QuadMed Medical Clinics, Dental Clinics, Pharmacy, and Rehabilitation Services, EAP, AODA

This Notice Describes How Medical Information About You May Be Used and Disclosed and How You Can Get Access to This Information. Please Read It Carefully.

Effective Date: January 2016

Purpose: The Health Insurance Portability and Accountability Act (“HIPAA”) and other privacy-related regulations (referred to in this Notice as the “Privacy Rule”) require QuadMed to inform its patients about the ways that QuadMed may use and disclose your protected health information. In addition, the Privacy Rule requires QuadMed to inform patients of your rights regarding disclosures of your health information.

It is the policy of QuadMed to keep medical information confidential and not disclose patient-protected health information without your consent, authorization or as specifically permitted or required by federal or state law as described in this Notice. We are required to provide you with a copy of this Notice and to abide by the terms of this Notice as currently in effect. The Privacy Rule also requires QuadMed to make a good faith effort to obtain written acknowledgement of your receipt of this Notice.

State laws and certain federal laws may be more protective of certain information than the federal Privacy Rule. For instance, many states restrict the use or disclosure of your information relating to treatment for mental health, development disabilities, alcoholism, drug dependence or information concerning HIV status, without obtaining your authorization. Certain federal laws may also restrict the use or disclosure of such information. Some states also have specific procedures for responding to discovery requests or subpoenas or for disclosing information to coroners or funeral directors. QuadMed will not use your information in any way that is not permitted by state law or other more restrictive federal laws. In the event there is any breach of your unsecured protected health information, we are required to notify you of such breach and will do so.

Any questions about this Notice, QuadMed’s privacy practices or questions you may have regarding possible violations of your privacy may be directed to QuadMed’s Privacy Officer. To facilitate complaints, QuadMed requests that you use our complaint form available at the QuadMed reception desks. This form will be sent to the QuadMed Privacy Officer who will address any concerns. No patient will be retaliated against for filing a complaint.

All forms referred to in this document are available to you through QuadMed Reception and through the QuadMed Privacy Officer.

The QuadMed Privacy Officer can be reached at:

QuadMed
Attn: Privacy Officer
Sussex Clinic
W227 N6103 Sussex Road Sussex, WI 53089
414.566.6400
In addition to filing a complaint at QuadMed, any patient may also contact the federal government directly, specifically the Office of Civil Rights at the Department of Health and Human Services at the appropriate Regional Office as listed at http://www.hhs.gov/ocr/office/about/rgn-hqaddresses.html or at the contact information below:

Office of Civil Rights

U.S. Department of Health and Human Services
200 Independence Avenue, S.W. Room 509 F, HHH Building Washington, D.C. 20201
202.619.0257 Toll Free: 1.877.696.6775
Email: OCRcomplaint@hhs.gov