The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) requires us to ask each of our patients to acknowledge receipt of our Notice of HIPAA Privacy Practices. The Notice is published on the Empower Sleep Medical Associates Inc website (“ESMA” and a covered entity as that term is defined under HIPAA), Empower Sleep Inc (“ES” and collectively with ESMA, “Empower Sleep”) website and Empower Sleep mobile application. You acknowledge receipt of the Notice by clicking on the “I Acknowledge the Receipt Notice of HIPAA Privacy Practices” checkbox, or by indicating your acknowledgement in another written or digital manner provided. You can receive a copy of the Notice by requesting one from Empower Sleep.
This notice is effective as of 2024-02-15, and will remain in effect until we replace it.
I. CHANGES TO NOTICE
We reserve the right to change this notice and the privacy practices described below at any time in accordance with applicable law. Prior to making significant changes to our privacy practices, we will alter this notice to reflect the changes, and make this revised notice available to you on request. Any changes we make to our privacy practices and/or this notice may be applicable to health information created or received by us prior to the date of the changes. You may request a copy of our notice at any time. For more information about our privacy practices, or for additional copies of this notice, please contact us using the information listed at the end of this notice.
II. PERMITTED USES AND DISCLOSURES OF HEALTH INFORMATION
A. TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS:
You should be aware that during the course of our relationship with you we will likely use and disclose health information about you for treatment, payment, and healthcare operations. Examples of these activities are as follows:
Treatment: We may use or disclose your health information to a physician or other healthcare provider providing treatment to you.
Payment: We may use and disclose your health information to obtain payment for services we provide to you.
Healthcare Operations: We may use and disclose your health information in connection with our healthcare operations to help administer and support our business activities. Healthcare operations include quality assessment and improvement activities, reviewing the competence or qualifications of healthcare professionals, evaluating practitioner and provider performance, and other business operations.
B. AUTHORIZATIONS
You may specifically authorize us to use your health information for any purpose or to disclose your health information to anyone, by submitting such an authorization in writing. Upon receiving an authorization from you in writing we may use or disclose your health information in accordance with that authorization. You may revoke an authorization at any time by notifying us in writing. Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect. Unless you give us a written authorization, we cannot use or disclose your health information for any reason except those permitted by this notice.
C. DISCLOSURES TO FAMILY AND PERSONAL REPRESENTATIVES:
We must disclose your health information to you, as described in the Patient Rights section of this notice. Such disclosures will be made to any of your personal representatives appropriately authorized to have access and control of your health information. We may disclose your health information to a family member, friend, or other person to the extent necessary to help with your healthcare or with payment for your healthcare only if authorized to do so.In the event of your incapacity or in emergency circumstances, we will disclose health information based on a determination using our professional judgment disclosing only health information that is directly relevant to the person’s involvement in your healthcare.
D. MARKETING AND ADVERTISING
In order to reach people who may be looking for support related to sleep, we advertise on some web properties such as Third Party websites and apps. In order to minimize advertising costs related to this process and downstream costs to you, we strive to deliver ads that are relevant, interesting, and personal.
Therefore, if you opt in to Advertising cookies and web beacons, your IP address, Third Party identifier (if applicable), hashed User ID (if applicable), and visitor data, excluding activity when you’re in a consultation or other related session with one of our licensed healthcare professionals. As a result, you may see ads for our services on some Third Party websites.
Even if you do opt in, we still do not engage in “retargeting” advertising. Retargeting advertising is a type of advertising whereby advertisers leverage the fact that you viewed a page or took an action on their site to advertise to you again on third party properties in the hope that you will see the ad and return to their site.
To be clear, we don’t share any data or information you share with your clinician or any other licensed healthcare professional related to your treatment. Even if you opt in to Advertising cookies and web beacons, we still don’t share information with Third Party advertisers like names, email addresses, phone numbers, clinician diagnosis, questionnaires answers, sessions data, journal entries, messages, worksheets, or any other type of private communication you have with any of our licensed healthcare professional through the Empower Sleep platform.
D. APPOINTMENT REMINDERS
We may use or disclose your health information to provide you with appointment reminders (i.e., SMS/Text messages, mobile push notifications, voicemail messages, postcards, emails or letters) unless you direct us in writing not to do so.
III. USES OR DISCLOSURES REQUIRED BY LAW
Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law as described below. You may revoke this authorization in writing at any time. If you revoke your authorization, we will no longer use or disclose your protected health information for the reasons covered by your written authorization. Please understand that we are unable to take back any disclosures already made with your authorization.
We may use or disclose your protected health information in the following situations without your authorization or providing you the opportunity to agree or object. These situations include:
Required By Law: We may use or disclose your protected health information to the extent that the use or disclosure is required by law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, if required by law, of any such uses or disclosures.
Public Health: We may disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. For example, a disclosure may be made for the purpose of preventing or controlling disease, injury or disability.
Communicable Diseases: We may disclose your protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.
Health Oversight: We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.
Abuse or Neglect: We may disclose your protected health information to a public health authority that is authorized by law to receive reports of child, elder, or adult abuse or neglect. In addition, we may disclose your protected health information if we believe that you have been a victim of abuse, neglect or domestic violence to the governmental entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.
Food and Drug Administration: We may disclose your protected health information to a person or company required by the Food and Drug Administration for the purpose of quality, safety, or effectiveness of FDA-regulated products or activities including, to report adverse events, product defects or problems, biologic product deviations, to track products; to enable product recalls; to make repairs or replacements, or to conduct post marketing surveillance, as required.
Legal Proceedings: We may disclose protected health information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), or in certain conditions in response to a subpoena, discovery request or other lawful process.
Law Enforcement: We may also disclose protected health information, so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include (1) legal processes and otherwise required by law, (2) limited information requests for identification and location purposes, (3) pertaining to victims of a crime, (4) suspicion that death has occurred as a result of criminal conduct, (5) in the event that a crime occurs on the premises of our practice, and (6) medical emergency (not on our practice’s premises) and it is likely that a crime has occurred.
Coroners, Funeral Directors, and Organ Donation: We may disclose protected health information to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law. We may also disclose protected health information to a funeral director, as authorized by law, in order to permit the funeral director to carry out their duties. We may disclose such information in reasonable anticipation of death. Protected health information may be used and disclosed for cadaveric organ, eye or tissue donation purposes.
Research: We may disclose your protected health information to researchers. In most cases, we will ask for your written authorization before using your PHI or sharing it with others in order to conduct research though under some circumstances, we may use and disclose your PHI without your written authorization if their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information. Under no circumstances, however, would we allow researchers to use your name or identity publicly without your authorization. Notwithstanding the above, we may release your PHI without your written authorization to people who are preparing a future research project as long as any information identifying you does not leave Empower Sleep.
Criminal Activity: Consistent with applicable federal and state laws, we may disclose your protected health information, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.
Military Activity and National Security: When the appropriate conditions apply, we may use or disclose protected health information of individuals who are Armed Forces personnel (1) for activities deemed necessary by appropriate military command authorities; (2) for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits, or (3) to foreign military authority if you are a member of that foreign military services. We may also disclose your protected health information to authorized federal officials for conducting national security and intelligence activities, including for the provision of protective services to the President or others legally authorized.
Workers’ Compensation: We may disclose your protected health information as authorized to comply with workers’ compensation laws and other similar legally established programs.
VI. OTHER PERMITTED AND REQUIRED USES AND DISCLOSURES THAT REQUIRE PROVIDING YOU THE OPPORTUNITY TO AGREE OR OBJECT
We may use and disclose your protected health information in the following instances. You have the opportunity to agree or object to the use or disclosure of all or part of your protected health information. If you are not present or able to agree or object to the use or disclosure of the protected health information, then your physician may, using professional judgment, determine whether the disclosure is in your best interest.
Facility Directories: Unless you object, we will use and disclose in our facility directory your name, the location at which you are receiving care, your general condition (such as fair or stable), and your religious affiliation. All of this information, except religious affiliation, will be disclosed to people that ask for you by name. Your religious affiliation will be only given to a member of the clergy, such as a priest or rabbi.
Others Involved in Your Health Care or Payment for your Care: Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your protected health information that directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death. Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.
IV. PATIENT RIGHTS
A. ACCESS TO RECORDS
Upon submission of a written request to us, you have the right to review or receive copies of your health information, with limited exceptions. You may obtain a form to request access by using the contact information listed at the end of this notice. You may request that we provide copies in a format other than photocopies and we will use the format you request if it is readily available. If you request an alternative format, we will charge a reasonable cost-based fee for providing your health information in that format. If you prefer, we will prepare a summary or an explanation of your health information for a fee. Inspection of records will be allowed during normal business hours per appointment. A fee for locating, making the file available and being present during the review may be charged. Contact us using the information list at the end of this notice if you are interested in receiving a summary of your information instead of copies.
B. ACCOUNTING OF CERTAIN DISCLOSURES
Upon written request, you have the right to receive a list of instances in which we or our business associates disclosed your health information for purposes, other than treatment, payment, healthcare operations, and other activities authorized by you, for the last 6 years, but not before April 14, 2003. If you request this accounting more than once in a 12-month period, we may charge you a reasonable, cost-based fee for responding to these additional requests.
C. RESTRICTIONS AND ALTERNATIVE COMMUNICATIONS
You have the right to request that we place additional restrictions on our use or disclosure of your health information for treatment, payment, and healthcare operations purposes. Depending on the circumstances of your request, we may or may not agree to those restrictions. If we do agree to your requested restrictions we must abide by those restrictions, except in emergency treatment scenarios. You have the right to request that we communicate with you about your health information by alternative means or to alternative locations (e.g., at your place of business rather than at your home). Such requests must be made in writing, must specify the alternative means or location, and must provide a satisfactory explanation of how payments will be handled under the alternative means or location you request.
D. AMENDMENTS TO RECORDS
You have the right to request that we amend your health information. Such requests must be made in writing and must explain why the information should be amended. These amendments will add to what is already in your file. Information that already exists will not be removed or altered. We may deny your request under certain circumstances.
E. ELECTRONIC NOTICES
If you receive this notice on our website, mobile application or by electronic mail (e-mail), you are entitled to receive this notice in written form. We will share such notice in writing with you upon your request via email at [email protected], via our phone number at (213) 375-4070 or by US Mail at 530 Technology Dr Suite 100, Irvine, CA 92618.
If you want more information about our privacy practices or have questions or concerns, please contact us using the information provided below.
Please direct any of your questions or complaints to:
Empower Sleep Inc.
Attn: Privacy Official
530 Technology Drive
Suite 100
Irvine, 94608
California
Phone: (213) 375-4070
Fax: (951) 463-4200
If you are concerned that we may have violated your privacy rights, or you disagree with a decision we made or any decisions we may make regarding the use, disclosure, or access to your health information, you may complain to us using the contact information listed below. You may also submit a written complaint to the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. We support your right to the privacy of your health information, and we will not retaliate against you if you file a complaint.
We support your right to the privacy of your health information, and we will not retaliate against you if you file a complaint.