required by law.

Request Confidential Communications

You may request that we communicate with you about medical matters in a specific way or location. However, if you do not respond to our communications, we may use other methods or locations to reach you.

Obtain a Paper Copy of this Notice

Even if you have received this Notice electronically, you have the right to request a paper copy at any time. You can also find the current Notice on our website or by asking a staff member.

Changes to This Notice

We reserve the right to change this Notice and to apply the revised Notice to all PHI we maintain. The effective date of any updated Notice will be clearly indicated. We will post the current Notice in our facility and make it available on our website. You may also request a copy of any revised Notice during your next visit after the revisions become effective.

Complaints

If you believe your privacy rights have been violated, you can submit a complaint by contacting our Compliance Officer at +38 044 237 32 14. We will not penalize you in any way for filing a complaint.

Further Information

If you have questions or need additional information, please reach us at:
Stepana Bandery Ave, 28A, Kyiv, Kyiv Oblast, Ukraine, Zip – 02000
Phone: +38 044 237 32 14

Effective Date: February 09 2025