The following is a description (“Notice”) of the privacy practices (“Privacy Policy”) Can-Am HIFU as those practices relate to “protected health information.” This Notice also describes the rights of individuals whose protected health information is maintained by Can-Am HIFU pursuant to the Privacy Policy.
PLEASE REVIEW THIS NOTICE AND THE PRIVACY POLICY CAREFULLY.
The Privacy Policy is designed to comply, where applicable, with Canadian and other international laws and regulations concerning protection and security of confidential information, including protected health information. Specifically, the Privacy Policy requires Can-Am HIFU’s compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), as amended. Any U.S.-based patient that receives treatment in a non-U.S. facility should receive a copy of this Notice. The Privacy Policy and this Notice are subject to change without notice to the patient; however, the current Notice is available on the Can-Am HIFU website (Can-AmHIFU.com) or a patient may request a paper copy by contacting the Privacy Department, as described below.
Protected Health Information:
“Protected health information” is information related to a patient’s physical or mental health or health care services that may identify the patient specifically. Protected health information may include, but is not limited to, health histories, examinations, results of tests, pre-operative and post-operative PSA results, biopsy results, imaging studies, complications, physician progress reports and other private medical information.
Authorization:
Can-Am HIFU will generally request authorization by a written consent before utilizing or disclosing a patient’s protected health information outside of Can-Am HIFU. A patient may revoke, by written notice to Can-Am HIFU, any authorization to use or disclose protected health information; however, this revocation shall not apply to any use or disclosure made prior to receipt of the revocation. All revocations should be addressed to the Privacy Department, as described below.
Can-Am HIFU’s Use or Disclosure for Treatment:
Can-Am HIFU may, in order to facilitate your treatment, disclose protected health information to (1) treating or proctoring physicians, (2) treatment facilities and their staff, or (3) Can-Am HIFU consultants bound by confidentiality agreements that review patient treatment information. In the event that a patient’s health is at risk and a patient’s consent cannot be obtained, Can-Am HIFU reserves the right to disclose a patient’s protected health information to the patient’s relative, guardian or known acquaintance to the extent necessary to protect the health of the patient.
Can-Am HIFU’s Use or Disclosure for Reimbursement:
Can-Am HIFU may, in order to facilitate your treatment, disclose protected health information to third-party payors. However, as Can-Am HIFU does not deal directly with third-party payors to seek reimbursement, such disclosures will only be made upon a request for such information by (1) the patient or (2) the third-party payor.
Required Disclosures:
In addition to voluntary disclosures, Can-Am HIFU may be required by law to disclose protected health information (1) to public health officials (Canadian or foreign governments) (2) in response to valid court order or legal request or (3) to prevent serious health risk to the patient or the general public.
Research:
Generally, Can-Am HIFU will not disclose protect health information for use in medical research without written consent of the patient. However, Can-Am HIFU may release certain protected health information without written consent if the released protected health information poses a minimal risk to identifying the patient individually (e.g. as part of a data set with no Social Security Number, Name, Initials, Phone Number or Address).
Internal Use:
Can-Am HIFU may use protected health information in order to contact patients concerning treatment received.
Patient Access Protected Health Information:
A patient may request a copy of their protected health information. Can-Am HIFU may choose to deny certain requests that are not required by law; however, Can-Am HIFU will provide all protected health information requested as required by law. Any such requests should be made to the Privacy Department as listed below and should include the information requested.
Amend Records:
A patient may ask Can-Am HIFU to amend their protected health information, if it is incomplete or incorrect. Any such requests should be made to the Privacy Department as described below and should include the proposed amendment and reason for the amendment.
Disclosure Logs:
A patient may request a log of disclosures of their protected health information made in the previous six (6) years to persons or organizations other than (1) Can-Am HIFU or its employees or consultants or (2) the patient. Patient will be notified in advance of any costs associated with complying with their request. Any such requests should be made to the Privacy Department as described below and should include the specific time period of the disclosures requested.
Questions or Reporting Improper Disclosures:
Questions concerning the privacy of protected health information or potential improper disclosure should be directed to the Privacy Department as described below. Can-Am HIFU will keep all communications concerning protected health information strictly confidential.
Can-Am HIFU, Privacy Department
123 Edward Street, Suite 1401
Toronto, Ontario
M5G 1E2
Toll Free in North America: 1-877-787-5906
Toronto and the GTA: 416-924-9760
Fax: 416-924-4993